The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents.

This study evaluated the efficacy of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) with depressed adolescents in Puerto Rico. Seventy-one adolescents meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria for a diagnosis of depression were randomly assigned to 1 of 3 conditions: CBT, IPT, or wait list (WL). Pretreatment, posttreatment, and 3-month follow-up measures of depression symptoms, self-esteem, social adjustment, family emotional involvement and criticism, and behavioral problems were completed. Results suggest that IPT and CBT significantly reduced depressive symptoms when compared with the WL condition. IPT was superior to the WL condition in increasing self-esteem and social adaptation. Clinical significance tests suggested that 82% of adolescents in IPT and 59% of those in CBT were functional after treatment. The results suggest that both IPT and CBT are efficacious treatments for depressed Puerto Rican adolescents. IPT's impact in other levels of outcome is discussed in terms of its consonance with Puerto Rican cultural values.     

Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial

Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia.     

Residual symptoms at remission from depression: impact on long-term outcome

Background: Although residual symptoms after remission from depression are common and predict early relapse, little is known about the impact of residual symptoms on longer-term clinical course of depression or social functioning. Methods: Sixty severe recurrent depressives, who remitted from an index episode of depression with residual symptoms or below residual symptomatology, were followed-up at 8–10 years. Subjects underwent detailed longitudinal interviewing on course of depression, treatment and socioecomonic functioning over follow-up. Results: Long-term follow-up data was obtained on all living subjects and 55 (95%) were interviewed. The residual symptoms group spent more time with depressive symptoms over follow-up but not at full criteria for major depression and showed greater impairment in longitudinal and follow-up social adjustment. No significant differences were found between the two groups in percentage recurring long-term, mean number of recurrences, readmissions, chronic episodes or clinical global outcome criteria. Limitations: Long-term clinical and social outcomes were assessed by a single retrospective longitudinal interview. Conclusions: Patients who remit from depression with residual symptomatology continue to have more depressive symptoms and impaired social functioning long-term and may need more aggressive treatment.     

Efficacy of cognitive behavioral internet-based therapy in parents after the loss of a child during pregnancy: pilot data from a randomized controlled trial

The loss of a child during pregnancy can be a traumatic event associated with long-lasting grief and psychological distress. This study examined the efficacy of an internet-based cognitive behavioral therapy program for mothers after pregnancy loss. In a randomized controlled trial with a waiting list control group, 83 participants who had lost a child during pregnancy were randomly allocated either to 5 weeks of internet therapy or to a 5-week waiting condition. Within a manualized cognitive behavioral treatment program, participants wrote ten essays on loss-specific topics. Posttraumatic stress, grief, and general psychopathology, especially depression, were assessed pretreatment, posttreatment, and at 3-month follow-up. Intention-to-treat analyses and completer analyses were performed. Relative to controls, participants in the treatment group showed significant improvements in posttraumatic stress, grief, depression, and overall mental health, but not in anxiety or somatization. Medium to large effect sizes were observed, and the improvement was maintained at 3-month follow-up. This internet-based cognitive behavioral therapy program represents an effective treatment approach with stable effects for women after pregnancy loss. Implementation of the program can thus help to improve the health care provision for mothers in this traumatic loss situation.     

Efficacy of Emotion-Focused and Problem-Focused Group Therapies for Women with Fertility Problems

Competing positions exist in the literature regarding whether problem-focused or emotion-focused coping is more useful when one confronts a chronic health-related problem. In this study, 29 infertile women, who on average had been attempting conception for almost 4 years, were assigned to six sessions of training in problem- or emotion-focused coping or to a no-treatment control condition. Problem-focused training produced improvements in general distress and infertility-specific well-being at treatment termination. However, emotion-focused training resulted in greater improvement at a 1-month follow-up. Emotion-focused participants reported less depression and more infertility-specific well-being at 1 month than did controls. At 18 months, problem-focused group members were more likely to have a child than were other participants. Results argue for the efficacy of both emotion-directed and problem-focused interventions in women's adjustment to infertility.     

Preventing relapse in obesity through posttreatment maintenance systems: Comparing the relative efficacy of two levels of therapist support

The present study compared the relative effectiveness of a therapist-supported maintenance condition with a minimal contact maintenance condition in preventing relapse following an obesity treatment program. Thirty-two subjects who completed an initial 12-week cognitive/behavioral plus aerobic exercise treatment program were matched on absolute weight loss and randomly assigned to one of two maintenance conditions. Subjects were assessed at pretreatment, posttreatment, and 3, 6, and 12 months following posttreatment using measures of weight, blood pressure, and depression. Three- and six-month follow-up results indicated that subjects who participated in the therapist-supported maintenance group continued to lose weight and/or maintained therapy-induced weight loss to a greater degree than control subjects. At the 12-month follow-up assessment therapist-supported subjects maintained therapy-induced weight loss better than the control subjects. These findings suggest that maintenance programs which provide continued contact emphasizing relapse prevention training may be an important adjunct in the maintenance of therapy-induced weight loss.This project was supported in part by the Florida Mental Health Institute of the University of South Florida 32446.     

Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: a randomized efficacy trial

In this depression prevention trial, 341 high-risk adolescents (mean age = 15.6 years, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed significantly greater reductions in depressive symptoms than did supportive-expressive, bibliotherapy, and assessment-only participants at posttest, though only the difference compared with assessment controls was significant at 6-month follow-up. CB participants showed significantly greater improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than did participants in all 3 other conditions. Supportive-expressive and bibliotherapy participants showed greater reductions in depressive symptoms than did assessment-only controls at certain follow-up assessments but produced no effects for social adjustment and substance use. CB, supportive-expressive, and bibliotherapy participants showed a significantly lower risk for major depression onset over the 6-month follow-up than did assessment-only controls. The evidence that this brief CB intervention reduced risk for future depression onset and outperformed alternative interventions for certain ecologically important outcomes suggests that this intervention may have clinical utility.     

Psychosocial intervention for women with primary, non-metastatic breast cancer: a comparison between participants and non-participants

BACKGROUND: Despite improvements in the medical treatment of breast cancer, resulting in better prognoses, women diagnosed with the illness often experience psychosocial problems. As a result, many psychosocial intervention programs have been developed, usually with positive results. The aim of this study was to examine the effects of two 12-week psychosocial intervention programs for women with a primary, non-metastatic breast cancer diagnosis in comparison to women who were on a waiting list for these interventions for 3 months. METHODS: Sixty-nine women with primary, non-metastatic breast cancer, but otherwise without psychosocial problems, were randomized to a group of patients treated with the intervention program (group psychotherapy or social support group) or a control group (on a waiting list). Differences between both groups in psychosocial adjustment, social support and coping at the short-term follow-up were described in this study. RESULTS: Women who participated in the group intervention programs did not differ from women in the control group regarding psychosocial adjustment at the end of the study. Women who participated in the social support groups reported to receive more social support from others not very close to them. They also used more palliative coping than women from the psychotherapy group. CONCLUSIONS: Apparently, women who are being diagnosed with breast cancer, but otherwise have no psychosocial adjustment problems following the diagnosis, do not especially benefit from a short-term intervention program compared to women in the control group.     

Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse

Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations.     

Effects of a supportive-expressive group intervention on long-term psychosocial adjustment in HIV-infected gay men

BACKGROUND: This study compared the effects of a supportive-expressive group intervention (GI) with an educational control condition (EC) on long-term psychosocial adjustment in gay men with HIV infection. METHOD: Subjects (n = 85) were randomized after stratification for disease stage and use of antiretroviral medication. GI consisted of 4 months of weekly group sessions followed by 5 monthly maintenance sessions plus written educational material, whereas the EC subjects received educational material only. RESULTS: There were no between-group differences in effects on distress, coping or social support in analyses examining 4 time points over 15 months. Both conditions decreased in distress over time on the Hopkins Symptom Checklist and Beck Depression Inventory. CONCLUSIONS: Several explanations are offered for the reason why no additional benefit of the GI was found on outcome measures studied when compared with the EC condition and recommendations are made for future psychosocial intervention research with HIV-infected persons.     

A randomised control trial for the effectiveness of group interpersonal psychotherapy for postnatal depression

This study is a randomised controlled trial comparing outcomes from an 8-week Interpersonal Psychotherapy group (IPT-G) for postnatal depression with ‘treatment as usual’ (TAU), conducted in a routine community setting in the Australian Capital Territory (ACT). Eligible women were recruited and randomly assigned to either IPT-G or TAU conditions. This study compared outcomes on such variables as depressive symptoms, marital adjustment, social support and mother–infant bond at baseline, mid-treatment, end-of-treatment and 3 months follow-up. Participants were also independently assessed using the Hamilton Depression Rating Scale (HAM-D). 50 women completed baseline assessments and were included in the analysis. Comparisons of treatment conditions showed that by end of treatment both the TAU and IPT-G groups significantly improved in terms of mean depression scores, however, the IPT-G women improved significantly more and had continued improvements at 3 months post therapy. Furthermore, women who received IPT-G displayed significant improvement in terms of marital functioning and perceptions of the mother-infant relationship compared to TAU participants. These findings highlight the potential benefits of an interpersonally based treatment, which not only improves outcomes for the mother but also potentially for the couple and the infant when compared to usual care.     

Preventing smoking relapse, using an individually tailored skills-training technique

The effectiveness of a relapse prevention program was studied in a population of 744 smokers. Subjects first attended an intensive 4-day series of 2-hr meetings in which they were trained to use more than 40 behavioral and cognitive smoking cessation techniques. At the 1-week follow-up session, those abstinent from smoking (79%, carbon monoxide verified) were randomly assigned to one of three follow-up conditions: (a) a three-session skills-training program in which subjects developed and actively rehearsed individually tailored coping strategies for likely relapse situations, (b) a three-session discussion control condition in which subjects discussed maintenance but did not develop or rehearse coping strategies, or (c) a no-treatment control condition. Survival analysis indicated higher abstinence rates for the skills-training group than for the control groups throughout the following year. After 12 months, the biochemically confirmed continuous abstinence rate was higher in the skills-training group (41.3%) than in the discussion and no-treatment groups (34.1% and 33.3%, respectively).     

Depression and anxiety as predictors of outcome after myocardial infarction

OBJECTIVE: The objective of this study was to investigate the significance of emotional distress immediately after a myocardial infarction as a predictor of physical, psychological, and social outcomes and resource use. METHODS: In an epidemiological survey, demographic and cardiological data were obtained for all patients from a defined geographical area who had had a myocardial infarction (according to diagnostic criteria of the Monitoring Trends and Determinants in Cardiovascular Disease [MONICA] trial). Hospital survivors were interviewed and were asked to complete self-report assessments on mental state and quality of life. Full replies were available at baseline for 347 subjects. Self-report follow-up questionnaire information was collected 3 months and 1 year later. RESULTS: Fifteen percent of patients scored as probable cases of anxiety or depression. They were more likely than noncases to report preinfarct distress and poor adjustment (as indicated on the 36-item Medical Outcome Study short form). There was an improvement at 3 months, but there was little overall or individual change after that time. Anxiety and depression did not predict subsequent mortality but did significantly predict poor outcome at 1 year on all dimensions of the 36-item short form quality-of-life measure and on specific measures of everyday activity and reports of chest pain, use of primary care resources, and secondary prevention lifestyle changes. CONCLUSIONS: Subjects who are distressed in the hospital are at high risk of adverse psychological and quality-of-life outcomes during the ensuing year. Our findings strengthen the argument for in-hospital identification and treatment of patients with depression and anxiety after myocardial infarction.     

Parents of Children with Cancer: A Longitudinal Study of Emotional Distress, Coping Style, and Marital Adjustment Two and Twenty Months After Diagnosis

Evaluated emotional distress, coping style, and marital adjustmentin 84 parents (42 couples) of children with cancer 2 monthsafter diagnosis and again about 20 months after diagnosis. Asexpected, mothers' mean state anxiety and trait anxiety scoresdecreased to near normal levels over time. Fathers' scores werelower initially and did not change. Neither mothers' nor fathers'mean marital adjustment scores changed over time. Marital adjustmentat treatment follow-up was predicted by depression and the spouse'smarital satisfaction in mothers, and depression, child healthstatus, and spouse's marital satisfaction in fathers. In contrastto findings obtained 2 months after diagnosis, coping stylewas not related to marital adjustment at follow-up. Resultsare discussed in terms of possible gender differences in therole of social support in marital adjustment and the stabilityversus situational specificity of coping styles.     

Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders

Undertook an evaluation of a cognitive-behavioral group family-based mtewention for childhood anxiety disorders in Brisbane, Australia. The treatment aimed to provide children and their families with skills in the management of anxiety and avoidance, problem solving, and mutual family support. Children (n = 60) ranging from 7 to 14 years old who fulfilled diagnostic criteria for separation anxiety, overanxious disorder, or social phobia were randomly allocated to 3 treatment conditions: group cognitive-behavioral therapy (GROUP-CBT), group cognitive-behavioral therapy plus family management (GROUP-FAM), and wait list (WL). The effectiveness of the interventions was evaluated at posttreatment and 12month follow-up. Results indicated that across treatment conditions, 64.8% of children no longer fulfilled diagnostic criteria for an anxiety disorder in comparison with 25.2% of children on the wait list. At 12-month FU, 64.5% of children in the GROUP-CBT group and 84.8% of children in the GROUP-FAM group were diagnosis free. Comparisons of children receiving GROUP-CBT with those receiving GROUP-FAM on self-report measures m d clinician ratings indicated marginal added benefits from GROUP-FAM treatment. Results show that CBT interventions for childhood anxiety disorders can be effectively administered in a group f o m t .     

Patient attrition in a comparative outcome study of depression. A follow-up report

Eighty-seven moderately to severely depressed psychiatric outpatients were randomly assigned to 12 weeks of cognitive therapy (n = 24), pharmacotherapy (n = 24), cognitive therapy plus pharmacotherapy (n = 22) or cognitive therapy plus active placebo (n = 17). Seventy patients completed the treatment protocol; 17 dropped out before the end of the treatment period. Completers and dropouts did not differ at pretreatment on demographic variables, measures of depression, cognitive functioning or social adjustment. Sixteen of the 17 patients who dropped out were followed up and interviewed to assess their clinical status and reasons for discontinuing treatment. Neither group remained depressed at follow-up. Practical matters and issues related to the type of treatment received seemed to contribute most to patients' decision to drop out. Patients assigned to the combination therapies were more likely to complete the research protocol than those assigned to single treatment modalities. These findings are discussed in terms of their implications for clinical practice and outcome research.     

Treating comorbid panic disorder in veterans with posttraumatic stress disorder

This study compares the effectiveness of panic control treatment (PCT) with that of a psychoeducational supportive treatment (PE-SUP) in treating panic disorder among a veteran sample with a primary diagnosis of chronic posttraumatic stress disorder (PTSD). Thirty-five patients randomized to receive 10 individual sessions of either PCT or PE-SUP underwent assessments at pretreatment, at 1-week posttreatment, and at a 3-month follow-up. Intent-to-treat analyses of covariance showed that PCT participants significantly improved on panic severity at posttreatment and panic fear at the 3-month follow-up. The PCT group also showed significant reductions in anxiety sensitivity at posttreatment and follow-up compared with that of the PE-SUP group. A significantly higher proportion of persons (63%) in the PCT group was panic free by the follow-up period compared with that of the PE-SUP group (19%). Patient self-report and clinician ratings showed no changes in general anxiety, depression, and PTSD symptoms in either group. These findings indicated that PCT was superior to an active control therapy in reducing the frequency, severity, and distress associated with panic disorder and suggested that brief cognitive-behavioral therapy for panic is effective for persons with chronic PTSD.     

Assertiveness training for disabled adults in wheelchairs: self-report, role-play, and activity pattern outcomes.

Thirty-four physically disabled adults participated in an 11-week assertiveness training (AT) program. Ss were randomly assigned to either AT or a waiting-list (WL) condition. Each was asked to complete three self-report measures, a role-play test, and a social and recreational activity diary. The AT Ss showed significant improvements on both self-reported assertiveness and role-play performance from pre- to posttreatment, whereas WL controls showed no changes on these measures. No significant changes in frequency of social or recreational activities were found at posttest for either AT or control Ss. A mixed pattern of results was shown at 6-month follow-up. Posttest gains were maintained across all self-report measures of assertiveness and acceptance of disability, whereas role-play performance approached baseline levels at 6-month follow-up. Overall results support the use of AT in enhancing perceived social efficacy and interpersonal skill of physically disabled adults in wheelchairs.     

Social support and treatment outcome in behavioral family therapy for child conduct problems.

This study assessed the role of social support in the outcome of child management training (CMT) for single parents of conduct problem children and assessed the impact of adjunctive ally support training (AST) on treatment outcome. Single parents (N = 22) with a child diagnosed as oppositional or conduct-disordered received CMT or CMT plus AST. Each group received the same 6-week parent training program and the AST group received an extra social support intervention. Measures of parent behavior, child deviance, social support (SS), and parental depression were obtained at pre- and posttreatment and at 6-month follow-up. Both groups improved, and changes maintained at follow-up. AST produced no extra gains. Responders from either group were more likely than nonresponders to report high levels of SS from friends. Results emphasize the importance of SS and the difficulty of incorporating changes in SS into treatment programs.     

A "family-based" approach to the treatment of obese type II diabetic patients

Forty-nine obese diabetic patients with obese spouses (diabetic or nondiabetic) were randomly assigned to an alone or together condition. Patients in the alone group participated by themselves in a 20-week behavioral weight control program; their spouses attended assessment sessions only. Patients in the together group attended the program with their spouses; both were targeted for weight loss and taught social support strategies. Weight losses of patients treated alone and together did not differ significantly at posttreatment (19.9 vs. 19.1 lb) or 1-year follow-up (11.6 vs. 7.0 lb). However, there was a significant interaction of treatment and gender; women did better when treated with their spouses, whereas men did better when treated alone. A "family-based" approach was not effective for these obese Type II diabetic patients as a whole but may be helpful for women.