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)     

Testing mediators of intervention effects in randomized controlled trials: An evaluation of three depression prevention programs.

Objective: Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. Method: In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive–behavioral (CB) intervention, group supportive expressive intervention, CB bibliotherapy, or assessment-only control condition. Results: The group CB intervention reduced depressive symptoms and negative cognitions and increased pleasant activities. Change in these mediators predicted change in depression, and intervention effects became weaker controlling for change in the mediators; yet, change in depression appeared typically to occur before change in the mediators. The supportive expressive intervention reduced depressive symptoms but affected only 1 of 2 mediators (emotional expression but not loneliness). Change in emotional expression did not correlate with change in depression, and change in depression usually occurred before change in the mediators. Bibliotherapy did not significantly affect depressive symptoms or the ostensive mediators (negative cognitions and pleasant activities), and change in depression usually occurred before change in the mediators. Conclusion: Results imply that this procedure provides a sensitive test of mediation but yielded limited support for the hypothesized mediators, suggesting that nonspecific factors may play an important mediational role. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological practice in primary care settings: Practical tips for clinicians.

Many psychologists are finding new opportunities for practice in primary care settings. These settings challenge many aspects of traditional practice and require adaptation and innovation. Psychologists must consider changes in their site of practice, treatment duration, type of intervention, and role as part of a health care team. This article describes the culture of primary care medicine and offers 10 practical tips for the adaptation in psychological practice to primary care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Late-life depression in primary care: where do we go from here?

One quarter of elderly patients in the primary care physician's office experience serious depressive symptoms. Despite efforts over the past 20 years to increase detection of late-life depression in primary care settings, patient outcomes have not improved. Undertreatment remains seriously problematic. Current efforts to improve recognition have included the development of depression practice guidelines, Depression Awareness Recognition and Treatment (D/ART) program, educational programs, and rudimentary outcomes measures. Screening tools for depression, such as the Geriatric Depression Scale, the Center for Epidemiologic Studies--Depressed, and Cornell Scale for Depression in Dementia, have also been developed to help clinicians screen for depressive symptoms in both ambulatory and inpatient settings. However, to improve clinical outcomes, increased research efforts should focus upon physicians' attitudes and practice patterns, effective treatments for minor depression, and effective ways to assess patients' perceptions of depression, as well as ways to identify age-specific barriers to treatment adherence. In addition, incorporating valid outcome measures into the primary care clinical setting will be crucial to measure the impact of our treatments.     

Empirically supported interventions and school psychology: Conceptual and practice issues—Part II.

In Part II of this 2-part article (Part I, see record 2000-03347-005), the authors present some conceptual and practice issues on the use of empirically supported interventions in school and community settings. Conceptual issues discussed include the foci of effective intervention studies, specification of interventions, and intervention manuals and procedural guidelines. The authors conclude with a discussion of essential practice issues, given a dual goal of advancing research in empirically supported interventions and of producing a knowledge base that has a direct meaning and application to school and community settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neighborhood Context, Personality, and Stressful Life Events as Predictors of Depression Among African American Women.

The authors tested neighborhood context, negative life events, and negative affectivity as predictors of the onset of major depression among 720 African American women. Neighborhood-level economic disadvantage (e.g., percentage of residents below the poverty line) and social disorder (e.g., delinquency, drug use) predicted the onset of major depression when controlling for individual-level demographic characteristics. Neighborhood-level disadvantage/disorder interacted with negative life events, such that women who experienced recent negative life events and lived in high disadvantage/disorder neighborhoods were more likely to become depressed than were those who lived in more benign settings, both concurrently and over a 2-year period. Neighborhood disadvantage/disorder can be viewed as a vulnerability factor that increases susceptibility to depression following the experience of negative life events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modification of depression risk factors: A solution-focused approach.

M. Seligman (1990) postulated that 3 meaning frames determine whether temporary sad feelings persist and eventually evolve into clinical depression: the permanence, pervasiveness, and personal causation of negative or stressful events. Successful treatment is thought to consist of interventions that modify these 3 meaning frames that contribute to depression. The authors combine Seligman's observations with 3 types of intervention questions used by therapists in solution-focused psychotherapy: exception, outcome, and coping and/or externalization questions. It is suggested that use of certain classes of intervention from solution-focused psychotherapy may shorten and potentiate treatment of depression. Solution-focused psychotherapy techniques are illustrated using a case study of a 69-yr-old man treated for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors and consequences of childhood depressive symptoms: A 5-year longitudinal study.

A 5-yr longitudinal study investigated the interrelationships among children's experience of depressive symptoms, negative life events, explanatory style, and helplessness behaviors in social and achievement situations. The results revealed that early in childhood, negative events, but not explanatory style, predicted depressive symptoms; later in childhood, a pessimistic explanatory style emerged as a significant predictor of depressive symptoms, alone and in conjunction with negative events. When children suffered periods of depression, their explanatory styles not only deteriorated but remained pessimistic even after their depression subsided, presumably putting them at risk for future episodes of depression. Some children seem repeatedly prone to depressive symptoms over periods of at least 2 yrs. Depressed children consistently showed helpless behaviors in social and achievement settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the AHCPR Depression in Primary Care guidelines: Further considerations for practitioners.

The majority of cases of clinical depression go unrecognized and untreated, despite the fact that depression is an eminently treatable disorder. The Agency for Health Care Policy and Research (AHCPR) recently published a set of clinical practice guidelines focused on depression in primary care settings. The review of the literature on which the guidelines are based is thorough and appropriate and should enhance the detection of depression and the quality of pharmacotherapy for depression. However, the guidelines encourage primary care physicians to provide pharmacotherapy to their depressed patients as the 1st line of treatment. The wisdom of this recommendation is questioned and revisions to the guidelines are suggested. Specifically, patients should be informed of the broad array of treatment options available and provided with a more balanced presentation of the potential benefits of psychotherapy for depression. Patients should decide which treatment alternative they wish to undergo. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral Activation Group Therapy in Public Mental Health Settings: A Pilot Investigation.

Depression is among the most common psychiatric disorders seen in mental health practices. Although effective treatments for the condition exist, managed care pressures providers to utilize empirically supported, cost-effective treatments. Behavioral activation (BA) treatment for depression has emerged in recent years as a promising, cost-effective intervention for major depressive disorder. If its effectiveness could be established. BA delivered through a group format would offer additional cost effectiveness over its individual therapy counterpart. This investigation examined the effects of behavioral activation group therapy (BAGT) for depression in public mental health settings. The results suggest that BAGT can be a valuable addition to the practicing psychologist's set of interventions to use with depressed clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cognitive stress-reduction intervention program for adolescents.

We examined the effectiveness of a cognitive intervention to help adolescents cope with stress and other forms of negative emotional arousal. Through this intervention procedure, youths learned how to identify and monitor stress-promoting cognitions, restructure these cognitions into more adaptive thoughts, use self-instructions to control stress-engendering self-statements, and practice and apply these acquired skills. The youths who received training were compared to a waiting list control group on measures of anxiety, anger, self-esteem, depression, and self-reports of cognitions in hypothetical stress situations. The training group showed significant reductions in levels of anxiety and anger, improvement in self-esteem, and an increase in the number of reported positive cognitions in response to a hypothetical situation. These treatment gains were maintained at a 10-week follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome studies of brief alcohol intervention in general practice: the problem of lost subjects

AIMS: To identify the attrition rate of eligible subjects from the general practice brief intervention studies, reasons for attrition, and the potential bias arising from lost subjects. DESIGN: Review of all published trials of brief intervention for excessive drinkers in primary care settings. FINDINGS: The attrition rate of eligible subjects from the general practice brief intervention studies ranges from 44.3 to 83.2% (mean 70.6%). The potential bias introduced by the characteristics of subjects available and not available for research is not adequately addressed. Where there is evidence, subjects unavailable for study or those lost to follow-up usually show different characteristics (e.g. younger, heavier drinkers, less educated) from those completing the study. CONCLUSIONS: Study populations in general practice-based brief alcohol interventions may have been those most susceptible to intervention. This suggests caution is appropriate in generalizing from brief intervention study results to routine primary care.     

Prevention and the clinical encounter

Development of an intervention to prevent depression in children of parents with severe affective disorder is described, along with the risk and resilience factors incorporated from prospective longitudinal studies of parents and children at risk. Strategies helpful in bridging the gap between clinical practice and prevention are discussed, and the differences in orientation necessary to include prevention in clinical practice are explored.     

Treating major depression in primary care practice: an update of the Agency for Health Care Policy and Research Practice Guidelines

The Depression Guideline Panel of the Agency for Health Care Policy and Research in 1993 published recommendations for treating major depression in primary care practice that were often based on studies of tertiary care psychiatric patients. We reviewed reports of randomized controlled trials in primary care settings published between 1992 and 1998. This evidence indicates that both antidepressant pharmacotherapy and time-limited depression-targeted psychotherapies are efficacious when transferred from psychiatric to primary care settings. In most cases, the choice between these treatments should depend on patient preference. Studies to date suggest that improving treatment of depression in primary care requires properly organized treatment programs, regular patient follow-up, monitoring of treatment adherence, and a prominent role for the mental health specialist as educator, consultant, and clinician for the more severely ill. Future research should focus on how guidelines are best implemented in routine practice, since conventional dissemination strategies have little impact.     

Mental health intensive outpatient programming: An outcome and satisfaction evaluation of a private practice model.

The current economic climate of mental health care requires an adaptation of traditional treatment paradigms for practitioners to succeed in the marketplace. Psychologists have not really capitalized on their training and expertise in developing outpatient treatment models for acute care. A private practice outpatient program, based in crisis intervention and group therapy, is described. The effectiveness of a mental health intensive outpatient program (IOP) in a private practice setting is demonstrated. IOPs represent an opportunity for private practice groups to collaborate with larger systems of care while providing clinically effective, consumer friendly, and safe treatment for acute patients in traditional outpatient settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal psychotherapy for co-occurring depression and chronic pain.

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover, when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans, and Latinos all report higher rates of pain and depression compared with other groups. This article describes a version of interpersonal psychotherapy tailored for patients with comorbid depression and chronic pain, interpersonal psychotherapy for depression and pain (IPT-P). IPT-P potentially could be delivered to many patient populations in a range of clinical settings, but this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non–treatment-seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option have the potential to improve clinical outcomes for individuals with depression and chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care for the whole person: Research update.

Quality health care must be informed by the best available scientific knowledge. This article offers research evidence supporting "health care for the whole person." We present an integrative biopsychosocial framework that can serve as a useful foundation for translational research endeavors and the development, evaluation, and dissemination of evidence-based health and mental health interventions. Pain and depression are used as exemplars of the biopsychosocial model. Empirical support for mental health interventions in primary care settings is highlighted, with particular emphasis on the treatment of depression across the life span. Research, practice, and policy implications based on the extant evidence base for health care for the whole person are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thorough informed consent: A developing clinical intervention with suicidal clients.

In this article, I provide commentary on the Rudd et al. (2009) article advocating thorough informed consent with suicidal clients. I examine the Rudd et al. recommendations in light of their previous empirical-research and clinical-practice articles on suicidality, and from the perspective of clinical practice with suicidal clients in university counseling center settings. I conclude that thorough informed consent is a clinical intervention that is still in preliminary stages of development, necessitating empirical research and clinical training before actual implementation as an ethical clinical intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching resourcefulness skills to older adults

With rapidly increasing numbers of elders in the United States, there is a growing need for interventions to promote independence and productive, healthy lifestyles among the elderly. Highly resourceful persons have been found to function better in their daily activities than those who lack resourcefulness skills. These skills, including self-controlling techniques and problem-solving, are believed to be learned and therefore can be taught. This pilot study examined the effects of teaching resourcefulness skills to healthy elders on measures of learned resourcefulness, anxiety, depression, adaptive functioning, and life satisfaction using a quasi-experimental pre-test-post-test design. The intervention group consisted of 20 elders and the placebo group had 17 elders. Those elders who received the 6-week small group intervention that taught the skills constituting resourcefulness scored significantly higher on post-test measures of learned resourcefulness, adaptive functioning, and life satisfaction. Although significant negative correlations were found between resourcefulness scores and scores on measures of anxiety and depression, there were no significant differences in anxiety and depression between the intervention and placebo groups on the post-test measures. The findings suggest that learned resourcefulness training (LRT) is an important nursing intervention for promoting healthy, independent, and productive lifestyles among older adults.