A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others.

In a randomized clinical trial, 90 concerned significant others (CSOs) of treatment-refusing illicit drug users were assigned to either (a) community reinforcement and family training (CRAFT), which teaches behavior change skills; (b) CRAFT with additional group aftercare sessions after the completion of the individual sessions; or (c) Al-Anon and Nar-Anon facilitation therapy (Al-Nar FT). All protocols received 12 hr of manual-guided individual treatment, Follow-up rates for the CSOs were consistently at least 96%. The CRAFT conditions were significantly more effective than Al-Nar FT in engaging initially unmotivated drug users into treatment. CRAFT alone engaged 58.6%, CRAFT + aftercare engaged 76.7%, and Al-Nar FT engaged 29.0%. No CSO engaged a treatment-refusing loved one once individual sessions had been completed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims.

Ninety-six female assault victims with chronic posttraumatic stress disorder (PTSD) were randomly assigned to 4 treatment conditions: prolonged exposure (PE), stress inoculation training (SIT), combined treatment (PE-SIT), or wait-list control (WL). Treatment consisted of 9 twice-weekly, individual sessions. Independent evaluations were conducted at pretreatment; posttreatment; and 3-, 6-, and 12-month follow-ups. All 3 active treatments reduced severity of PTSD and depression compared with WL but did not differ significantly from each other, and these gains were maintained throughout the follow-up period. However, in the intent-to-treat sample, PE was superior to SIT and PE-SIT on posttreatment anxiety and global social adjustment at follow-up and had larger effect sizes on PTSD severity, depression, and anxiety. SIT and PE-SIT did not differ significantly from each other on any outcome measure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

State and trait anxiety, coping styles and depression among psychiatric inpatients.

Examined relationships among state and trait anxiety, coping styles, and depression in 17 male and 26 female adult psychiatric inpatients. Ss completed measures of state and trait anxiety, situation perception, depression and coping styles (Multidimensional Anxiety Scales, Multidimensional Coping Inventory, and Beck Depression Inventory) at 2 times (approximately 2 days after admission to the hospital and approximately 4 days after the 1st test administration). Results reveal significant positive correlations between level of depressive symptomatology and both state and trait anxiety. Emotion-oriented coping was positively correlated with depression, whereas task-oriented coping was negatively correlated with depression. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use after residential treatment among individuals with co-occurring disorders: The role of anxiety/depressive symptoms and trauma exposure.

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relaxation and cognitive treatments of anger.

60 undergraduates, selected on the basis of scores on the Trait form of the State-Trait Anger Scale, participated in cognitive and relaxation coping skill interventions for anger reduction or in a no-treatment control. Ss also completed measures such as the State form of the State-Trait Anxiety Inventory and the Beck Depression Inventory. By 4-wk follow-up, cognitive and relaxation groups reported significantly less general anger, physical symptoms of anger, daily ratings of anger, and less state anger and tendency to cope with verbal antagonism in response to imaginal provocations than did controls and did not differ from one another. Constructive coping in the imaginal provocations and trait anxiety showed the cognitive condition improved relative to the control, whereas the relaxation group did not differ significantly from other groups. No between-groups differences were found for personal anger situations, depression, or heart rate and coping via physical antagonism in response to provocations. One-year follow-up revealed maintenance of patterns for general anger and anxiety reduction. Results are discussed in terms of the value of applied relaxation for anger reduction. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder.

With a randomized group design, a 12-session anger treatment was evaluated with severely angry Vietnam War veterans suffering combat-related posttraumatic stress disorder (PTSD). Eight participants in anger treatment and 7 in a routine clinical care control condition completed multiple measures of anger control, anger reaction, and anger disposition, as well as measures of anxiety, depression, and PTSD at pre- and posttreatment. Controlling for pretreatment scores, significant effects were found on anger reaction and anger control measures but not on anger disposition or physiological measures. Eighteen-month follow-up (for both completers and dropouts) supported the posttreatment anger control findings. The challenges of treatment research with this refractory population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger style, psychopathology, and regional brain activity.

Depression and anxiety often involve high levels of trait anger and disturbances in anger expression. Reported anger experience and outward anger expression have recently been associated with left-biased asymmetry of frontal cortical activity, assumed to reflect approach motivation. However, different styles of anger expression could presumably involve different brain mechanisms and/or interact with psychopathology to produce various patterns of brain asymmetry. The present study explored these issues by comparing resting regional electroencephalographic activity in participants high in trait anger who differed in anger expression style (high anger-in, high anger-out, both) and participants low in trait anger, with depression and anxiety systematically assessed. Trait anger, not anger-in or anger-out, predicted left-biased asymmetry at medial frontal EEG sites. The anger-in group reported higher levels of anxious apprehension than did the anger-out group. Furthermore, anxious apprehension moderated the relationship between trait anger, anger-in, and asymmetry in favor of the left hemisphere. Results suggest that motivational direction is not always the driving force behind the relationship of anger and left frontal asymmetry. Findings also support a distinction between anxious apprehension and anxious arousal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance-dependent, conduct-disordered adolescent males: severity of diagnosis predicts 2-year outcome

Most delinquent youths have conduct disorder (CD), often with comorbid substance use disorder (SUD), attention-deficit/hyperactivity disorder (ADHD) and depression. Some youths' conduct problems later abate, while those of others persist into adult antisocial personality disorder. Earlier CD onset and ADHD reportedly predict persisting antisocial problems, but predictors of persisting SUD are poorly understood. Males aged 13-19 years (n = 89), most referred by criminal justice and social service agencies, received residential treatment for comorbid CD and SUD. They had diagnostic assessments for SUD at intake and for CD, ADHD, and depression (as well as drug-use assessments) at intake and 6, 12 and 24 months later. At intake nearly all had DSM-III-R substance dependence (usually on alcohol and marijuana) and CD with considerable violence and criminality. The 2-year follow-ups revealed improvements in criminality, CD, depression and ADHD, but substance use remained largely unchanged. Various aspects of conduct, crime and substance outcomes at 2 years were predicted by intake measures of intensity of substance involvement, and by CD severity and onset age, but not by severity of either ADHD or depression, nor by treatment duration. Earlier CD onset, more severe CD and more drug dependence predicted worse outcomes, supporting the validity of these diagnoses in adolescents.     

A multisite randomized effectiveness trial of motivational enhancement therapy for Spanish-speaking substance users.

Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition × Time interactions nor Site × Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger, impulsivity, and anger control in combat-related posttraumatic stress disorder.

Examined the association of combat-related posttraumatic stress disorder (PTSD) with anger. 24 veterans of the Vietnam War with PTSD scored significantly higher on an Anger factor comprising multiple measures of anger than did comparison groups of 23 well-adjusted Vietnam combat veterans and 12 noncombat Vietnam-era veterans with psychiatric diagnoses. In contrast, the 3 groups did not differ significantly on orthogonal factors, one of which comprised cognitive impulsivity measures and the other of which reflected motor impulsivity. Changes in heart rate in response to provocation loaded positively on the Anger factor and negatively on the 2 Impulsivity factors. Concurrent depression and trait anxiety did not have an effect on level of anger in individuals with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: A randomized clinical trial.

Purpose: To compare coping effectiveness training (CET) with supportive group therapy (SGT) for anxiety, depression, and adjustment to injury in an acute spinal cord injury/dysfunction (SCI/D) rehabilitation population. CET was shown to result in decreased anxiety and depression symptoms when compared to historical no-treatment control groups (Kennedy, Duff, Evans, & Beedie, 2003; King & Kennedy, 1999). The present study sought to extend those findings with a comparison of CET to an alternative active therapy condition, SGT. Research Method: Participants (N = 40) entering a hospital-based program were assigned to treatment condition using block randomization. Questionnaire mood measures were completed at program admission, program discharge, and 3-month postdischarge follow-up. Adjustment to disability was assessed at follow-up only. Analyses of variance tested for group differences in anxiety, depression, and adjustment to injury. Results: Both groups reported reductions in mood symptoms with no differences between treatment conditions. However, similar reductions were obtained after fewer sessions of CET. Symptoms of depression increased in both groups following hospital discharge. Conclusions: Clinical and research implications, including innovative interventions during the period after discharge, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships between depressive rumination, anger rumination, and borderline personality features.

We examined relationships between depressive rumination, anger rumination, and features of borderline personality disorder in a sample of 93 students with a wide range of borderline symptoms. All completed self-report measures of borderline features; trait-level negative affect; depressive and anger rumination; and current symptoms of depression, anxiety, and stress. Depressive and anger rumination were strongly associated with borderline features after controlling for comorbid symptoms of depression, anxiety, and stress. Both types of rumination showed significant incremental validity over trait-level sadness, anger, and general negative affect in predicting borderline features. Relationships with borderline features were stronger for anger rumination than for depressive rumination. Relationships between trait-level negative affect and borderline features were substantially reduced when anger rumination was included in regression models, suggesting the need for longitudinal analyses of mediation. Findings suggest that severity of borderline symptoms is influenced by ruminative thinking in response to negative affect, especially anger. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Treating intimate partner violence among substance-abusing dyads: The effect of couples therapy.

This study examined whether participation in couples therapy, compared with individual therapy, had a differential effect on the day-to-day relationship between substance use and occurrences of intimate partner violence (IPV) among married or cohabiting substance-abusing men. Patients (N = 207) were randomly assigned to either partner-involved behavioral couples therapy (BCT; included non-substance-abusing female partners in conjoint sessions) or individual-based treatment (IBT; male partners only). Couples in BCT reported lower levels of IPV and substance use at a 12-month posttreatment follow-up compared with couples with male partners in IBT. Moreover, treatment assignment was a significant moderator of the day-to-day relationship between substance use and IPV. Likelihood of nonsevere and severe male-to-female partner violence on days of male partners’ substance use was lower among couples who received BCT compared with IBT. These findings indicate couples therapy may play an important role in the treatment of IPV among substance-abusing couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of forgiveness therapy on depression, anxiety, and posttraumatic stress for women after spousal emotional abuse.

Emotionally abused women experience negative psychological outcomes long after the abusive spousal relationship has ended. This study compares forgiveness therapy (FT) with an alternative treatment (AT; anger validation, assertiveness, interpersonal skill building) for emotionally abused women who had been permanently separated for 2 or more years (M = 5.00 years, SD = 2.61; n = 10 per group). Participants, who were matched, yoked, and randomized to treatment group, met individually with the intervener. Mean intervention time was 7.95 months (SD = 2.61). The relative efficacy of FT and AT was assessed at p     

Anger reduction in early adolescents.

High-anger 6–8th graders received cognitive-relaxation coping skills (CRCS), social skills training (SST), or no treatment. Compared to the control, CRCS and SST were equally effective in reducing trait, general, and personal–situational anger and outward negative anger expression, as well as increasing controlled anger expression. On other variables, however, CRCS showed some superiority. Although both interventions led to equivalent reductions on one measure of anxiety, CRCS lowered depression, shyness, general deviance, and another measure of anxiety, whereas SST did not and was not significantly different from other groups. CRCS lowered school deviance more than SST. No between-group differences were found on self-esteem, alcohol consumption, or intoxication. Possible explanations of these findings were discussed, along with methodological issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative affect and interpersonal rejection among prison inmates in a therapeutic community: A social relations analysis.

The authors used D. A. Kenny's (1994a) social relations model to examine J. C. Coyne's (1976b) interpersonal theory of depression among a clinical sample of well-acquainted prison inmates. Members of 12 therapy groups (N/&=/&142) diagnosed with a substance abuse disorder completed a self-report measure of depression and anxiety and indicated their desire to interact with other group members. There was both consensus about which group members were rejected and individual differences in the participants' reported desire for future interaction with other group members. Those reporting high levels of depressive negative affect were most likely to be rejected. Those lowest in positive affect indicated the least desire for future interaction with others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An innovative approach to short-term group cognitive therapy in the combined treatment of anxiety and depression.

Twenty-six adult outpatients completed a 12-session group cognitive therapy program specifically designed to conjointly treat individuals with comorbid depressive and anxiety symptoms. The program takes a content specificity approach, differentially treating depression and anxiety from a cognitive therapy perspective. Participants showed significant improvement on measures of depression, anxiety, and dysfunctional attitudes from pre- to posttest. Findings suggest clinical and practical utility for this intervention and support the use of combination therapeutics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral group therapy for panic disorder in the general clinical setting: a naturalistic study with 1-year follow-up

BACKGROUND: Cognitive-behavioral therapy (CBT) is well documented in the treatment of panic disorder. As most investigators have studied selected patients without comorbid disorders, it is less clear how well the treatment will perform in the usual clinical setting for patients with comorbid disorders and with physicians who do not have training in CBT. During the last 6 years, we have offered CBT in outpatient groups for patients with panic disorder and agoraphobia. The purpose of this prospective study was to assess the outcome of group treatment and compare the results with those of studies that used individual treatment. We wanted to identify variables that might predict outcome at follow-up and to assess the number and characteristics of dropouts. METHOD: Eighty-three consecutive patients with DSM-III-R panic disorder (56 women and 27 men; mean age = 34.5 years) were studied. Mean duration of panic disorder was 7.5 years. There was a high degree of comorbid major depression, social phobia, and psychoactive substance abuse/dependence. Treatment consisted of 4-hour group sessions conducted once a week for 11 weeks. More than half of the patients used antidepressant drugs. Degree of phobic avoidance, bodily sensations, anxiety cognitions, and depression were assessed at pretreatment, baseline, and end of treatment and at follow-up after 3 and 12 months. RESULTS: There was a large decrease in scores from start to end on all assessments. Sixty-three (89%) of 73 completers responded (> or = 50% reduction in Phobic Avoidance Rating Scale scores). Gains were maintained and even improved upon at follow-up. The results are comparable with studies that used individual therapy. A high depression score at the end of treatment predicted poor outcome at 1-year follow-up. Twelve (14%) of 83 did not complete the program. The presence of severe personality disorders and ongoing alcohol or substance abuse or dependence was associated with poor outcome and high dropout rate. CONCLUSION: CBT appears to be effective in the usual clinical setting, even in the hands of therapists without formal competence. Group therapy is a feasible arrangement, and the results from group treatment are comparable to those of individual approaches. Precise diagnosis and treatment of comorbid depression are of utmost importance. Patients with additional substance abuse or dependence, as well as severe personality disorders, may find this treatment modality less helpful.     

The impact of continuing care adherence on environmental risks, substance use, and substance-related problems following adolescent residential treatment.

The effectiveness of adolescent treatment to reduce substance use has been demonstrated by a number of different literature reviews, yet longer term outcome studies have suggested that continued alcohol and other drug use is common. Participation in continuing care services and reductions in environmental risk factors (e.g., peer substance use or alcohol or drug use in the home) have both been found to be associated with improved posttreatment substance use. The authors conducted Path analysis to examine the experimental direct effect of the Assertive Continuing Care Protocol (S. H. Godley, M. D. Godley, & M. L. Dennis, 2001) on general continuing care adherence following residential treatment and the protocol's indirect effect (via general continuing care adherence) on social and environmental risk factors, as well as subsequent substance use and substance-related problems. Supporting previous findings, the final model indicates that greater adherence to continuing care is associated with reductions in environmental risk, which in turn is associated with reduced adolescent substance use and substance-related problems 9 months after discharge from residential treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Meta-Analysis of Massage Therapy Research.

Massage therapy (MT) is an ancient form of treatment that is now gaining popularity as part of the complementary and alternative medical therapy movement. A meta-analysis was conducted of studies that used random assignment to test the effectiveness of MT. Mean effect sizes were calculated from 37 studies for 9 dependent variables. Single applications of MT reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were MT's largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy. No moderators were statistically significant, though continued testing is needed. The limitations of a medical model of MT are discussed, and it is proposed that new MT theories and research use a psychotherapy perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)