Journal of Consulting and Clinical Psychology - Vol 76, Iss 5

Diagnostic agreement predicts treatment process and outcomes in youth mental health clinics.

Jensen-Doss, Amanda; Weisz, John R. — 2008

Several studies have documented low rates of agreement between clinician- and researcher-generated diagnoses. However, little is known about whether this lack of agreement has implications for the processes and outcomes of subsequent treatment. To study this possibility, the authors used diagnostic agreement to predict therapy engagement and outcomes for 197 youths treated in 5 community mental health clinics. Diagnostic agreement predicted better therapy engagement, with the agree group having fewer therapy no-shows and cancellations and a decreased likelihood of therapy dropout. Additionally, support for a link between agreement and treatment outcomes was found, as the agree group obtained larger reductions in parent-reported internalizing problems during treatment. These findings suggest that diagnostic accuracy may be an important precursor to successful treatment and highlight the importance of future research to find ways to incorporate standardized diagnostic procedures into clinical care settings. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Does marriage and relationship education work? A meta-analytic study.

2008

In this meta-analytic study, the authors examined the efficacy of marriage and relationship education (MRE) on 2 common outcomes: relationship quality and communication skills. A thorough search produced 86 codable reports that yielded 117 studies and more than 500 effect sizes. The effect sizes for relationship quality for experimental studies ranged from d = .30 to .36, while the communication skills effect sizes ranged from d = .43 to .45. Quasi-experimental studies generated smaller effect sizes, but these appeared to be due to pretest group differences. Moderate-dosage programs produced larger effect sizes than did low-dosage programs. For communication skills, published studies had larger effects than those of unpublished studies at follow-up; there were no publication differences for relationship quality. There was no evidence of a gender difference. Unfortunately, a lack of racial/ethnic and economic diversity in the samples prevented reliable conclusions about the effectiveness of MRE for disadvantaged couples, a crucial deficit in the body of research. In addition, intervention outcomes important to policy makers, such as relationship stability and aggression, rarely have been addressed. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Rate and predictors of divorce among parents of youths with ADHD.

2008

Numerous studies have asserted the prevalence of marital conflict among families of children with attention-deficit/hyperactivity disorder (ADHD), but evidence is surprisingly less convincing regarding whether parents of youths with ADHD are more at risk for divorce than are parents of children without ADHD. Using survival analyses, the authors compared the rate of marital dissolution between parents of adolescents and young adults with and without ADHD. Results indicated that parents of youths diagnosed with ADHD in childhood (n = 282) were more likely to divorce and had a shorter latency to divorce compared with parents of children without ADHD (n = 206). Among a subset of those families of youths with ADHD, prospective analyses indicated that maternal and paternal education level; paternal antisocial behavior; and child age, race/ethnicity, and oppositional-defiant/conduct problems each uniquely predicted the timing of divorce between parents of youths with ADHD. These data underscore how parent and child variables likely interact to exacerbate marital discord and, ultimately, dissolution among families of children diagnosed with ADHD. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Is marital discord taxonic and can taxonic status be assessed reliably? Results from a national, representative sample of married couples.

Whisman, Mark A.; Beach, Steven R. H.; Snyder, Douglas K. — 2008

Addressing potential weaknesses in an earlier investigation, the authors examined the latent structure of marital discord using 4 product indicators from the Marital Satisfaction Inventory-Revised (Snyder, 1997) in a representative sample of community couples (N = 1,020). Results from 3 taxometric procedures suggested that marital discord is taxonic, with an estimated base rate of .31. Cut scores for classifying members of this marital discord taxon were identified. Additional analyses with several data sets of community and clinic couples provided evidence that the marital discord taxon classification demonstrated good (a) 6-week test-retest reliability, (b) criterion validity (i.e., differences in taxon prevalence in community vs. clinic couples), and (c) construct validity (i.e., correlations with therapist ratings of relationship quality). These results suggest that discordant couples differ qualitatively and not just quantitatively from nondiscordant couples and that user friendly methods, suitable for a range of research and clinical applications, can be used to identify marital discord. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Using a vulnerability-stress-adaptation framework to predict physical aggression trajectories in newlywed marriage.

Langer, Amie; Lawrence, Erika; Barry, Robin A. — 2008

The authors used a vulnerability-stress-adaptation framework to examine personality traits and chronic stress as predictors of the developmental course of physical aggression in the early years of marriage. Additionally, personality traits and physical aggression were examined as predictors of the developmental course of chronic stress. Data from 103 couples collected 4 times over the first 3 years of marriage were analyzed with an actor-partner interdependence model and structural equation modeling techniques. Personality traits of husbands predicted their own physical aggression and stress trajectories, as well as their wives' levels of stress and physical aggression. Personality traits of wives predicted their levels of stress and physical aggression and predicted changes in their physical aggression over time. Both husbands' and wives' changes in stress predicted changes in physical aggression over time. Implications for employment of a vulnerability-stress-adaptation model in the study of physical aggression and for improvement of the efficacy of therapies targeting physical aggression in intimate relationships are delineated. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Personality disorder symptoms and marital functioning.

South, Susan C.; Turkheimer, Eric; Oltmanns, Thomas F. — 2008

Pathological personality is strongly linked with interpersonal impairment, yet no study to date has examined the relationship between concurrent personality pathology and dysfunction in marriage--a relationship that most people find central to their lives. In a cross-sectional study of a community sample of married couples (N = 82), the authors used multilevel modeling to estimate the association of self- and spouse-reported symptoms of personality disorder (PD) with levels of marital satisfaction and verbal aggression and perpetration of physical violence. Inclusion of self- and spouse report of total PD symptoms resulted in improved model fit and greater variance explained, with much of the improvement coming after the addition of spouse report. The incremental validity of spouse report for several of the 10 PD scales was supported for marital satisfaction and verbal aggression, particularly for the Borderline and Dependent PD scales. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Prognostic significance of spouse we talk in couples coping with heart failure.

2008

Recent research suggests that marital quality predicts the survival of patients with heart failure (HF), and it is hypothesized that a communal orientation to coping marked by first-person plural pronoun use (we talk) may be a factor in this. During a home interview, 57 HF patients (46 men and 16 women) and their spouses discussed how they coped with the patients' health problems. Analysis of pronoun counts from both partners revealed that we talk by the spouse, but not the patient, independently predicted positive change in the patient's HF symptoms and general health over the next 6 months and did so better than direct self-report measures of marital quality and the communal coping construct. We talk by the patient and spouse did not correlate, however, and gender had no apparent moderating effects on how pronoun use predicted health change. The results highlight the utility of automatic text analysis in couple-interaction research and provide further evidence that looking beyond the patient can improve prediction of health outcomes. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Prospective associations between coping and health among youth with asthma.

Schreier, Hannah M. C.; Chen, Edith — 2008

The present study evaluated whether primary and secondary coping would predict longitudinal asthma-related clinical outcomes, such as peak expiratory flow rate (PEFR) and self-reported school absenteeism, rescue inhaler use, and asthma-related physician contacts, in youth with asthma. The 62 youth (68% males) had an average age of 12.6 ± 2.73 years and were primarily of European origin. Coping and asthma outcomes were obtained by youth self-report at baseline and over a 12-month follow-up period. Greater secondary coping at baseline was related to greater increases in PEFR and a greater likelihood of physician contact over the following year. Greater primary coping at baseline was related to greater likelihood of rescue inhaler use, school absenteeism, and physician contact over the following year. In contrast, asthma measures at baseline did not predict changes in coping over the following year. These patterns suggest that youth who engage in secondary coping accept and adapt to their asthma in ways that improve pulmonary function over time. Youth who engage in primary coping may be more likely to communicate asthma problems to others, and such communication perhaps leads to increases in behaviors meant to address these problems. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Vulnerability and resilience in women with arthritis: Test of a two-factor model.

Smith, Bruce W.; Zautra, Alex J. — 2008

The purpose of this study was to test a 2-factor model of affective health in women with rheumatoid arthritis (RA; n = 82) or osteoarthritis (OA; n = 88). Positive and negative social interactions and affect were assessed for 11 consecutive weeks. For each participant, Vulnerability and Resilience factors were created from factor analyses of positive and negative personal characteristics, respectively. Multilevel analyses tested the hypothesis that weekly changes in social interactions or affect would only be predicted by the factor of the same valence. The Vulnerability (and not the Resilience) factor predicted changes in negative interactions. The Resilience (and not the Vulnerability) factor predicted changes in positive interactions. The Vulnerability (and not the Resilience) factor predicted changes in current and next-week negative affect. The Resilience and Vulnerability factors each predicted changes in current and next-week positive affect, although the effects for Vulnerability were smaller than for Resilience. Finally, the Vulnerability factor interacted with pain to predict more future negative affect. The main implication is that both Vulnerability and Resilience should be considered in theory, research, and interventions. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Actual change and inaccurate recall contribute to posttraumatic growth following radiotherapy.

Ransom, Sean; Sheldon, Kennon M.; Jacobsen, Paul B. — 2008

People with cancer often report that they experience personal growth as a result of the disease, but such reports have unclear validity. Some suggest such growth results from Rogers's (1951) hypothesized organismic valuing process (OVP), an innate tendency for people to gravitate toward well-being; others suggest this growth may be a positive illusion resulting from temporal self-comparisons. To test these conceptualizations, the authors examined 83 individuals with Stages 0-III breast or prostate cancer. Patients completed measures of positive attributes and personal life goals before radiotherapy (Time 1) and after radiotherapy (Time 2). At Time 2, participants also attempted to recreate their Time 1 responses and completed a posttraumatic growth (PTG) measure. PTG was significantly related with actual increases (but not perceived increases) in the relative importance of intrinsic goals versus extrinsic goals and with perceived increases (but not actual increases) in positive attributes. These measures were unrelated to one another and thus explained unique variance in PTG. Data suggest that both actual change processes related to the OVP and biases in autobiographic recall may independently contribute to PTG reports. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Barriers to engagement in sleep restriction and stimulus control in chronic insomnia.

Vincent, Norah; Lewycky, Samantha; Finnegan, Heather — 2008

Sleep restriction (SRT) and stimulus control (SC) have been found to be effective interventions for chronic insomnia (Morgenthaler et al., 2006), and yet adherence to SRT and SC varies widely. The objective of this study was to investigate correlates to adherence to SC/SRT among 40 outpatients with primary or comorbid insomnia using a correlational design. Participants completed a self-report measure of sleepiness prior to completion of a 6-week cognitive behavioral treatment group for insomnia. At the posttreatment period, they rated their ability to engage in SC/SRT using a survey. Results from standard multiple regression analyses showed that perceiving fewer barriers (i.e., less boredom, annoyance) to engaging in SC/SRT and experiencing less pretreatment sleepiness were each associated with better adherence to SC/SRT. Adherence to SC/SRT was associated with outcome. Implications of these findings are that more work is needed to make SC/SRT less uncomfortable, possibly by augmenting energy levels prior to introducing these approaches. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Internalized heterosexism among HIV-positive, gay-identified men: Implications for HIV prevention and care.

Johnson, Mallory O.; Carrico, Adam W.; Chesney, Margaret A.; Morin, Stephen F. — 2008

Internalized heterosexism (IH), or the internalization of societal antihomosexual attitudes, has been consistently linked to depression and low self-esteem among gay men, and it has been inconclusively associated with substance use and sexual risk in gay and bisexual men. Using structural equation modeling, the authors tested a model framed in social action theory (C. K. Ewart, 1991, 2004) in which IH is associated with HIV transmission risk and poor adherence to HIV antiretroviral therapy (ART) through the mechanisms of negative affect and stimulant use. Data from a sample of 465 gay-identified men interviewed as part of an HIV risk reduction behavioral trial were used to test the fit of the model. Results support the hypothesized model in which IH was associated with unprotected receptive (but not insertive) anal intercourse with HIV-negative or unknown HIV status partners, and with ART nonadherence indirectly via increased negative affect and more regular stimulant use. The model accounted for 15% of the variance in unprotected receptive anal intercourse and 17% of the variance in ART nonadherence. Findings support the potential utility of addressing IH in HIV prevention and treatment with HIV-positive gay men. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Does precontemplation represent a homogeneous stage category? A latent class analysis on German smokers.

2008

The authors examined the subtype structure of smokers classified in the precontemplation stage of change within the transtheoretical model. From a general practice-based sample of 1,499 daily smoking patients from Germany (participation rate 80%), they used a subgroup of 929 smokers who were classified in the precontemplation stage and applied latent class analysis, using the pros and cons of nonsmoking and smoking cessation self-efficacy as the defining variables. Cross-sectional validation of the emerging classes was based on smoking behavior and processes of change variables. For longitudinal validation, generalized estimation equation analyses were used on motivational and abstinence criteria from 6-, 12-, 18-, and 24-month follow-ups. A 4-class model best represented the data. Three subtypes (labeled progressive, immotive, and disengaged pessimistic) were similar to clusters identified in U.S. studies. The 4th (disengaged optimistic), by contrast, was reminiscent of a type that had previously only emerged in a Dutch study. Cross-sectional and longitudinal validation results confirmed the distinctiveness and predictive power of the classes. The findings highlight the importance of tailoring interventions for smoking behavior change to the needs of different subgroups of precontemplating smokers. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Addressing heavy drinking in smoking cessation treatment: A randomized clinical trial.

2008

Heavy alcohol use frequently co-occurs with cigarette smoking and may impede smoking cessation. This clinical trial examined whether smoking cessation treatment that incorporates brief alcohol intervention can improve smoking cessation outcomes (7-day verified point prevalence abstinence) and reduce drinks consumed per week. Heavy drinkers seeking smoking cessation treatment were assigned by urn randomization to receive, along with 8 weeks of nicotine replacement therapy, either a 4-session standard smoking cessation treatment (ST, n = 119) or standard treatment of equal intensity that incorporated brief alcohol intervention (ST-BI, n = 117). Across follow-ups over 26 weeks, participants in ST-BI reported approximately 20% fewer drinks per week (p < .027) and greater smoking abstinence (adjusted odds ratio = 1.56; 95% confidence interval = 1.01, 2.43) than did those in ST; however, effects on smoking were primarily evident at 2 weeks after quit date and were essentially absent by 16 weeks. The effect of ST-BI on smoking outcome was most robust among moderately heavy drinkers compared with that on very heavy drinkers. Integrating brief alcohol intervention into smoking cessation treatment appears feasible, but further development is needed to yield lasting effects on smoking. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs.

Park, Crystal L.; Edmondson, Donald; Fenster, Juliane R.; Blank, Thomas O. — 2008

Cancer survivors' efforts at meaning making may influence the extent to which they successfully make meaning from their experience (i.e., experience posttraumatic growth, find life meaningful, and restore beliefs in a just world), which may, in turn, influence their psychological adjustment. Previous research regarding both meaning making processes and meanings made as determinants of adjustment has shown inconsistent effects, partly because of the lack of clearly articulated theoretical frameworks and problematic research strategies. In a 1-year longitudinal study, the authors distinguished the meaning making process from the outcomes of that process (meanings made), employing specific measures of both. The authors tested pathways through which meaning making efforts led to 3 different meanings made (growth, life meaning, and restored just-world belief) in a sample of 172 young to middle-age adult cancer survivors, and they explored whether those meanings made mediated the effect of meaning making efforts on psychological adjustment. Cross-sectional and longitudinal path models of the meaning making process indicate that meaning making efforts are related to better adjustment through the successful creation of adaptive meanings made from the cancer experience. The authors conclude with clinical implications and suggestions for future research. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Cognitive-behavioral therapy for intermittent explosive disorder: A pilot randomized clinical trial.

2008

No randomized clinical trials have evaluated the efficacy of psychotherapy for intermittent explosive disorder (IED). In the present study, the authors tested the efficacy of 12-week group and individual cognitive-behavioral therapies (adapted from J. L. Deffenbacher & M. McKay, 2000) by comparing them with a wait-list control in a randomized clinical trial among adults with IED (N = 45). Aggression, anger, and associated symptoms were assessed at baseline, midtreatment, posttreatment, and 3-month follow-up. Group and individual cognitive-behavioral therapy tended not to differ, with each reducing aggression, anger, hostile thinking, and depressive symptoms, while improving anger control relative to wait-list participants. Posttreatment effect sizes were large. These effects were maintained at 3-month follow-up. Findings provide initial support for the use of multicomponent cognitive-behavioral therapy in the treatment of IED. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Are body dissatisfaction, eating disturbance, and body mass index predictors of suicidal behavior in adolescents? A longitudinal study.

Crow, Scott; Eisenberg, Marla E.; Story, Mary; Neumark-Sztainer, Dianne — 2008

Disordered eating, body dissatisfaction, and obesity have been associated cross sectionally with suicidal behavior in adolescents. To determine the extent to which these variables predicted suicidal ideation and attempts, the authors examined these relationships in a longitudinal design. The study population included 2,516 older adolescents and young adults who completed surveys for Project EAT-II (Time 2), a 5-year follow-up study of adolescents who had taken part in Project EAT (Time 1). Odds ratios for suicidal behaviors at Time 2 were estimated with multiple logistic regression. Predictor variables included Time 1 extreme and unhealthy weight control behaviors (EWCB and UWCB), body dissatisfaction, and body mass index percentile. Suicidal ideation was reported by 15.2% of young men and 21.6% of young women, and suicide attempts were reported by 3.5% of young men and 8.7% of young women. For young women, suicidal ideation at Time 2 was predicted by Time 1 EWCB. The odds ratio for suicide attempts was similarly elevated in young women who had reported EWCB at Time 1. These odds ratios for both suicidal ideation and suicide attempts remained elevated even after controlling for Time 2 depressive symptoms. In young men, EWCB was not associated with suicidal ideation or suicide attempts 5 years later. Body mass index and body dissatisfaction did not predict suicidal ideation or suicide attempts in young men or young women. These results emphasize the importance of EWCB. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Psychopathic traits in a large community sample: Links to violence, alcohol use, and intelligence.

Neumann, Craig S.; Hare, Robert D. — 2008

Numerous studies conducted with offender or forensic psychiatric samples have revealed that individuals with psychopathic traits are at risk for violence and other externalizing psychopathology. These traits appear to be continuously distributed in these samples, leading investigators to speculate on the presence of such traits in the general population. Nonetheless, few studies of psychopathy have been conducted with large random samples of individuals from the community. The community sample from the MacArthur Violence Risk Assessment Study provides an opportunity to examine the prevalence and structural nature of psychopathic traits, as well as their association with external correlates in an urban community. The community data (N = 514) represent a stratified random sample of persons between the ages of 18 and 40 who were assessed on the Psychopathy Checklist: Screening Version (PCL: SV) and also for violent behavior, alcohol use, and intellectual functioning. Structural equation model analyses revealed that a 4-factor model found in offender and forensic psychiatric samples fit the community data well and was invariant across sex and ethnicity. Also, a superordinate factor comprehensively accounted for the 4 psychopathy first-order factors and significantly predicted the external correlates. The findings offer insight into the dimensional nature of the psychopathy construct. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Examination of predictors and moderators for self-help treatments of binge-eating disorder.

Masheb, Robin M.; Grilo, Carlos M. — 2008

Predictors and moderators of outcomes were examined in 75 overweight patients with binge-eating disorder (BED) who participated in a randomized clinical trial of guided self-help treatments. Age variables, psychiatric and personality disorder comorbidity, and clinical characteristics were tested as predictors and moderators of treatment outcomes. Current age and age of BED onset did not predict outcomes. Key dimensional outcomes (binge frequency, eating psychopathology, and negative affect) were predominately predicted, but not moderated, by their respective pretreatment levels. Presence of personality disorders, particularly Cluster C, predicted both posttreatment negative affect and eating disorder psychopathology. Negative affect, but not major depressive disorder, predicted attrition, posttreatment negative affect, and eating disorder psychopathology. Despite the prognostic significance of these findings for dimensional outcomes, none of the variables tested were predictive of binge remission (i.e., a categorical outcome). No moderator effects were found. The present study found poorer prognosis for patients with negative affect and personality disorders, suggesting that treatment outcomes may be enhanced by attending to the cognitive and personality styles of these patients. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Teacher key opinion leaders and mental health consultation in low-income urban schools.

2008

Diffusion theory posits that information is disseminated throughout a social network by the persuasion of key opinion leaders (KOLs). This study examined the relative and combined influence of peer-identified KOL teachers (n = 12) and mental health providers (n = 21) on classroom teachers' (n = 61) self-reported use of commonly recommended classroom practices for children with attention-deficit/hyperactivity disorder in 6 low-income urban African American communities, relative to teachers (n = 54) at 4 matched schools who received mental health provider consultation only. Mixed-effects regression models showed that KOLs in collaboration with mental health providers promoted higher rates of teachers' self-reported use of recommended strategies than mental health providers alone, and that these effects were mediated by KOL support but not by mental health provider support. The results suggest an expanded role for KOL teachers as indigenous and natural supports for the dissemination and implementation of school-based mental health programs. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

"Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders": Correction.

Siev, Jedidiah; Chambless, Dianne L. — 2008

Reports an error in "Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders" by Jedidiah Siev and Dianne L. Chambless (Journal of Consulting and Clinical Psychology, 2007[Aug], Vol 75[4], 513-522). The individual measures were not listed in the domains labeled "Panic" and "Cognitive" for the Öst and Westling (1995) citation in Table 3. The corrected table is included, with the added text appearing in bold font. (The following abstract of the original article appeared in record 2007-11558-001.) The aim of this study was to address claims that among bona fide treatments no one is more efficacious than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all panic-related measures, as well as on indices of clinically significant change. There is ample evidence that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GAD, but do for PD, is evidence for the specificity of treatment to disorder, even for 2 treatments within a CBT class, and 2 disorders within an anxiety class. (PsycINFO Database Record (c) 2008 APA, all rights reserved)