Journal of Consulting & Clinical Psychology

Mediators of a randomized controlled trial of a preventive intervention for youth of parents with depressive disorders.
Objective: The present study assessed two theory-driven mediators of the effects of a family group cognitive-behavioral (FGCB) preventive intervention for youth of parents with a history of major depressive disorder (MDD) or dysthymia on long-term youth psychopathology symptoms and diagnoses. Method: Sample included 180 parents (Mage = 41.9, 89% female, 82% White, non-Hispanic) and one of their children/adolescents ages 9–15 years (Mage = 11.4, 49% female, 74% White, non-Hispanic). Changes in the hypothesized mediators, observations of positive parenting (Iowa Family Interaction Rating Scales) and youth secondary control coping (SCC) skills (Responses to Stress Questionnaire), were assessed at 6 months. Changes in youth psychopathology symptoms were assessed on the Child Behavior Checklist and Youth Self-Report at 18- and 24-month follow-ups and MDD diagnoses with the Kiddie Schedule for Affective Disorders and Schizophrenia at 12 and 24 months. Results: Changes in youth SCC skills (e.g., acceptance, reappraisal) after the intervention mediated the effects of the FGCB program on changes in youth internalizing and externalizing symptoms at 18- and 24-month follow-ups. Effects for changes in positive parenting behaviors as a mediator were more limited. SCC skills were further shown to mediate the effects of the FGCB intervention on MDD diagnoses from 12 to 24 months. Conclusions: This study provides clear and strong evidence that changes in youth SCC skills mediated the long-term effects of preventive intervention for families of depressed parents. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Sudden gains in the treatment of children and adolescents with prolonged grief.
Objective: Sudden gains describe large and stable reductions in symptoms between two consecutive treatment sessions and have not yet been investigated in prolonged grief disorder (PGD), a new disorder in the 11th edition of the International Classification of Diseases and text revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders characterized by separation distress and accompanying symptoms beyond 6 months of bereavement. The study aimed to examine the occurrence of sudden gains and their relation to treatment outcome and content during cognitive behavioral therapy (CBT) and supportive counseling for children and adolescents with PGD symptoms. Method: We used data from 118 patients (50% female; age: M = 12.93, SD = 2.81) who were randomized to receive either nine individual sessions of CBT or nondirective supportive counseling. Session-by-session PGD symptoms were assessed using the Grief Checklist. We identified sudden gains using the original criteria by Tang and DeRubeis (1999) and compared treatment outcomes between sudden gainers and nonsudden gainers using linear mixed models. Results: Nine patients (7.63%) experienced a total of 10 sudden gains. Most sudden gains occurred during CBT. We found no differences between sudden gainers and nonsudden gainers regarding PGD symptoms, posttraumatic stress, and depressive symptoms, but problem behaviors declined toward the follow-up assessments in sudden gainers. Conclusions: Sudden gains seem to be a rare event with limited clinical relevance in the treatment of PGD symptoms in children and adolescents. Results imply future research into predictors of sudden gains and other forms of symptom change during PGD treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
In search of lost time: Discrete- versus continuous-time models of working alliance and symptom severity.
Objective: The therapeutic alliance is one of the most stable predictors of symptom burden over the course of therapy. So far, this effect has only been examined on the basis of sessions. Continuous-time models (CTM) allow this relationship to be modeled as a continuous process in which the actual time interval between measurements is considered. The aim of the present study was to compare the fit of discrete-time models (DTM) of the alliance–symptom relationship with CTM using different time variables (sessions vs. actual time interval). Method: Data from 1,413 patients at a university psychotherapy outpatient clinic were analyzed. The alliance and symptom burden were assessed each session with the Bernese Session Report and the Hopkins Symptom Checklist-Short-Form, respectively. Different DTM and CTM were estimated using the R-package ctsem and compared in their fit via the Akaike information criterion. Results: CTMs with session as the time unit fitted the data best. Significant negative within-person effects of alliance and symptom burden were found. These effects showed a significant positive correlation, implying that individuals with a stronger effect of the alliance on symptom severity also showed a stronger effect of symptom severity on the alliance. Conclusions: When modeling the relationship of symptom severity and alliance, it seems to be of more importance to capture the fact that a session occurred than to capture the exact time intervals between sessions. Future studies should examine this finding for other psychotherapeutic factors. Interpersonal factors might explain the positive association of the reciprocal alliance–symptom effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Employing survival analysis of administrative claims to identify prospective predictors of evidence-based practice sustainment versus provider turnover.
Objective: This study described therapists’ delivery of six child mental health evidence-based practices (EBPs) over 33 months during the sustainment phase of a system-driven implementation aimed at improving access to EBPs in community settings. Method: Seven hundred seventy-seven therapists and 162 program leaders delivering at least one of six EBPs of interest completed surveys, and these data were matched to therapist administrative claims data. Survival analyses examined (a) therapists’ discontinuation of delivery of all Los Angeles County Department of Mental Health direct client services (i.e., turnover) and (b) therapists’ discontinuation of a specific EBP while continuing to provide psychotherapy services. Results: A majority of therapists (58.3%) were observed to discontinue providing any direct client services over the 33-month period, and discontinuation rates for specific EBPs ranged from 100% of therapists (Cognitive Behavioral Intervention for Trauma in Schools) to 76.4% (Managing and Adapting Practice). Different factors predicted the discontinuation of all service delivery compared to the discontinuation of a specific EBP. Greater therapist emotional exhaustion predicted higher likelihood of discontinuation of all direct client services. For EBP discontinuation, EBP-level factors (e.g., EBPs that required ongoing consultation), therapist-level factors (e.g., ability to provide services in a language other than English), and agency-level factors (e.g., more positive program leader perceptions of the EBP) predicted lower likelihood of discontinuation of the specific EBP. Conclusions: Different factors contribute to the risk of therapists leaving the service system versus discontinuing the delivery of specific EBPs. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
A randomized controlled trial comparing brief online self-guided interventions for loneliness.
Objective: Loneliness is a global health issue, but current loneliness interventions are not scalable enough to reach many who might benefit from them. Brief online interventions could greatly expand access to evidence-based loneliness interventions. Method: We conducted a preregistered three-armed trial (N = 908, ages 16–78) to compare three self-guided online interventions: a single-session intervention (SSI) for loneliness, a 3-week, three-session intervention for loneliness, and an active control supportive therapy SSI (https://ClinicalTrials.gov, ID: NCT05687162). Results: Loneliness decreased between baseline and Week 8 across all conditions (b = −5.80; d = −0.55; 95% CI [−0.62, −0.47]; p <.01), but did not decrease significantly more in those assigned to either the loneliness SSI (b = −1.27; d = −0.12; 95% CI [−0.30, 0.06]; p = .20) or the 3-week intervention (b = −0.93; d = −0.09; 95% CI [−0.27, 0.09]; p = .34) than those assigned to the control SSI. Participants found all three interventions acceptable but rated both loneliness interventions as more acceptable than the control (p <.01). Far more participants completed the 10-min control SSI (86.6%) and 20-min loneliness SSI (69.4%) than the 60-min 3-week intervention (14.9%). Conclusions: An SSI for loneliness was not significantly less effective than a longer loneliness intervention and had a much higher completion rate. Yet, against our hypotheses, neither loneliness intervention reduced loneliness more than an active control SSI did. Future work should aim to design more effective SSIs for loneliness and identify populations for which SSIs might be most helpful. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

Journal of Consulting and Clinical Psychology - Vol 93, Iss 1