An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury.

Study Design: Systematic review. Objective: To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI). Method: Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO) were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and nonrandomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping, and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible. Results: Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment, and coping. Conclusions: CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment, and coping problems. As CBT may involve many different components, it is important in the future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The YouthMood Project: A cluster randomized controlled trial of an online cognitive behavioral program with adolescents.

The aim in the current study was to investigate the effectiveness of an online, self-directed cognitive–behavioral therapy program (MoodGYM) in preventing and reducing the symptoms of anxiety and depression in an adolescent school-based population. A cluster randomized controlled trial was conducted with 30 schools (N = 1,477) from across Australia, with each school randomly allocated to the intervention or wait-list control condition. At postintervention and 6-month follow-up, participants in the intervention condition had significantly lower levels of anxiety than did participants in the wait-list control condition (Cohen’s d = 0.15–0.25). The effects of the MoodGYM program on depressive symptoms were less strong, with only male participants in the intervention condition exhibiting significant reductions in depressive symptoms at postintervention and 6-month follow-up (Cohen’s d = 0.27–0.43). Although small to moderate, the effects obtained in the current study provide support for the utility of universal prevention programs in schools. The effectiveness of booster sessions should be explored in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resilience in the face of coping with a severe physical injury: A study of trajectories of adjustment in a rehabilitation setting.

Objective: Despite the popularity of the concept of resilience, little research has been conducted on populations in physical rehabilitation settings. Our purpose was to identify three trajectories of psychological adjustment to an acquired severe physical injury characterized by resilience, recovery, or distress in a longitudinal design. Participants: Eighty inpatients with a severe injury at a rehabilitation hospital. The participants had spinal cord injury or multiple traumas. Design: Classification into the three trajectories was based on symptoms of psychological distress (posttraumatic stress disorder, depression, anxiety, and negative affect) and participants’ level of positive affect at admission to and discharge from the rehabilitation hospital. Results: The most common trajectory was the resilience trajectory (54%), followed by the recovery trajectory (25%) and the distress trajectory (21%). The most interesting differences between the trajectories were the result of optimism, affect, social support, and pain. Trait negative and positive affect predicted classification into the trajectories. Conclusions: An adaptation pattern characterized by resilience was found to be the most common response to an acquired severe injury, and trait affect predicts the outcome pattern. Interventions based on resilience are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review.

Objective: Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples. Method: We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. Results: Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges’s g = 0.63) and mood symptoms (Hedges’s g = 0.59) from pre- to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges’s g) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up. Conclusions: These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse prevention program for treatment of obsessive-compulsive disorder.

18 participants with obsessive-compulsive disorder received 3 wks of intensive treatment by exposure and response prevention, which were followed by either a relapse prevention (RP) program or associative therapy (AT; an attention-control program). Independent evaluators conducted assessments of obsessive-compulsive symptoms, anxiety, and depression, before and after intensive behavior therapy, after the week of intensive RP or AT and at a 6-mo follow-up. Results indicated that the RP program was effective in preventing relapse: Both treatment groups improved immediately after the intensive treatment, but the RP group remained improved at follow-up, whereas the AT group showed some return of symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resilience and indicators of adjustment during rehabilitation from a spinal cord injury.

Objectives: The purposes of this study were to (a) identify changes in resilience and indicators of adjustment (i.e., satisfaction with life, depressive symptomatology, spirituality, functional independence) during inpatient rehabilitation after spinal cord injury (SCI) and (b) examine the relationship between each variable at different stages of the rehabilitation process. Design: The sample consisted of 42 individuals with a SCI, including 33 men and 9 women who were inpatients for a mean stay of 51 days (SD = 14.63). A repeated measures design was employed, with questionnaires completed at 3 times during the rehabilitation program (admit, 3 weeks, and discharge). Results: Results from the repeated measures multivariate analysis of covariance and post hoc follow-up tests indicated that there was no significant change in resilience, but that there was significant change for each indicator of adjustment during inpatient rehabilitation. Findings also indicated significant correlations between resilience, satisfaction with life, spirituality, and depressive symptoms. Conclusion: Future studies that focus on developing interventions and examine the factors that predict resilience could help build resilience, which in turn may improve rehabilitation outcomes. (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)     

Negative mood, depressive symptoms, and major depression after smoking cessation treatment in smokers with a history of major depressive disorder.

Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological and physical benefits of circuit weight training in law enforcement personnel.

The effects of circuit weight training on mood, perceived stress, job satisfaction, and physical symptoms were investigated in a sample of state law enforcement officers. 43 male officers who were not regularly exercising were assigned to either 4 mo of circuit weight training or a wait-list control condition. Four months of circuit weight training led to a significant increase in strength on cardiovascular fitness. Ss also demonstrated significant improvements in mood, including decreases in somatization, anxiety, depression, and hostility. Circuit weight training also resulted in a decrease in reports of physical symptoms and in improvements in job satisfaction. Results indicate that Ss who dropped out of the exercise training program evidenced significantly greater anxiety, depression, and hostility at pretreatment than Ss who completed the program. These findings suggest that circuit weight training programs may contribute to important psychological benefits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy trial of a brief cognitive–behavioral depression prevention program for high-risk adolescents: Effects at 1- and 2-year follow-up.

Objective: To evaluate the effects of a brief group cognitive–behavioral (CB) depression prevention program for high-risk adolescents with elevated depressive symptoms at 1- and 2-year follow-up. Method: In this indicated prevention trial, 341 at-risk youths were randomized to a group CB intervention, group supportive expressive intervention, CB bibliotherapy, or educational brochure control condition. Results: Significantly greater reductions in depressive symptoms were shown by group CB participants relative to brochure control participants by 1-year follow-up and bibliotherapy participants by 1- and 2-year follow-up but not relative to supportive expressive participants. Supportive expressive participants showed greater symptom reduction than CB bibliotherapy participants did at 2-year follow-up. Risk for onset of major or minor depression over the 2-year follow-up was significantly lower for group CB participants (14%; odds ratio = 2.2) and CB bibliotherapy participants (3%; odds ratio = 8.1) than for brochure controls (23%). Conclusions: Results indicate that this group CB intervention reduces initial symptoms and risk for future depressive episodes, although both supportive expressive therapy and CB bibliotherapy also produce intervention effects that persist long term. Indeed, CB bibliotherapy emerged as the least expensive method of reducing risk for future episodes of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School-based prevention of depression and anxiety symptoms in early adolescence: A pilot of a parent intervention component.

Previous studies suggest that school-based cognitive-behavioral interventions can reduce and prevent depressive symptoms in youth. This pilot study investigated the effectiveness of a cognitive-behavioral depression prevention program, the Penn Resiliency Program for Children and Adolescents (the PRP-CA), when combined with a parent intervention component. Forty-four middle school students and their parents were randomly assigned to the enhanced PRP (the PRP-CA plus parent program) or control conditions. Students completed measures of depression and anxiety symptoms at baseline and 2 weeks, 6 months, and 1 year after the intervention ended. The combined version of the PRP significantly reduced symptoms of depression and anxiety during the follow-up period. Children assigned to the intervention condition were less likely than controls to report clinical levels of anxiety symptoms. Findings suggest that school-based cognitive-behavioral interventions that include parents may prevent depression and anxiety symptoms in early adolescence. (PsycINFO Database Record (c) 2011 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)     

Early longitudinal course of acute-chronic and paranoid-undifferentiated schizophrenia subtypes and schizophreniform disorder.

This prospective longitudinal study examined symptoms and adjustment at 2 and 4 yrs posthospital discharge in Research Diagnostic Criteria (RDC) and Diagnostic and Statistical Manual of Mental Disorders (DSM-III) schizophrenia subtypes and in DSM-III schizophreniform disorder. Delusions, hallucinations, thought disorder, anxiety, depression, and specific areas of community adjustment were assessed at each follow-up. RDC acute and subacute schizophrenia and DSM-III schizophreniform disorder were associated with more satisfactory overall adjustment and lower frequencies of psychotic symptoms over time. No significant differences in the course of symptoms or adjustment were found between paranoid and undifferentiated schizophrenia subtypes. Schizophrenia subtyping schemes, based on length of illness features, appear more prognostically viable than do symptom-based approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving the quality of life of caregivers of persons with spinal cord injury: A randomized controlled trial.

Objective: To assess the efficacy of two psychosocial interventions for caregivers of older persons with spinal cord injury (SCI). Design: A multisite, three-group, randomized controlled trial comparing two active intervention conditions with each other and to an information-only control group. One hundred seventy-three caregiver and care-recipient dyads were randomly assigned to one of three conditions: a caregiver-only treatment condition in which caregivers received a multicomponent intervention based on their risk profile; a dual-target condition in which the caregiver intervention was complemented by a treatment targeting the care recipient, designed to address both caregiver and care recipient risk factors; and an information-only control condition in which the caregiver received standard printed information about caregiving, SCI, and aging. Outcome Measures: A multivariate outcome comprised of six indicators linked to the goals of the interventions was the primary outcome of the study. The multivariate outcome included measures of depressive symptoms, burden, social support and integration, self-care problems, and physical health symptoms. Results: At 12 months, caregivers in the dual-target condition had improved quality of life as measured by our multivariate outcome when compared to the control condition. Using the dyad as the unit of analysis, the dual-target condition was superior to both the control condition and the caregiver-only condition in our multivariate outcomes analysis. Dyads enrolled in the dual-target condition had significantly fewer health symptoms than control condition and caregiver-only condition participants and were less depressed when compared to participants in the caregiver-only condition. In follow-up analyses we found that a higher proportion of caregivers in the dual-target condition had clinically significant improvements in depression, burden, and health symptoms when compared with the caregiver-only condition. Conclusion: Caregivers are in need of and can benefit from interventions that help them manage the medical and functional limitations of the care recipient. Intervention strategies that target both the caregiver and care recipient are particularly promising strategies for improving the quality of life of caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The symptom perception hypothesis revised: Depression and anxiety play different roles in concurrent and retrospective physical symptom reporting.

According to the classic symptom perception hypothesis (Costa & McCrae, 1987; Watson & Pennebaker, 1989), the global predisposition to frequently experience a variety of negative emotions—that is, neuroticism (N) or trait negative affectivity (NA)—is associated with inflated physical symptom reporting. We tested a revision of this hypothesis, which posits distinctive roles for depression and anxiety in the physical symptom experience. Three studies tested predictions from the revised symptom perception hypothesis: (a) that depressive affect should be related to inflated retrospective physical symptom reports and (b) that anxious affect should be related to inflated concurrent, or momentary, physical symptom reports. Study 1 assessed the relations among N/NA, depressive affect, and recall of physical symptoms experienced in the previous 3 weeks. Depressive affect was uniquely and positively associated with recalling more symptoms. When entered with depressive affect in multiple regression analyses, neuroticism was not associated with level of symptoms recalled. In Study 2, participants were randomly assigned to anxious, depressed, angry, happy, or neutral mood inductions and then reported about concurrent symptom experience. Participants in the anxious mood condition reported significantly more concurrent physical symptoms than did those in the other 4 conditions. In Study 3, anxious, depressed, or neutral mood was induced, followed by assessment of both concurrent and retrospective physical symptoms. Those assigned to the anxious mood induction reported more concurrent symptoms, while those in the depressed mood condition reported having experienced more symptoms in the past. These findings are consistent with the idea that encoding and retrieval processes, which are differentially associated with anxious versus depressed affect, influence different aspects of physical symptom reporting. The results have implications for self-diagnosis, medical treatment-seeking, and care, and potential insights about other complex social and interpersonal behaviors are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting employment status at 2 years' postdischarge from spinal cord injury rehabilitation.

Objectives: This exploratory study examined the extent to which postinjury employment was predictable when patients were followed up 2 years' postdischarge from a specialist Spinal Cord Injury (SCI) Unit. Participants and Design: Seventy-two individuals with SCI for whom there were discharge Functional Independence Measure (FIM) scores, 60 complete sets of data were available for Discriminant Function Analysis. Results: Using a combination of variables assessed prior to or shortly after discharge from rehabilitation, complemented by psychosocial variables assessed at the time of follow-up, moderate classification accuracy was achieved with respect to employment status at the 2-year follow-up period (72%), with the set of predictor variables being more accurate at predicting those subsequently in paid employment (83%) than those not (67%). Conclusions: The main implication of the study results is that nontraditional variables (i.e., variables other than injury and demographic variables), including, particularly, contextual environmental variables such as community integration, access to transport, and social support, are worthy of further research, especially because many of these are amenable to rehabilitation program interventions, and thus may facilitate the attainment of enhanced rates of postdischarge employment among those living with SCI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A preliminary study of partial hospital management of severe obsessive-compulsive disorder

OBJECTIVE: The study examined the effectiveness of a partial hospital treatment program combining behavioral therapy, medication, and psychosocial intervention for severe and treatment-resistant obsessive-compulsive disorder. METHODS: A total of 58 patients with a primary diagnosis of obsessive-compulsive disorder who underwent treatment in a partial hospital program were assessed at baseline, at program discharge, and at six-, 12-, and 18-month follow-ups. Obsessive-compulsive symptoms, depression, anxiety symptoms, and global functioning were rated. RESULTS: The majority of patients (71 percent) met the criterion for a successful outcome, which was a 25 percent decrease in score on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Fifty-five percent finished the program with YBOCS scores of 16 or less, indicating only mild symptoms. Most of these patients sustained their improvement at six, 12, and 18 months after discharge, and many showed further improvement with continued outpatient management. CONCLUSIONS: The partial hospital treatment program for obsessive-compulsive disorder appears to be an effective intervention that should be implemented and investigated further.     

Why are depression and anxiety correlated? A test of the tripartite model.

L. A. Clark and D. Watson's (1991) tripartite model groups the symptoms of depression and anxiety into 3 components: nonspecific symptoms of general distress, which do not distinguish depression and anxiety; physiologic arousal, which is relatively unique to anxiety; and anhedonia (or low positive affect), which is unique to depression. Structural equation modeling was used to test this model with self-report data from 3 different samples: outpatients seeking treatment for mood disorder, anxiety disorder, or both (n?=?483), outpatients seeking treatment for substance abuse (n?=?453), and college students (n?=?516). The tripartite model did not fit any of the sample covariance matrices, because the nonspecific symptoms of depression and anxiety could not be adequately represented by a single General Distress factor. An alternative model, in which the Anhedonia and Nonspecific Depression factors loaded on a second-order Depression factor, while the Somatic Arousal and Nonspecific Anxiety factors loaded on a second-order Anxiety factors produced an excellent fit in all the groups. The Nonspecific Depression and Nonspecific Anxiety factors were the most valid and specific indicators of depression and anxiety, respectively. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relevance of aquatic biodegradation tests for predicting degradation of polymeric materials during biological solid waste treatment

L. A. Clark and D. Watson's (1991) tripartite model groups the symptoms of depression and anxiety into 3 components: nonspecific symptoms of general distress, which do not distinguish depression and anxiety; physiologic arousal, which is relatively unique to anxiety; and anhedonia (or low positive affect), which is unique to depression. Structural equation modeling was used to test this model with self-report data from 3 different samples: outpatients seeking treatment for mood disorder, anxiety disorder, or both (n = 483) outpatients seeking treatment for substance abuse (n = 453), and college students (n = 516). The tripartite model did not fit any of the sample covariance matrices, because the nonspecific symptoms of depression and anxiety could not be adequately represented by a single General Distress factor. An alternative model, in which the Anhedonia and Nonspecific Depression factors loaded on a second-order Depression factor, while the Somatic Arousal and Nonspecific Anxiety factors loaded on a second-order Anxiety factor, produced an excellent fit in all the groups. The Nonspecific Depression and Nonspecific Anxiety factors were the most valid and specific indicators of depression and anxiety, respectively. Anhedonia and Somatic Arousal were significantly less valid measures of depression and anxiety. The implications of these findings are discussed.     

An online family intervention to reduce parental distress following pediatric brain injury.

This study examined whether an online problem-solving intervention could improve parental adjustment following pediatric traumatic brain injury (TBI). Families of children with moderate-to-severe TBI were recruited from the trauma registry of a large children's hospital and randomly assigned to receive online family problem solving therapy (FPS; n = 20) or Internet resources (IRC; n = 20) in addition to usual care. The FPS group reported significantly less global distress, depressive symptoms, and anxiety at follow-up than did the IRC group after controlling for baseline symptoms. The FPS group also reported significant improvements in problem-solving skills, although the groups did not differ significantly at follow-up. Findings suggest that an online, skill-building approach can be effective in facilitating parental adaptation after TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)