Journal of Consulting & Clinical Psychology

Suicidal, abused African American women's response to a culturally informed intervention.
Objective: This study examined (a) the efficacy of a manualized, culturally informed, empowerment-focused psychoeducational group intervention (Nia) designed in accord with the theory of triadic influence or treatment as usual (TAU) for reducing psychological symptomatology (suicidal ideation, depressive symptoms, posttraumatic stress symptoms, general psychological distress), and (b) the effect of Nia versus TAU on the relation between exposure to intimate partner violence (IPV) and psychological symptomatology in these women. Method: Two hundred eight low-socioeconomic-status African American women with a recent history of IPV and a suicide attempt were randomized to Nia or TAU and assessed at baseline, postintervention, and 6- and 12-month follow-up. They were assessed on their levels of IPV (Index of Spouse Abuse), suicidal ideation (Beck Scale for Suicidal Ideation), depressive symptoms (Beck Depression Inventory–II), posttraumatic stress symptoms, and general psychological distress (Brief Symptom Inventory). Results:Hierarchical linear modeling found that women receiving the culturally informed Nia intervention showed more rapid reductions in depressive symptoms and general distress initially, and the between-group difference in depressive symptoms persisted at follow-up. Following intervention, compared with women randomized to TAU, women in Nia exhibited less severe suicidal ideation when exposed to physical and nonphysical IPV. Conclusions:Findings highlight the value of incorporating Nia as an adjunctive intervention for abused, suicidal, low-income women. They underscore the ways the intervention needs to be bolstered to address more directly more mediating and moderating constructs, as well as the need to target more effectively the key outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Childhood abuse and mental health indicators among ethnically diverse lesbian, gay, and bisexual adults.
Objective: Prior research has established that lesbian, gay, and bisexual (LGB) people experience higher rates of childhood abuse than heterosexuals. However, there has been little research on the mental health impact of these experiences or how race/ethnicity might influence prevalence and mental health impact of childhood abuse in this population. The study's objective was to examine the relationships between race/ethnicity, childhood abuse, and mental health indicators in a national sample of LGB adults. Method: Participants were recruited via the Internet through snowball and targeted sampling methods. Six hundred and sixty-nine LGB adults, 21% of whom were people of color, participated in an online survey. Participants completed the Childhood Trauma Questionnaire–Short Form, the Center for Epidemiologic Studies Depression Scale, the Patient Health Questionnaire Generalized Anxiety Disorder Scale, the Posttraumatic Stress Disorder (PTSD) Checklist–Civilian Version, and the Perceived Stress Scale–Short Form. Results: Latina/o and Asian American participants reported the highest levels of physical abuse (p <.01), and Latina/o and African American participants reported the highest levels of sexual abuse (p <.01). Childhood emotional abuse was the strongest predictor of psychopathology symptoms for all participants (ps <.01). Relative to White participants, emotional abuse showed a stronger relationship with PTSD and anxiety symptoms for African American participants (ps <.01), and physical abuse showed a stronger relationship with PTSD and anxiety symptoms for Latina/o participants (ps <.05). Conclusions: Race/ethnicity may be an important factor when examining childhood abuse and mental health correlates among LGB populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Trauma, binge eating, and the “strong Black woman”.
Objective: The primary goal of this study was to test a culturally specific model of binge eating in African American female trauma survivors, investigating potential mechanisms through which trauma exposure and distress were related to binge eating symptomatology. Method: Participants were 179 African American female trauma survivors who completed questionnaires about traumatic experiences; emotional inhibition/regulation difficulties; self-silencing (prioritizing others' needs and adopting external self-evaluation standards); eating for psychological reasons; binge eating; and internalization of “Strong Black Woman” (SBW) ideology, an important cultural symbol emphasizing strength and self-sufficiency. Results: Structural path analysis supported the proposed model in which SBW ideology, emotional inhibition/regulation difficulties, and eating for psychological reasons mediated the relationship between trauma exposure/distress and binge eating. The proposed model provided better fit to the data than several competing models. Conclusions: These findings suggest that among African American trauma survivors, trauma exposure and distress predict greater internalization of SBW ideology, which is associated with emotional inhibition/regulation difficulties, eating for psychological reasons, and ultimately binge eating. Implications of these findings for assessment, treatment, and prevention efforts are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Impact of race on early treatment termination and outcomes in posttraumatic stress disorder treatment.
Objective:The present study investigated the influence of race on posttraumatic stress disorder (PTSD) treatment among 94 African American and 214 Caucasian female victims of interpersonal violence participating in 2 studies of cognitive–behavioral treatment for PTSD that were conducted sequentially and continuously. Method:In each study, participants were randomized into 1of 3 conditions. The first study compared cognitive processing therapy with prolonged exposure and a delayed treatment condition. In the second study, cognitive processing therapy was compared with its constituent components: cognitive therapy only and written accounts. Participants were assessed with the Clinician Administered PTSD Scale and the Structured Clinical Interview for DSM–IV, as well as through self-report measures of PTSD. Results:Analyses revealed that African Americans were significantly less likely to complete treatment compared with Caucasians (45% vs. 73%, respectively, p <.001) and that the differences held even after controlling for education and income. Despite racial differences in treatment completion status, analyses with the intent-to-treat sample indicated no racial differences in outcomes on PTSD measures. Conclusions:The lack of difference in treatment outcomes despite racial differences in dropout may be explained by greater symptom improvement of African Americans who dropped out compared with Caucasians who dropped out. Implications of these findings and practical approaches to addressing sociocultural barriers to care are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Future directions in studies of trauma among ethnoracial and sexual minority samples: Commentary.
Objective: Studies examining psychological trauma or posttraumatic stress disorder (PTSD) in ethnoracial or sexual minority groups are relatively few. The Journal of Consulting and Clinical Psychology recently published 4 articles (Balsam, Lehavot, Beadnall, & Circo, 2010; Harrington, Crowther, & Shipherd, 2010; Lester, Resick, Young-Xu, & Artz, 2010; Marshall, Schell, & Miles, 2009) that examine trauma exposure and posttraumatic outcomes in ethnoracial and sexual minority samples. This commentary focuses on the overlap between traumatic stress and diversity studies in order to consider future areas in need of development. Method: Within the framework of a generalized overview of current trends in the study of traumatic stress, an assessment of the strengths and limitations of these 4 articles is provided. Populations and syndromes covered by the articles include ethnoracial differences in child maltreatment and adverse mental health outcomes among sexual minority participants, PTSD symptom elevations among Hispanic Americans, binge eating and the strong Black woman schema, and retention of African American female participants in cognitive behavioral psychotherapy trials for PTSD. Results: Recommendations to enhance culturally competent traumatic stress studies include increasing the examination of within-group cultural variability and key social, contextual, and cultural variables and constructs; examining the temporal sequencing of traumatic events and key transitions in sexual and ethnic minority identity development; and conducting prevention and treatment studies for those sexual minority children most at risk for maltreatment. Conclusions: By following these recommendations, the next generation of studies of traumatic stress studies will be enhanced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: A randomized clinical trial.
Objective: To examine the efficacy of a developmentally appropriate parent–child cognitive behavioral therapy (CBT) protocol for anxiety disorders in children ages 4–7 years. Method: Design: Randomized wait-list controlled trial. Conduct: Sixty-four children (53% female, mean age 5.4 years, 80% European American) with anxiety disorders were randomized to a parent–child CBT intervention (n = 34) or a 6-month wait-list condition (n = 30). Children were assessed by interviewers blind to treatment assignment, using structured diagnostic interviews with parents, laboratory assessments of behavioral inhibition, and parent questionnaires. Analysis: Chi-square analyses of outcome rates and linear and ordinal regression of repeated measures, examining time by intervention interactions. Results: The response rate (much or very much improved on the Clinical Global Impression Scale for Anxiety) among 57 completers was 69% versus 32% (CBT vs. controls), p <.01; intent-to-treat: 59% vs. 30%, p = .016. Treated children showed a significantly greater decrease in anxiety disorders (effect size [ES] = .55) and increase in parent-rated coping (ES = .69) than controls, as well as significantly better CGI improvement on social phobia/avoidant disorder (ES = .95), separation anxiety disorder (ES = .82), and specific phobia (ES = .78), but not on generalized anxiety disorder. Results on the Child Behavior Checklist Internalizing scale were not significant and were limited by low return rates. Treatment response was unrelated to age or parental anxiety but was negatively predicted by behavioral inhibition. Gains were maintained at 1-year follow-up. Conclusions: Results suggest that developmentally modified parent–child CBT may show promise in 4- to 7-year-old children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Trajectories of psychosocial adjustment in adolescents with spina bifida: A 6-year, four-wave longitudinal follow-up.
Objective: As a follow-up to an earlier cross-sectional study (Holmbeck et al., 2003), the current multimethod, multi-informant investigation examined individual growth in psychosocial adjustment across the adolescent transition in 2 samples: young adolescents with spina bifida (SB) and typically developing adolescents (N = 68 in both groups at Time 1). Method: Growth curve modeling procedures were used to describe the developmental course of psychosocial adjustment across 4 waves of data collection from ages 8 to 15. Child gender was included in the models as a moderator of associations between illness status and adjustment trajectories. Results and Conclusions: Findings revealed that preadolescent differences between groups were maintained for several adjustment variables, indicating that adolescents with SB have enduring academic and attention problems and difficulties with social development (e.g., fewer friends and less influence during family interactions). For other outcomes, trajectories of adjustment levels for adolescents with SB converged on levels observed in comparison adolescents, indicating some areas of resilience. Girls with SB were at risk for increasing levels of social difficulties and negative perceptions of their physical appearance. Clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Evaluation of the Brief Problem Checklist: Child and caregiver interviews to measure clinical progress.
Objective: To support ongoing monitoring of child response during treatment, we sought to develop a brief, easily administered, clinically relevant, and psychometrically sound measure. Method: We first developed child and caregiver forms of a 12-item Brief Problem Checklist (BPC) interview by applying item response theory and factor analysis to Youth Self-Report (YSR; Achenbach & Rescorla, 2001) and Child Behavior Checklist (CBCL;Achenbach & Rescorla, 2001) data for a sample of 2,332 youths. These interviews were then administered weekly via telephone to an ethnically diverse clinical sample of 184 boys and girls 7–13 years of age and their caregivers participating in outpatient treatment, to examine psychometric properties and feasibility. Results: Internal consistency and test–retest reliability were excellent, and factor analysis yielded 1 internalizing and 1 externalizing factor. Validity tests showed large and significant correlations with corresponding scales on paper-and-pencil administrations of the CBCL and YSR as well as with diagnoses obtained from a structured diagnostic interview. Discriminant validity of the BPC interviews was supported by low correlations with divergent criteria. Longitudinal data for the initial 6 months of treatment demonstrated that the BPC significantly predicted change on related measures of child symptoms. Estimates obtained from random coefficient growth models showed generally higher slope reliabilities for the BPC given weekly relative to the CBCL and YSR given every 3 months. Conclusions: Given their combination of brevity and psychometric strength, the child and caregiver BPC interviews appear to be a promising strategy for efficient, ongoing assessment of clinical progress during the course of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy.
Objective: A randomized trial assessed the effectiveness of a 2-level strategy for implementing evidence-based mental health treatments for delinquent youth. Method: A 2 × 2 design encompassing 14 rural Appalachian counties included 2 factors: (a) the random assignment of delinquent youth within each county to a multisystemic therapy (MST) program or usual services and (b) the random assignment of counties to the ARC (for availability, responsiveness, and continuity) organizational intervention for implementing effective community-based mental health services. The design created 4 treatment conditions (MST plus ARC, MST only, ARC only, control). Outcome measures for 615 youth who were 69% male, 91% Caucasian, and aged 9–17 years included the Child Behavior Checklist and out-of-home placements. Results: A multilevel, mixed-effects, regression analysis of 6-month treatment outcomes found that youth total problem behavior in the MST plus ARC condition was at a nonclinical level and significantly lower than in other conditions. Total problem behavior was equivalent and at nonclinical levels in all conditions by the 18-month follow-up, but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate (16%) than youth in the control condition (34%). Conclusions: Two-level strategies that combine an organizational intervention such as ARC and an evidence-based treatment such as MST are promising approaches to implementing effective community-based mental health services. More research is needed to understand how such strategies can be used effectively in a variety of organizational contexts and with other types of evidence-based treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Pre-hurricane perceived social support protects against psychological distress: A longitudinal analysis of low-income mothers.
Objective: In this study, we examined the influence of pre-disaster perceived social support on post-disaster psychological distress among survivors of Hurricane Katrina. Method: Participants (N = 386) were low-income mothers between 18 and 34 years of age at baseline (M = 26.4, SD = 4.43). The majority (84.8%) was African American; 10.4% identified as Caucasian, 3.2% identified as Hispanic, and 1.8% identified as other. Participants were enrolled in an educational intervention study in 2004 and 2005. Those who had completed a 1-year follow-up assessment prior to Hurricane Katrina were reassessed approximately 1 year after the hurricane. Measures of perceived social support and psychological distress were included in pre- and post-disaster assessments. Using structural equation modeling and multiple mediator analysis, we tested a model wherein pre-disaster perceived social support predicted post-disaster psychological distress both directly and indirectly through its effects on pre-disaster psychological distress, exposure to hurricane-related stressors, and post-disaster perceived social support. We predicted that higher pre-disaster perceived social support would be predictive of lower pre-disaster psychological distress, lower hurricane-related stressors, and higher post-disaster perceived social support, and that these variables would, in turn, predict lower post-disaster psychologically distress. Results: Our analyses provide partial support for the hypothesized model. Although pre-disaster perceived social support did not exert a direct effect on post-disaster psychological distress, the indirect effects of all 3 proposed mediators were significant. Conclusions: Pre-disaster social support can decrease both exposure to natural disasters and the negative psychological effects of natural disaster exposure. These findings underscore the importance of bolstering the post-disaster social support networks of low-income mothers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.
Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. Method: To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. Results: Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37–.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions: The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Comparing indicators of sexual sadism as predictors of recidivism among adult male sexual offenders.
Objective: In this longitudinal study, the predictive validity of a psychiatric diagnosis of sexual sadism was compared with three behavioral indicators of sadism: index sexual offense violence, sexual intrusiveness, and phallometrically assessed sexual arousal to depictions of sexual or nonsexual violence. Method: Five hundred and eighty six adult male sexual offenders were assessed between 1982 and 1992, and these offenders were followed for up to 20-years postrelease via official criminal records. Assessment information included the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis, offense characteristics, phallometric assessment results, and an actuarial risk measure (the Sex Offender Risk Appraisal Guide). Results: Predictive validity was demonstrated in univariate analyses for the behavioral indicators of sexual sadism (area under the curve [AUCs] from .58 to .62) but not psychiatric diagnosis (AUC = .54). Cox regression analyses revealed that phallometrically assessed sexual arousal to violence was still significantly associated with violent (including sexual) recidivism after actuarially estimated risk to reoffend was controlled. A psychiatric diagnosis of sexual sadism, in contrast, was unrelated to recidivism. Conclusions: The results support the use of more behaviorally operationalized indicators of sexual sadism, especially phallometric assessment of sexual arousal, and suggest the DSM criteria for sexual sadism require further work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Borderline personality traits and disorder: Predicting prospective patient functioning.
Objective: Decisions about the composition of personality assessment in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–V) will be heavily influenced by the clinical utility of candidate constructs. In this study, we addressed 1 aspect of clinical utility by testing the incremental validity of 5-factor model (FFM) personality traits and borderline personality disorder (BPD) symptoms for predicting prospective patient functioning. Method: FFM personality traits and BPD features were correlated with one another and predicted 2-, 4-, 6-, 8-, and 10-year psychosocial functioning scores for 362 patients with personality disorders. Results: Traits and symptom domains related significantly and pervasively to one another and to prospective functioning. FFM extraversion and agreeableness tended to be most incrementally predictive of psychosocial functioning across all intervals; cognitive and impulse action features of BPD features incremented FFM traits in some models. Conclusions: These data suggest that BPD symptoms and personality traits are important long-term indicators of clinical functioning that both overlap with and increment one another in clinical predictions. Results support the integration of personality traits and disorders in DSM–V. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Psychiatric disorders and sexual risk among adolescents in mental health treatment.
Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Journal of Consulting and Clinical Psychology - Vol 78, Iss 4