Transporting a school-based intervention for social anxiety in Canadian adolescents.

Prevention/intervention programs for anxiety disorders, the most common form of psychological distress reported by children and adolescents, are critical, as unaddressed anxiety has been associated with a host of negative life-outcomes. This study examines the transportability and dissemination of the Skills for Academic and Social Success (SASS), an early intervention program that can be delivered in high school settings and is aimed at reducing symptoms of anxiety among adolescents. A total of 27 adolescent high school students participated. Teachers and adolescent peer counselors were trained to deliver a modified version of SASS, involving ten 60-minute sessions. The results reveal that at-risk adolescents participating in the SASS program showed a reduction in anxiety, behavioural avoidance, and depression symptoms from pre- to posttesting, which provides further support for the transportability and dissemination of the SASS program in secondary schools. Limitations of the study and future directions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A brief image-based prevention intervention for adolescents.

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior–image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16–0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32–0.43, ps     

Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs.

This study evaluated the efficacy of 2 programs for preventing depressive symptoms in adolescents. Participants were 380 high school students randomly assigned to a cognitive-behavioral program (CB), an interpersonal psychotherapy-adolescent skills training program (IPT-AST), or a no-intervention control. The interventions involved eight 90-min weekly sessions run in small groups during wellness classes. At postintervention, students in both the CB and IPT-AST groups reported significantly lower levels of depressive symptoms than did those in the no-intervention group, controlling for baseline depression scores; the 2 intervention groups did not differ significantly from each other. The effect sizes, using Cohen's d, for the CB intervention and the IPT-AST intervention were 0.37 and 0.26, respectively. Differences between control and intervention groups were largest for adolescents with high levels of depressive symptoms at baseline. For a high-risk subgroup, defined as having scored in the top 25th percentile on the baseline depression measure, the effect sizes for the CB and the IPT-AST interventions were 0.89 and 0.84, respectively. For the whole sample, sociotropy and achievement orientation moderated the effect of the interventions. Intervention effects were short term and were not maintained at 6-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of a family cognitive-behavioral preventive intervention for children of depressed parents.

A family cognitive-behavioral preventive intervention for parents with a history of depression and their 9–15-year-old children was compared with a self-study written information condition in a randomized clinical trial (n = 111 families). Outcomes were assessed at postintervention (2 months), after completion of 4 monthly booster sessions (6 months), and at 12-month follow-up. Children were assessed by child reports on depressive symptoms, internalizing problems, and externalizing problems; by parent reports on internalizing and externalizing problems; and by child and parent reports on a standardized diagnostic interview. Parent depressive symptoms and parent episodes of major depression also were assessed. Evidence emerged for significant differences favoring the family group intervention on both child and parent outcomes; strongest effects for child outcomes were found at the 12-month assessment with medium effect sizes on most measures. Implications for the prevention of adverse outcomes in children of depressed parents are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cognitive-behavioral perspective on termination.

The issue of termination as viewed from a cognitive-behavioral orientation is considered within the context of the duration of treatment, the goals of therapy, and the underlying coping skills model that characterizes this orientation. These factors make a cognitive-behavioral approach to therapy both similar to and different from other orientations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of a coping group intervention for adults with HIV who are AIDS bereaved: Longitudinal effects on grief.

The authors sought to study the longitudinal effects of a cognitive-behavioral group intervention for coping with AIDS bereavement among a diverse sample of adults who were HIV positive. Participants (N = 267) were randomly assigned to receive the 12-week intervention or individual therapy upon request. Measures were administered at baseline, postintervention, and 4-, 8-, and 12-month follow-ups. Longitudinal data were analyzed with linear mixed models to examine change in grief by condition across the study period and the effect of the intervention on grief through its interaction with psychiatric distress. The authors used the Grief Reaction Index to assess grief and the Symptom Checklist-90-Revised to assess global psychiatric distress. Participants in both conditions reported decreases in grief severity. However, among those with higher levels of psychiatric distress, participants in the group intervention had significantly lower grief severity scores compared with participants in the individual therapy condition. The long-term effectiveness of this AIDS-bereavement intervention for psychiatrically distressed people with HIV/AIDS supports the need for tailored interventions among those at risk for complicated grief responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

From the lab to the clinic: Effectiveness of cognitive-behavioral treatments for anxiety disorders.

A controversy exists over whether results of randomized controlled trials of psychological treatment methods generalize to routine clinical practice. To examine the generalizability of cognitive-behavioral interventions for anxiety disorders, a meta-analysis of 11 effectiveness studies was conducted. Only studies that closely approximated real-world clinical practice were included in the present meta-analysis (e.g., studies were conducted in a nonuniversity setting, practitioners had regular caseloads, clients were not excluded if they had comorbid conditions). Cognitive-behavioral interventions were associated with significant improvement in anxiety symptoms at the end of treatment (dw = 1.35) and again at follow-up (dw = 1.14). On the basis of these results, it seems that cognitive-behavioral interventions for anxiety disorders generalize to real-world clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief motivational intervention with homeless adolescents: Evaluating effects on substance use and service utilization.

A brief motivational intervention with 117 homeless adolescents was evaluated using a randomized design and 3-month follow-up. The intervention was designed to raise youths' concerns about their substance use, support harm reduction, and encourage greater service utilization at a collaborating agency. The study was designed to strengthen initial promising results of an earlier study (P. L. Peterson, J. S. Baer, E. A. Wells, J. A. Ginzler, & S. B. Garrett, 2006). Several modifications in the clinical protocol were included to enhance engagement with the intervention. Analyses revealed no significant benefits for intervention participants when homeless youths' substance use rates were compared with those of control participants. Service utilization during the intervention period increased for those receiving the intervention but returned to baseline levels at follow-up. Participants reported overall reductions in substance use over time. Differences between sampling methods for the current and previous study are discussed, as are the limitations of brief interventions with this population. Future research needs to elucidate mechanisms of change and service engagement for highly vulnerable youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults.

The authors used a randomized trial to compare cognitive-behavioral therapy (CBT) and supportive counseling (SC) in the treatment of anxiety symptoms in older adults who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for anxiety disorders. Both conditions had a 6-week baseline no-treatment phase. Treatment was delivered primarily in patients' own homes and in an individual format. Outcomes were assessed at posttreatment and at 3-, 6-, and 12-month follow-ups. There was no spontaneous improvement during the baseline phase. Both groups showed improvement on anxiety measures following treatment, with a better outcome for the CBT group on self-rating of anxiety and depression. Over the follow-up period, the CBT group maintained improvement and had significantly greater improvement than the SC group on anxiety and 1 depression measure. Treatment response for anxiety was also superior for the CBT group, although there was no difference between groups in endstate functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up.

A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical observations of a Cantonese cognitive-behavioral treatment program for Chinese immigrants.

In this article, the authors describe our clinical observations about the process of delivering a Cantonese-language cognitive- behavioral therapy program to treat depression in Hong Kong immigrants to Vancouver, Canada. Our experiences indicated that standard referral and assessment procedures were not optimal for this population. Other factors that required consideration were how to convert Cantonese terms for dysphoric affect into English equivalents and how to implement cognitive modification strategies when dealing with culture-syntonic beliefs about social relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of an intensive psychosocial intervention for children of parents with multiple sclerosis.

Objective: To evaluate an intervention for children of parents with multiple sclerosis (MS). It was hypothesized that the intervention would increase knowledge of MS, approach coping, and social support and decrease avoidant coping and stress appraisals. It was expected that these changes would reduce the adverse impacts of caregiving and produce better adjustment. Method: Twenty children (9-14 years) who had a parent with MS attended a 6-day camp intervention. These children completed questionnaires at pre- and postintervention and at 3-month follow-up; their parents with MS (N = 14) completed questionnaires at preintervention and at follow-up. Results: After the intervention, children reported significant decreases in distress, stress appraisals, caregiving compulsion, and activity restrictions and increases in social support and knowledge of MS. Parental data confirmed the increase in the children's knowledge of MS, and overall, qualitative data supported the quantitative findings. Qualitative data showed that the intervention had indirect effects on some parents and families. Conclusions: Findings offer preliminary support for the use of a stress- and coping-based intervention for supporting children and their families with parental MS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence for clinical smoking cessation for adolescents.

Objective: This report reviews the evidence that informs the role of health and mental health care providers in addressing youth smoking cessation. Design: Qualitative literature review. Results: Physicians do not consistently screen adolescents for tobacco use and fail to provide recommended cessation advice. Challenges to addressing smoking cessation include the need for procedures to ensure confidentiality and the existence of competing demands to provide other services. Few published studies have specifically addressed the effectiveness of clinical interventions. Interventions that require return visits or follow-up phone contacts are technically difficult to implement in this population. Successful interventions may require resources not available in nonresearch settings. Most studies have used brief clinical intervention as a control condition, making it impossible to evaluate its effectiveness. Conclusion: There is little evidence that supports current clinical smoking cessation guidelines for adolescents. More research is needed to develop inexpensive, efficient clinical interventions that can provide youths access to smoking cessation help. Future challenges include reorganizing clinical systems to offer greater counseling by support staff or in electronic formats and to provide effective booster messages and follow-up care in a population that is difficult to track. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of preparatory measures for coping with anxiety raised by media coverage of terrorism.

This study examines effects of television broadcasts of terrorism on viewers' anxiety and raises suggestions for 2 intervention strategies to moderate elevated anxiety. Participants were 120 young Israeli adults randomly allocated to a terrorism or a nonterrorism television broadcast and assigned to 1 of 3 intervention conditions prior to exposure--cognitive based, emotional based, or none. Anxiety was measured explicitly and projectively prior and subsequent to manipulation. Results showed greater posttest anxiety in terrorism versus nonterrorism groups. In the terrorism group, therapeutic interventions led to lower posttest levels of explicit and projective anxiety than the control intervention, with advantage to the cognitive intervention on projective anxiety. In the nonterrorism group, the emotional intervention produced greater posttest anxiety on the explicit anxiety measure. Findings indicate noxious effects of television coverage of terrorism and suggest preparatory measures that maximize public coping. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief intervention for drug-abusing adolescents in a school setting.

This study evaluated the use of 2 brief interventions (BIs) to reduce drug use among 14- to 17-year-olds identified in a school setting as drug abusers. Students (N = 79) were randomly assigned to receive 1 of 3 target conditions: 2 sessions with the adolescent only (BI-A), 2 sessions with the adolescent and 1 with the parent (BI-AP), or an assessment-only control condition (CON). Follow-up assessments of 78 participants done 6 months postintervention showed that the adolescents in the BI-A and BI-AP conditions generally had superior outcomes on their drug use behaviors compared with the CON group. Also, those receiving the BI-AP had better outcomes on most outcome variables compared with adolescents receiving BI-A. The 6-month abstinence rates did not differ across groups. The potential value of a school-based BI for students with a substance abuse disorder is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents.

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latent variable analysis of coping, anxiety/depression, and somatic symptoms in adolescents with chronic pain.

Reports of adolescents' coping with recurrent pain, symptoms of anxiety/depression, and somatic complaints were obtained from a sample of 164 adolescents with recurrent abdominal pain and their parents. Confirmatory factor analysis revealed that coping consisted of 3 nonorthogonal factors: Primary Control Engagement Coping (problem solving, emotional expression, and emotional regulation), Secondary Control Engagement Coping (positive thinking, cognitive restructuring, acceptance, and distraction), and Disengagement Coping (denial, avoidance, and wishful thinking). Structural equation modeling using latent variables revealed that secondary control engagement coping predicted lower levels of anxiety/depression symptoms and somatic complaints, and disengagement coping was related to higher levels of anxiety/depression and somatic complaints. Implications for understanding child and adolescent coping with pain are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems.

Clients with generalized anxiety disorder (GAD) received either (1) applied relaxation and self-control desensitization, (2) cognitive therapy, or (3) a combination of these methods. Treatment resulted in significant improvement in anxiety and depression that was maintained for 2 yrs. The large majority no longer met diagnostic criteria; a minority sought further treatment during follow-up. No differences in outcome were found between conditions; review of the GAD therapy literature suggested that this may have been due to strong effects generated by each component condition. Finally, interpersonal difficulties remaining at posttherapy, measured by the Inventory of Interpersonal Problems Circumplex Scales (L. E. Alden, J. S. Wiggins, & A. L. Pincus, 1990) in a subset of clients, were negatively associated with posttherapy and follow-up improvement, suggesting the possible utility of adding interpersonal treatment to cognitive-behavioral therapy to increase therapeutic effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)