Do brief personalized feedback interventions work for mandated students or is it just getting caught that works?

Studies evaluating the efficacy of brief interventions with mandated college students have reported declines in drinking from baseline to short-term follow-up regardless of intervention condition. A key question is whether these observed changes are due to the intervention or to the incident and/or reprimand. This study evaluates a brief personalized feedback intervention (PFI) for students (N = 230) who were referred to a student assistance program because of infractions of university rules regarding substance use to determine whether observed changes in substance use are attributable to the intervention. Half the students received immediate feedback (at baseline and after the 2-month follow-up), and half received delayed feedback (only after the 2-month follow-up). Students in both conditions generally reduced their drinking and alcohol-related problems from baseline to the 2-month follow-up and from the 2-month to the 7-month follow-up; however, there were no significant between-group differences at either follow-up. Therefore, it appears that the incident and/or reprimand are important instigators of mandated student change and that written PFIs do not enhance these effects on a short-term basis but may on a longer term basis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of a targeted personalized drinking feedback intervention among intercollegiate athletes: A randomized controlled trial.

College athletes are an at-risk population for excessive alcohol use and subsequent alcohol-related harms. The purpose of this study was to test the efficacy of an electronically delivered personalized drinking feedback (PDF) intervention targeted specifically to college athletes, both in comparison with a standard (i.e., nontargeted) PDF intervention and an education-only (EO) condition that also included targeted information. Data were collected on 263 intercollegiate athletes from three colleges (76% women, 86% White) who were randomly assigned to one of the conditions. Results provided partial support for the efficacy of the targeted PDF intervention. Students in the targeted PDF condition reported a lower peak blood alcohol concentration (BAC) at the 6-month follow-up than those in the other conditions. Heavy drinking students in the targeted PDF condition reported a lower peak BAC than those in the other conditions at the 1-month follow-up and a lower peak BAC than those in the EO condition at the 6-month follow-up. Finally, in-season athletes in the targeted PDF condition reported fewer drinks per week than those in the PDF-standard condition at the 1-month follow-up. These findings provide preliminary support for the use of targeted PDF interventions with at-risk alcohol users, such as college athletes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational enhancement and self-help treatments for problem gambling.

Two brief treatments for problem gambling were compared with a waiting-list control in a randomized trial. Eighty-four percent of participants (N?=?102) reported a significant reduction in gambling over a 12-month follow-up period. Participants who received a motivational enhancement telephone intervention and a self-help workbook in the mail, but not those who received the workbook only, had better outcomes than participants in a 1-month waiting-list control. Participants who received the motivational interview and workbook showed better outcomes than those receiving the workbook only at 3-and 6-month follow-ups. At the 12-month follow-up, the advantage of the motivational interview and workbook condition was found only for participants with less severe gambling problems. Overall, these results support the effectiveness of a brief telephone and mail-based treatment for problem gambling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Phospholipase C isozymes in the human brain and their changes in Alzheimer''s disease

OBJECTIVE: We compared the efficacy of bladder training, pelvic muscle exercise with biofeedback-assisted instruction, and combination therapy, on urinary incontinence in women. The primary hypothesis was that combination therapy would be the most effective in reducing incontinent episodes. STUDY DESIGN: A randomized clinical trial with three treatment groups was conducted in gynecologic practices at two university medical centers. Two hundred and four women diagnosed with genuine stress incontinence (n = 145) and/or detrusor instability (n = 59) received a 12-week intervention program (6 weekly office visits and 6 weeks of mail/telephone contact) with immediate and 3-month follow-up. Outcome variables included number of incontinent episodes, quality of life, perceived improvement, and satisfaction. Data analyses consisted of analysis of covariance using baseline values as covariates and chi2 tests. RESULTS: The combination therapy group had significantly fewer incontinent episodes, better quality of life, and greater treatment satisfaction immediately after treatment. No differences among groups were observed 3 months later. Women with genuine stress incontinence had greater improvement in life impact, and those with detrusor instability had less symptom distress at the immediate follow-up; otherwise, no differences were noted by diagnosis, incontinence severity, or treatment site. CONCLUSIONS: Combination therapy had the greatest immediate efficacy in the management of female urinary incontinence regardless of urodynamic diagnosis. However, each of the 3 interventions had similar effects 3 months after treatment. Results suggest that the specific treatment may not be as important as having a structured intervention program with education, counseling, and frequent patient contact.     

Targeting Misperceptions of Descriptive Drinking Norms: Efficacy of a Computer-Delivered Personalized Normative Feedback Intervention.

The authors evaluated the efficacy of a computer-delivered personalized normative feedback intervention in reducing alcohol consumption among heavy-drinking college students. Participants included 252 students who were randomly assigned to an intervention or control group following a baseline assessment. Immediately after completing measures of reasons for drinking, perceived norms, and drinking behavior, participants in the intervention condition were provided with computerized information detailing their own drinking behavior, their perceptions of typical student drinking, and actual typical student drinking. Results indicated that normative feedback was effective in changing perceived norms and alcohol consumption at 3- and 6-month follow-up assessments. In addition, the intervention was somewhat more effective at 3-month follow-up among participants who drank more for social reasons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping and parenting: Mediators of 12-month outcomes of a family group cognitive–behavioral preventive intervention with families of depressed parents.

Objective: In a randomized clinical trial with 111 families of parents with a history of major depressive disorder (86% mothers, 14% fathers; 86% Caucasian, 5% African-American, 3% Hispanic, 1% American Indian or Alaska Native, 4% mixed ethnicity), changes in adolescents' (mean age = 11 years; 42% female, 58% male) coping and parents' parenting skills were examined as mediators of the effects of a family group cognitive–behavioral preventive intervention on adolescents' internalizing and externalizing symptoms. Method: Changes in hypothesized mediators were assessed at 6 months, and changes in adolescents' symptoms were measured at a 12-month follow-up. Results: Significant differences favoring the family intervention compared with a written information comparison condition were found for changes in composite measures of parent–adolescent reports of adolescents' use of secondary control coping skills and direct observations of parents' positive parenting skills. Changes in adolescents' secondary control coping and positive parenting mediated the effects of the intervention on depressive, internalizing, and externalizing symptoms, accounting for approximately half of the effect of the intervention on the outcomes. Further, reciprocal relations between children's internalizing symptoms and parenting were found from baseline to 6-month follow-up. Conclusion: The present study provides the first evidence for specific mediators of a family group cognitive–behavioral preventive intervention for families of parents with a history of major depressive disorder. The identification of both coping and parenting as mediators of children's mental health outcomes suggests that these variables are important active ingredients in the prevention of mental health problems in children of depressed parents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping Strategies in Bulimia Nervosa Treatment: Impact on Outcome in Group Cognitive-Behavioral Therapy.

This study's purpose was to examine the extent to which participants (N = 143) receiving cognitive-behavioral therapy for bulimia nervosa (BN) reported implementing therapeutic strategies to abstain from BN behaviors, and to assess whether use of specific strategies predicts outcome at treatment end and 1- and 6-month follow-up. Frequency of outcome expectancies (OE), stimulus-response prevention (SRP), and social support-seeking (SSS) strategies significantly increased by end of treatment. By 1-month follow-up, use of SSS, not OE or SRP, declined significantly relative to treatment end. Although frequency of coping strategy use at treatment end did not predict 1-month BN symptom remission, SSS use at 1-month follow-up predicted 6-month remission. Findings highlight the importance of social support to maintain treatment gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of self-help materials, personalized feedback, and telephone counseling with nonvolunteer smokers.

The incremental effects of (a) a self-help booklet alone, (b) self-help booklet with computer-generated personalized feedback, and (c) self-help booklet, personalized feedback, and outreach telephone counseling were evaluated in a population-based, nonvolunteer sample of smokers. Smokers (N?=?1 ,137) were identified through a telephone survey of a random sample of 5,903 enrollees in a health maintenance organization and randomized to a no-treatment control group or I of the 3 intervention conditions. Smoking status was ascertained 3, 12, and 21 months postrandomization. Cotinine validation of self-reported cessation was obtained at the 12-month follow-up. Overall, the telephone counseling significantly increased smoking cessation at the 3-month follow-up, but not at 12 or 21 months. Among smokers who were precontemplative at baseline, telephone counseling significantly increased prevalent abstinence at 3 and 12 months and continuous abstinence at 21 months (defined as self-reported abstinence at 3, 12, and 21 months (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What is adequate nutrition?

BACKGROUND/AIMS: Retrospective studies have suggested that early loss of serum HCV-RNA predicts sustained response to alpha-interferon treatment in chronic hepatitis C, but the optimal duration of therapy after loss of HCV-RNA is not known. The aims of this study were: a) to prospectively evaluate the effectiveness of HCV-RNA testing after 1 month of alpha-interferon treatment in the prediction of sustained response, and b) to compare the efficacy of 6 and 12 months of therapy in patients with a negative serum HCV-RNA test after the first month of treatment. METHODS: One hundred and thirty patients were administered interferon alpha-2b at doses related to body weight (< or > or = 60 kg) and to HCV genotype: 5 or 8 MU tiw for type 1, and 3 or 5 MU tiw for genotypes non-1. Serum HCV-RNA testing was performed using in-house nested RT-PCR at month 1, at the end of treatment and 6 months afterwards. We considered sustained response to be the maintenance of normal alanine aminotransferase and negativity at serum HCV-RNA testing until the end of follow-up. RESULTS: Sustained response was observed in 2/72 (2.8%) patients with detectable HCV-RNA after the initial month of therapy, in 8/30 (26.7%) patients with early loss of HCV-RNA treated for 6 months and in 20/28 (71.4%) patients treated for 12 months (p<0.01). CONCLUSIONS: Serum HCV-RNA detectability after the first month is strongly associated with a very poor chance of sustained response, and these cases should be offered other treatments. Patients with early loss of HCV-RNA should complete a 12-month treatment, which appeared more effective than a 6-month treatment.     

Interactive versus noninteractive interventions and dose–response relationships for stage-matched smoking cessation programs in a managed care setting.

This study compared interactive and noninteractive smoking cessation interventions for a population of smokers who were all members of 1 division of a managed care company. In addition, it examined whether a dose-response relationship existed. Screening was completed for 19,236 members who were contacted by telephone or mail. Of the 4,653 who were identified as smokers, 85.3% were enrolled. A 2 Intervention (interactive or noninteractive)?×?4 Contacts (1, 2, 3, or 6 contacts)?×?4 Occasions (0, 6, 12, and 18 months) design was used. The interactive intervention was stage-matched expert-system reports plus manuals; the noninteractive intervention was stage-matched manuals. Contact occurred in 1 of 4 series (1, 2, 3 or 6 contacts) at 3-month intervals. The expert system outperformed the stage-matched manuals, but there was no clear dose-response relationship for either intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: A randomized controlled trial.

Objective: Cognitive–behavioral therapy (CBT) is the best established treatment for binge-eating disorder (BED) but does not produce weight loss. The efficacy of behavioral weight loss (BWL) in obese patients with BED is uncertain. This study compared CBT, BWL, and a sequential approach in which CBT is delivered first, followed by BWL (CBT + BWL). Method: 125 obese patients with BED were randomly assigned to 1 of the 3 manualized treatments delivered in groups. Independent assessments were performed posttreatment and at 6- and 12-month follow-ups. Results: At 12-month follow-up, intent-to-treat binge-eating remission rates were 51% (CBT), 36% (BWL), and 40% (CBT + BWL), and mean percent BMI losses were ?0.9, ?2.1, and 1.5, respectively. Mixed-models analyses revealed that CBT produced significantly greater reductions in binge eating than BWL through 12-month follow-up and that BWL produced significantly greater percent BMI loss during treatment. The overall significant percent BMI loss in CBT + BWL was attributable to the significant effects during the BWL component. Binge-eating remission at major assessment points was associated significantly with greater percent BMI loss cross-sectionally and prospectively (i.e., at subsequent follow-ups). Conclusions: CBT was superior to BWL for producing reductions in binge eating through 12-month follow-up, while BWL produced statistically greater, albeit modest, weight losses during treatment. Results do not support the utility of the sequential approach of providing BWL following CBT. Remission from binge eating was associated with significantly greater percent BMI loss. Findings support BWL as an alternative treatment option to CBT for BED. (PsycINFO Database Record (c) 2011 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)     

Computer-assisted cognitive rehabilitation for the treatment of patients with substance use disorders: A randomized clinical trial.

The purpose of this study was to examine the comparative efficacy of cognitive rehabilitation as an intervention for substance misuse. Patients with substance use disorders entering long-term residential care (N = 160) were randomly assigned to one of two conditions: (a) standard treatment plus computer-assisted cognitive rehabilitation (CACR), which was designed to improve cognitive performance in areas such as problem solving, attention, memory, and information processing speed; and (b) an equally intensive attention control condition consisting of standard treatment plus a computer-assisted typing tutorial (CATT). Participants were assessed at baseline, during treatment, at treatment completion, and 3-, 6-, 9-, and 12-month follow-up. Intent-to-treat analyses showed that, compared with those randomized to CATT, patients who received CACR were significantly more engaged in treatment (e.g., higher ratings of positive participation by treatment staff, higher ratings of therapeutic alliance), more committed to treatment (e.g., longer stays in residence) and reported better long-term outcomes (e.g., higher percentage of days abstinent after treatment). Mediational analyses revealed the positive comparative effect of CACR on abstinence during the year after treatment was mediated by treatment engagement and length of stay in residence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief cognitive therapy for panic disorder: A randomized controlled trial.

Cognitive therapy (CT) is a specific and highly effective treatment for panic disorder (PD). Treatment normally involves 12–15 1-hr sessions. In an attempt to produce a more cost-effective version, a briefer treatment that made extensive use of between-sessions patient self-study modules was created. Forty-three PD patients were randomly allocated to full CT (FCT), brief CT (BCT), or a 3-month wait list. FCT and BCT were superior to wait list on all measures, and the gains obtained in treatment were maintained at 12-month follow-up. There were no significant differences between FCT and BCT. Both treatments had large (approximately 3.0) and essentially identical effect sizes. BCT required 6.5 hr of therapist time, including booster sessions. Patients' initial expectation of therapy success was negatively correlated with posttreatment panic-anxiety. Cognitive measures at the end of treatment predicted panic-anxiety at 12-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations between in-treatment and follow-up abstinence among cocaine-dependent homeless persons in three clinical trials.

Clinical trials with cocaine-dependent outpatients have found a strong relation between in-treatment and follow-up abstinence, and the strength of this relation is constant across treatment conditions with variable efficacy in generating abstinence. The authors conducted secondary analyses of data from 3 clinical trials to determine whether this relation generalizes to cocaine-dependent homeless persons. The 3 trials (total N = 543) were conducted in a community health care facility for homeless people. The 7 treatment arms across the 3 trials were combinations of day treatment, abstinence-contingent housing, and vocational training. Drug use was measured with urine toxicology testing. Consecutive weeks of abstinence during treatment were strongly related to abstinence at the 12-month follow-up, whether or not missing 12-month data were included in the analysis. The treatment arms differed in their efficacy in generating abstinence, but the relation between in-treatment and follow-up abstinence did not differ across treatment arms. These results replicate earlier reports of these relations and extend them to a population of homeless people. The lack of differences between treatment arms in the in-treatment–follow-up abstinence relation implies that that relation is independent of the treatment-specific intervention components that generate group differences in abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized clinical trial of a brief, mailed intervention for symptoms of depression.

This research evaluated the efficacy of a brief, mailed personalized feedback intervention designed to alleviate depressed mood and antecedents (ineffective coping and hopelessness). College students (N = 177) were randomly assigned to intervention or control group following a baseline assessment. A week after completing the baseline assessment, participants in the intervention condition were mailed feedback and information detailing their mood, coping strategies, as well as suggestions for enhancing mood. Results indicated that feedback was effective in reducing depressive symptoms, hopelessness, and among men, increasing willingness to use coping strategies at the 1-month follow-up. Hopelessness mediated reductions in depressive symptoms. Results support the use of personalized feedback as a low-cost, initial intervention for college students suffering from symptoms of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief Relationship Therapy for Alcoholism: A Randomized Clinical Trial Examining Clinical Efficacy and Cost-Effectiveness.

The purpose of this study was to examine the clinical efficacy and cost effectiveness of brief relationship therapy (BRT), a shortened version of standard behavioral couples therapy (S-BCT), with alcoholic male patients (N = 100) and their nonsubstance-abusing female partners. Participants were randomly assigned to 1 of 4 treatment conditions: (a) BRT, (b) S-BCT, (c) individual-based treatment (IBT), or (d) psychoeducational attention control treatment (PACT). Equivalency testing revealed that, compared with those assigned to S-BCT, participants who were randomly assigned to BRT had equivalent posttreatment and 12-month follow-up heavy drinking outcomes. Moreover, at 12-month follow-up, heavy drinking and dyadic adjustment outcomes for patients who received BRT were superior to those of patients who received IBT or PACT. BRT was significantly more cost effective than the S-BCT, IBT, or PACT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals.

Objective: To evaluate cognitive-behavioral therapy to enhance medication adherence and reduce depression (CBT-AD) in individuals with HIV. Design: A two arm, randomized, controlled, cross-over trial comparing CBT-AD to enhanced treatment as usual only (ETAU). ETAU, which both groups received, included a single-session intervention for adherence and a letter to the patient's provider documenting her or his continued depression. The intervention group also received 10 to 12 sessions of CBT-AD. Main Outcome Measures: Adherence to antiretroviral therapy as assessed by Medication Event Monitoring Systems (MEMs) and depression as assessed by blinded structured evaluation. Results: At the acute outcome assessment (3-months), those who received CBT-AD evidenced significantly greater improvements in medication adherence and depression relative to the comparison group. Those who were originally assigned to the comparison group who chose to cross over to CBT-AD showed similar improvements in both depression and adherence outcomes. Treatment gains for those in the intervention group were generally maintained at 6- and 12-month follow-up assessments. By the end of the follow-up period, those originally assigned CBT-AD demonstrated improvements in plasma HIV RNA concentrations, though these differences did not emerge before the cross-over, and hence there were not between-groups differences. Conclusions: CBT-AD is a potentially efficacious approach for individuals with HIV struggling with depression and adherence. Replication and extension in larger efficacy trials are needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of motivational enhancement therapy with nontreatment-seeking adolescent cannabis users: A further test of the teen marijuana check-up.

Cannabis use adversely affects adolescents and interventions that are attractive to adolescents are needed. This trial compared the effects of a brief motivational intervention for cannabis use with a brief educational feedback control and a no-assessment control. Participants were randomized into one of three treatment conditions: Motivational Enhancement Therapy (MET), Educational Feedback Control (EFC), or Delayed Feedback Control (DFC). Those who were assigned to MET and EFC were administered a computerized baseline assessment immediately following randomization and completed assessments at the 3- and 12-month follow-up periods. Participants in the DFC condition were not assessed until the 3-month follow-up. Following the completion of treatment sessions, all participants were offered up to four optional individual treatment sessions aimed at cessation of cannabis use. The research was conducted in high schools in Seattle, Washington. The participant s included 310 self-referred adolescents who smoked cannabis regularly. The main outcome measures included days of cannabis use, associated negative consequences, and engagement in additional treatment. At the 3-month follow-up, participants in both the MET and EFC conditions reported significantly fewer days of cannabis use and negative consequences compared to those in the DFC. The frequency of cannabis use was less in MET relative to EFC at 3 months, but it did not translate to differences in negative consequences. Reductions in use and problems were sustained at 12 months, but there were no differences between MET and EFC interventions. Engagement in additional treatment was minimal and did not differ by condition. Brief interventions can attract adolescent cannabis users and have positive impacts on them, but the mechanisms of the effects are yet to be identified. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The role of exposure with response prevention in the cognitive-behavioural therapy for bulimia nervosa

BACKGROUND: One hundred and thirty-five women with bulimia nervosa participated in a randomized clinical trial designed to determine whether the addition of exposure with response prevention to a core of cognitive-behavioural therapy (CBT) leads to greater clinical improvement and lower risk of relapse. We present results from the end of treatment and 6- and 12-month follow-up. METHODS: Participants received eight sessions of CBT and were then randomized to either exposure to pre-binge cues (B-ERP), exposure to pre-purge cues (P-ERP), or a relaxation training control condition (RELAX). RESULTS: CBT produced significant clinical change. At the end of the behavioural treatments, there were no significant differences across the three groups on abstinence (66% in B-ERP, 45% in P-ERP and 47% in RELAX), or frequency of bingeing and purging. B-ERP, but not P-ERP, significantly reduced anxiety on the cue reactivity assessment, food restriction, body dissatisfaction and depression. These differences were not maintained at 6-month follow-up. At 12-months, B-ERP was independently associated with lower food restriction and better global functioning. CONCLUSIONS: CBT is a highly effective treatment for bulimia nervosa. B-ERP was modestly superior to P-ERP at post-treatment; however, the advantage did not remain throughout the follow-up interval. ERP for bulimia nervosa is an expensive and logistically complicated treatment that does not appear to offer any significant additive benefits that are proportional to the amount of effort required to implement the treatment.