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Journal of Clinical Psychology

Impact factor: 1.668 5-Year impact factor: 2.237 Print ISSN: 0021-9762 Online ISSN: 1097-4679 Publisher: Wiley Blackwell (John Wiley & Sons)

Subject: Clinical Psychology

Most recent papers:

  • Kripalu Yoga for Military Veterans With PTSD: A Randomized Trial.
    Kristen M. Reinhardt, Jessica J. Noggle Taylor, Jennifer Johnston, Abida Zameer, Seetal Cheema, Sat Bir S. Khalsa.
    Journal of Clinical Psychology. 9 days ago
    Objectives This randomized controlled trial of yoga for military veterans and active duty personnel with posttraumatic stress disorder (PTSD) evaluated the efficacy of a 10‐week yoga intervention on PTSD. Method Fifty‐one participants were randomized into yoga or no‐treatment assessment‐only control groups. Primary outcome measures included questionnaires and the Clinician Administered PTSD Scale. Results Both yoga (n = 9) and control (n = 6) participants showed significant decreases in reexperiencing symptoms, with no significant between‐group differences. Secondary within‐group analyses of a self‐selected wait‐list yoga group (n = 7) showed significant reductions in PTSD symptoms after yoga participation, in contrast to their control group participation. Consistent with current literature regarding high rates of PTSD treatment dropout for veterans, this study faced challenges retaining participants across conditions. Conclusion These results are consistent with recent literature indicating that yoga may have potential as a PTSD therapy in a veteran or military population. However, additional larger sample size trials are necessary to confirm this conclusion.
    May 19, 2017   doi: 10.1002/jclp.22483   open full text
  • A Systematic Review of the Effect of Therapists’ Internalized Models of Relationships on the Quality of the Therapeutic Relationship.
    Catherine Steel, James Macdonald, Thomas Schroder.
    Journal of Clinical Psychology. 13 days ago
    Objective Previous reviews have found equivocal evidence of an association between therapists’ internalized relational models and the therapeutic relationship and have neglected empirical literature based on Sullivan's notion of introject. This review expanded upon previous reviews to examine the effect of therapist internalized relational models on a broader conceptualization of the therapeutic relationship. Method Systematic search processes identified 22 papers measuring therapist attachment and/or introject and therapeutic relationship: 19 on therapist attachment, 5 on introject with 2 overlapping. Results Overall, despite heterogeneity in design and variable methodological quality, evidence suggests that therapist attachment affects therapeutic relationship quality, observed in client‐rated evaluation, therapist negative countertransference, empathy, and problems in therapy. Interaction effects between client and therapist attachment style were also found. Evidence suggesting that therapist introject also affects therapeutic relationship quality, including therapists’ manner and feelings toward their clients, was stronger. Conclusion Evidence clearly shows that therapists’ internalized relational models affect the therapeutic relationship. More research is necessary to clarify exactly how therapist and client internalized relational models interact and translate these findings into clinical practice.
    May 15, 2017   doi: 10.1002/jclp.22484   open full text
  • Professional Burnout, Early Maladaptive Schemas, and Physical Health in Clinical and Counselling Psychology Trainees.
    April Kaeding, Christina Sougleris, Corinne Reid, Michiel F. Vreeswijk, Christopher Hayes, Jill Dorrian, Susan Simpson.
    Journal of Clinical Psychology. 13 days ago
    Objective Little is known about the personal factors that increase vulnerability to job‐related stress and burnout among psychologists in training. This study was based on a large international sample and aimed to explore the role of early maladaptive schemas (EMS) in predicting vulnerability to burnout, as well as attendant effects on short‐term physical health, in clinical and counseling postgraduate psychology trainees. Method An online, quantitative, cross‐sectional survey method design was used to collect self‐report data that measured burnout, EMS, and physical health from 1,297 trainees. Results Only the unrelenting standards (US) schema predicted high burnout among trainees. The most commonly endorsed physical health symptoms were back and neck pain and tiredness, and were more severe for those experiencing high burnout. Conclusion The current study contributes to our understanding of the role of the US EMS in the evolution of burnout in trainees and has implications for the development of self‐awareness training programs for this population.
    May 15, 2017   doi: 10.1002/jclp.22485   open full text
  • Couples Coping Through Deployment: Findings From a Sample of National Guard Families.
    Adrian J. Blow, Ryan P. Bowles, Adam Farero, Sailaja Subramaniam, Sara Lappan, Emily Nichols, Lisa Gorman, Michelle Kees, Danielle Guty.
    Journal of Clinical Psychology. May 11, 2017
    Objective Military families face numerous changes and stresses as they negotiate deployments and other life transitions. How they cope with these events is an important part of their overall well‐being and resilience. This longitudinal study on coping in a sample of National Guard couples examined the association between the predeployment coping (active vs. avoidant) of each in the relationship, and their own and their significant others’ mental health (anxiety, depression, posttraumatic stress disorder [PTSD]) and family well‐being (dyadic adjustment and parenting stress) postdeployment. Method A total of 238 matched couples completed the predeployment survey, 143 matched couples completed the post, with 122 matched couples completing both pre‐ and postdeployment surveys. Results While active coping was not significantly associated with any outcomes, predeployment avoidant coping in both soldiers and significant others was associated with increased anxiety, PTSD, and depression post deployment (actor effects). Additionally, soldier avoidant coping predeployment was associated with increased parenting stress for soldiers, while significant other avoidant coping predeployment was associated with increased relationship distress for significant others (actor effects). Finally, significant other avoidant coping predeployment was associated with higher parenting distress for soldiers postdeployment (partner effect). Conclusion Findings suggest that interventions are needed to combat avoidant coping (behavioral disengagement, denial, substance abuse) predeployment because this way of coping is strongly related to negative outcomes. In addition, those who work clinically with these families should work to reduce avoidant coping strategies and any familial dynamics exacerbated by this way of coping.
    May 11, 2017   doi: 10.1002/jclp.22487   open full text
  • Emotion Reactivity, Comfort Expressing Emotions, and Future Suicidal Ideation in Emerging Adults.
    Lillian Polanco‐Roman, Alyssa Moore, Aliona Tsypes, Colleen Jacobson, Regina Miranda.
    Journal of Clinical Psychology. May 11, 2017
    Objective Emotion reactivity and difficulties in expressing emotions have been implicated in risk for suicidal behavior. This study examined comfort in expressing emotions (positive vs. negative) and depressive symptoms as mediators of the prospective relation between emotion reactivity and suicidal ideation. Design Emerging adults (N = 143; 72% female; 28% White) completed measures of emotion reactivity, comfort expressing emotions, and suicidal ideation at baseline and of depressive symptoms and suicidal ideation 12 months later. Results Emotion reactivity predicted suicidal ideation at follow‐up through depressive symptoms. Difficulty expressing love–but not happiness, sadness, and anger–partially mediated the relationship between emotion reactivity and suicidal ideation at follow‐up before but not after adjusting for baseline ideation. Conclusion The relation between high emotion reactivity and suicidal ideation may be explained by discomfort in the expression of positive emotions and by depressive symptoms. Promotion of comfort in positive emotion expression may reduce vulnerability to suicidal ideation.
    May 11, 2017   doi: 10.1002/jclp.22486   open full text
  • Parental Secondary Stress: The Often Hidden Consequences of Nonsuicidal Self‐Injury in Youth.
    Janis Whitlock, Elizabeth Lloyd‐Richardson, Feven Fisseha, Thaddeus Bates.
    Journal of Clinical Psychology. May 11, 2017
    Objective This study aims to deepen understanding of the effects on parents of having a self‐injuring child by (a) analyzing differences in dimensions of caregiver strain between caregivers of youth with nonsuicidal self‐injury (NSSI+) and parents of youth with no known mental health history (MH−); (b) identifying factors that contribute to caregiver strain; and (c) examining parent outcome expectancies. Method Participants were 196 NSSI+ parents and 57 MH− parents. Quantitative measures of psychosocial variables, parent mental health and support variables, and child self‐injury characteristics were assessed in relation to caregiver strain, and NSSI+ parental expectancies were assessed via mixed methods. Results Parents with a NSSI+ youth were more likely to exhibit all forms of objective and subjective strain than parents of youth with no mental health challenges. Despite this, many parents expressed beliefs that their child would experience personal growth as a result of their NSSI experience. Conclusion Findings reveal the important role of mindful parenting practices and informal social support.
    May 11, 2017   doi: 10.1002/jclp.22488   open full text
  • Using Advances From Cognitive Behavioral Models of Anxiety to Guide Treatment for Social Anxiety Disorder.
    Rachel K. Narr, Bethany A. Teachman.
    Journal of Clinical Psychology. April 17, 2017
    This case features an adult male with moderate social anxiety disorder and mild depressive symptoms who showed an initial positive response to an earlier experience of cognitive behavior therapy, but then relapsed when he started avoiding social situations again because of continuing beliefs that experiencing anxiety was unacceptable. His treatment at our clinic focused on shifting unhelpful thinking about the likelihood and consequences of becoming anxious and reengaging in avoided social situations so he could learn to tolerate negative affect and uncertainty. The treatment approach draws from cognitive behavioral models of social anxiety and highlights advances in clinical science, especially recent work on the causal role of interpretation biases (the tendency to assign negative or threatening meaning to ambiguous situations) in the maintenance and reduction of anxiety.
    April 17, 2017   doi: 10.1002/jclp.22450   open full text
  • Translating the Cognitive Model of PTSD to the Treatment of Very Young Children: A Single Case Study of an 8‐Year‐Old Motor Vehicle Accident Survivor.
    Benjamin Goodall, Isobel Chadwick, Anna McKinnon, Aliza Werner‐Seidler, Richard Meiser‐Stedman, Patrick Smith, Tim Dalgleish.
    Journal of Clinical Psychology. April 17, 2017
    Posttraumatic stress disorder (PTSD) is a clinical condition that occurs after a discrete traumatic event, such as an accident or assault. Research into PTSD has primarily been adult‐focused; however, there is a growing body of evidence evaluating the theory and treatment of PTSD in young children. Consequently, cognitive behavior therapy (CBT) interventions for PTSD in youth have been developed that focus on 3 core components of the cognitive model–a disorganized memory of the trauma, maladaptive appraisals of the trauma and its effects (meanings), and dysfunctional coping mechanisms (management). Here, we describe the extension of this treatment approach (termed CBT‐3M) to very young children (3–8 years) through the case of Dylan, an 8‐year‐old motor vehicle accident survivor. This serves as an illustration of the underlying theory and its successful application. Further work is intended to provide evidence of the efficacy of this treatment via an ongoing treatment trial.
    April 17, 2017   doi: 10.1002/jclp.22449   open full text
  • A Self‐Determination Theory Perspective on Postpartum Depressive Symptoms and Early Parenting Behaviors.
    Katrijn Brenning, Bart Soenens.
    Journal of Clinical Psychology. April 17, 2017
    Objective On the basis of self‐determination theory, this study investigates longitudinal associations between satisfaction and frustration mothers’ basic psychological needs (i.e., autonomy, relatedness, competence) and mothers’ postnatal depressive symptoms and early parenting behaviors. Method Participants were 214 women assessed during their pregnancy (Time 1), 4 months after delivery (Time 2), and when the child was 2 years old (Time 3). Results Results demonstrate effects of prenatal basic psychological needs (needs frustration more specifically) on postnatal depressive symptoms. In addition, general prenatal needs satisfaction and frustration predicted more relationship‐specific needs satisfaction and frustration, respectively (in the mother–child relationship). In turn, postnatal relationship‐specific needs satisfaction predicted more high‐quality parenting when the child is 2 years old. More specifically, needs satisfaction was related to more maternal responsiveness and autonomy support. Conclusion Overall, these findings underscore the importance of psychological needs experiences for both mothers’ personal adjustment after birth and for the early mother–child relationship.
    April 17, 2017   doi: 10.1002/jclp.22480   open full text
  • Associations Among Meaning in Life, Body Image, Psychopathology, and Suicide Ideation in Spanish Participants With Eating Disorders.
    José H. Marco, Montserrat Cañabate, Sandra Pérez, Ginés Llorca.
    Journal of Clinical Psychology. April 17, 2017
    Objective The aims of this study were to (a) analyze whether participants with eating disorders have lower meaning in life than the nonclinical population; (b) discover whether participants with eating disorders with low meaning in life have more body image disturbances, more psychopathology, and higher suicide ideation than participants with high meaning in life; (c) analyze whether meaning in life is associated with eating disorder psychopathology; and (d) analyze whether meaning in life is able to predict eating disorder psychopathology and suicide ideation, when body image is controlled. Method The clinical sample comprised 247 Spanish participants diagnosed with eating disorders, and the nonclinical sample comprised Spanish 227 participants. Results Participants with eating disorders had lower meaning in life than the nonclinical population. Patients with low meaning in life had higher psychopathology and suicide ideation than participants with high meaning in life. Meaning in life was a significant predictor of the eating disorder psychopathology and suicide ideation. Conclusion Low meaning in life is associated with eating disorder psychopathology in a Spanish sample with eating disorders.
    April 17, 2017   doi: 10.1002/jclp.22481   open full text
  • The Mediating Role of Integration of Loss in the Relationship Between Dissociation and Prolonged Grief Disorder.
    Ilanit Hasson‐Ohayon, Tuvia Peri, Itai Rotschild, Rivka Tuval‐Mashiach.
    Journal of Clinical Psychology. April 05, 2017
    Objective Findings from the field of trauma have shown that there is a negative relationship between dissociation and integration of loss into the self‐narrative. At the same time, an increasing amount of literature on grief has stressed the importance of an integrated self‐narrative in the grieving process. Accordingly, the current study examined the possible mediating role played by the extent to which individuals have integrated their loss into their self‐narrative in the relationship between dissociation and symptoms of prolonged grief disorder (PGD). Method The Prolonged Grief Disorder Scale (PGD‐13), the Outcome Questionnaire, the Integration of Stressful Life Experiences Scale, the Dissociative Experiences Scale, and a sociodemographic questionnaire were administered to 66 individuals who had lost a loved one. Results The hypothesized mediation model of integration was confirmed. Conclusion The effect of people's dissociative tendencies on their PGD symptoms seems to occur via the impairment of their ability to integrate the memory of their loss into their general autobiographical memory. Empirical and clinical implications are discussed.
    April 05, 2017   doi: 10.1002/jclp.22479   open full text
  • Development and Initial Evaluation of the Psychometric Properties of the Dialectical Behavior Therapy Barriers to Implementation Scale (BTI‐S).
    Carla D. Chugani, Michael E. Mitchell, Yevgeny Botanov, Marsha M. Linehan.
    Journal of Clinical Psychology. April 05, 2017
    Objective We examined the psychometric properties of the Dialectical Behavior Therapy (DBT) Barriers to Implementation Scale (BTI‐S). Method Participants were clinicians completing a bipartite training, separated by 6 months of self‐study, to implement DBT. Exploratory factor analysis was conducted with data collected from the initial training period (N = 790), while confirmatory factor analysis was based on data from the final training period (N = 660). Results The final model included 26 items and 4 factors with overall acceptable fit, χ2(293, N = 660) = 460.989, p < .001, comparative fit index = .909, Tucker‐Lewis index = .899, root mean square root mean square error of approximation (90% confidence interval) = .015. The internal reliability of the scores was low (range = .56 to .72). Conclusion The final model fits reasonably well and measures four domains considered important for implementation of DBT. However, the low reliability of the scores indicates that the BTI‐S would be improved with further development.
    April 05, 2017   doi: 10.1002/jclp.22478   open full text
  • The Existential Concerns Questionnaire (ECQ)–Development and Initial Validation of a New Existential Anxiety Scale in a Nonclinical and Clinical Sample.
    Vincent Bruggen, Peter Klooster, Gerben Westerhof, Joël Vos, Elian Kleine, Ernst Bohlmeijer, Gerrit Glas.
    Journal of Clinical Psychology. April 03, 2017
    Objective Existential anxiety (EA) is a construct that refers to fears that are provoked by core threats of human existence, such as death, meaninglessness, and fundamental loneliness. The objective of this study was to develop an EA measure that can be used in research and clinical practice. Method The Existential Concerns Questionnaire (ECQ) was completed by a nonclinical sample of 389 adults, together with questionnaires measuring death anxiety, intolerance of uncertainty, neuroticism, distress, meaning, and life events. Adaptations were made based on item analysis and factor analysis. A total of 99 adults who had an anxiety and/or depressive disorder completed the final version. Results The ECQ was demonstrated to be essentially unidimensional and showed good reliability and stability. Correlations with other measures were within the expected range of strength, except for a weak association with life events. Conclusion Initial results regarding the psychometric properties of the ECQ are promising.
    April 03, 2017   doi: 10.1002/jclp.22474   open full text
  • Experience of Shame Mediates the Relationship Between Pathological Narcissism and Suicidal Ideation in Psychiatric Outpatients.
    Nenad Jaksic, Darko Marcinko, Milena Skocic Hanzek, Blaz Rebernjak, John S. Ogrodniczuk.
    Journal of Clinical Psychology. March 27, 2017
    Objective Pathological narcissism, described by 2 dysfunctional phenotypic forms–grandiosity and vulnerability–has often been connected to suicidal tendencies in theoretical and clinical literatures. Furthermore, shame proneness has been implicated as a key mechanism that links these 2 constructs. However, empirical evidence for the presumed relationship between pathological narcissism and suicidal tendencies is sparse, and no prior research has investigated the role of shame proneness in this relationship. The objective of the present research was to investigate the complex relations among pathological narcissism, experience of shame, and suicidal ideation in psychiatric outpatients. Method A sample of 250 adult psychiatric outpatients (61% female; mean age 39.15 years) were assessed between January and May 2014. The participants filled out the Pathological Narcissism Inventory, the Experience of Shame Scale, and the Suicide Assessment Scale‐self‐rating. Results Narcissistic vulnerability was found to have unique positive associations with acute suicidal ideation, whereas narcissistic grandiosity exhibited substantially weaker relations with the same construct. Two dimensions of shame–characterological and bodily shame–mediated the relationship between narcissistic vulnerability and suicidal ideation. The mediating role of behavioral shame was not demonstrated. Conclusions Narcissistic vulnerability seems to be more strongly related to suicidal tendencies than narcissistic grandiosity, while experience of shame represents one of the underlying mechanisms of this relationship among psychiatric outpatients. The implications of these findings are discussed in relation to the role of pathological narcissism in the psychotherapeutic management of suicidality.
    March 27, 2017   doi: 10.1002/jclp.22472   open full text
  • When Emotional Pain Becomes Physical: Adverse Childhood Experiences, Pain, and the Role of Mood and Anxiety Disorders.
    Natalie J. Sachs‐Ericsson, Julia L. Sheffler, Ian H. Stanley, Jennifer R. Piazza, Kristopher J. Preacher.
    Journal of Clinical Psychology. March 22, 2017
    Objective We examined the association between retrospective reports of adverse childhood experiences (ACEs) and painful medical conditions. We also examined the mediating and moderating roles of mood and anxiety disorders in the ACEs–painful medical conditions relationship. Method Ten‐year longitudinal data were obtained from the National Comorbidity Surveys (NCS‐1, NCS‐2; N = 5001). The NCS‐1 obtained reports of ACEs, current health conditions, current pain severity, and mood and anxiety disorders. The NCS‐2 assessed for painful medical conditions (e.g., arthritis/rheumatism, chronic back/neck problems, severe headaches, other chronic pain). Results Specific ACEs (e.g., verbal and sexual abuse, parental psychopathology, and early parental loss) were associated with the painful medical conditions. Baseline measures of depression, bipolar disorder, and posttraumatic stress disorder were also associated with the number of painful medical conditions. Anxiety and mood disorders were found to partially mediate the ACEs–painful medical conditions relationship. We determined through mediation analyses that ACEs were linked to an increase in anxiety and mood disorders, which, in turn, were associated with an increase in the number of painful medical conditions. We determined through moderation analyses that ACEs had an effect on increasing the painful medical conditions at both high and low levels of anxiety and mood disorders; though, surprisingly, the effect was greater among participants at lower levels of mood and anxiety disorders. Conclusion There are pernicious effects of ACEs across mental and physical domains. Dysregulation of the hypothalamic‐pituitary‐adrenal stress response and the theory of reserve capacity are reviewed to integrate our findings of the complex relationships.
    March 22, 2017   doi: 10.1002/jclp.22444   open full text
  • Depressive Symptoms and the Anticipation and Experience of Uplifting Events in Everyday Life.
    Lisa R. Starr, Rachel Hershenberg.
    Journal of Clinical Psychology. March 16, 2017
    Objective Despite proliferation of laboratory‐based studies examining reward functioning in depression, few studies have examined these processes in everyday life. We addressed this shortcoming by exploring experience and anticipation of uplifting experiences under ecologically valid conditions Method One hundred fifty‐seven young adults, oversampled for depressive symptoms, completed a 14‐day diary tracking mood in relation to recent and anticipated positive events Results Consistent with studies supporting “mood‐brightening” effects in depression, participants with greater baseline dysphoria showed stronger associations between elevated daily uplifts and lower daily depressive symptoms, particularly when events were interpersonal in nature. Baseline dysphoria was associated with lower daily anticipation of positive next‐day experiences; however, when dysphoric individuals did anticipate positive experiences, they experienced greater reductions in depressed mood Conclusion Results suggest that despite reward processing deficits found in laboratory studies, dysphoric individuals show improvements in mood in conjunction with anticipation and consumption of uplifting events in daily life.
    March 16, 2017   doi: 10.1002/jclp.22447   open full text
  • Impact of Killing in War: A Randomized, Controlled Pilot Trial.
    Shira Maguen, Kristine Burkman, Erin Madden, Julie Dinh, Jeane Bosch, Jessica Keyser, Martha Schmitz, Thomas C. Neylan.
    Journal of Clinical Psychology. March 10, 2017
    Objective The purpose of this pilot study was to test the effectiveness of Impact of Killing (IOK), a novel, cognitive‐behavioral treatment (CBT) aimed at reducing mental health symptoms and functional impairment. Method Participants were 33 combat Veterans with a posttraumatic stress disorder (PTSD) diagnosis who had completed trauma‐focused psychotherapy and reported distress regarding killing or feeling responsible for the deaths of others in war. Veterans were randomized to either IOK treatment or a 6‐week waitlist condition, after which Veterans could receive IOK. IOK is a 6‐ to 8‐session, weekly, individual, CBT, lasting 60–90 minutes, and focused on key themes, including physiology of killing responses, moral injury, self‐forgiveness, spirituality, making amends, and improved functioning. Results We found that compared to controls (N = 16), the IOK group (N = 17) experienced a significant improvement in PTSD symptoms, general psychiatric symptoms, and quality of life functional measures. Veterans who received IOK reported that the treatment was acceptable and feasible. Conclusion These results provide preliminary evidence that Veterans can benefit from a treatment focused on the impact of killing after initial trauma therapy.
    March 10, 2017   doi: 10.1002/jclp.22471   open full text
  • The Associations Between Army National Guard Versus Active Duty Soldier Status and Perceived Burdensomeness, Thwarted Belongingness, and Acquired Capability.
    Matthew C. Podlogar, Claire Houtsma, Lauren R. Khazem, Fallon Ringer, Thomas Mofield, Bradley A. Green, Michael D. Anestis, Ingrid C. Lim, Thomas E. Joiner.
    Journal of Clinical Psychology. March 10, 2017
    Objective This study aimed to examine if levels of thwarted belongingness, perceived burdensomeness, and acquired capability significantly differed between guardsmen and active duty soldiers. Method Multivariate analysis of covariance was used to test for differences between active duty Army (n = 1,393) and Army National Guard (n = 623) groups, before and after controlling for the effects of age, gender, race, marital status, level of education, and deployment history. Results Guardsmen reported significantly higher mean levels of thwarted belongingness and perceived burdensomeness than did active duty soldiers, even after adjusting for demographic differences. Guardsmen also reported slightly lower levels of acquired capability, though this effect was accounted for by demographic differences. Conclusion These findings support the notion that National Guard and active duty soldiers differ on perceived burdensomeness and thwarted belongingness. Additional research investigating sources of perceived burdensomeness and thwarted belongingness among guardsmen is needed.
    March 10, 2017   doi: 10.1002/jclp.22473   open full text
  • Suicide Risk Among BDSM Practitioners: The Role of Acquired Capability for Suicide.
    Sarah L. Brown, Jared F. Roush, Sean M. Mitchell, Kelly C. Cukrowicz.
    Journal of Clinical Psychology. March 10, 2017
    Objective Bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners are at increased risk for suicidal thoughts and behaviors. We hypothesized the association between (a) lifetime frequency of BDSM‐related sexual behaviors and (b) BDSM identification and suicide attempt status would be mediated by acquired capability components (i.e., fearlessness about death and pain tolerance). Gender differences were examined. Method Participants were 576 BDSM practitioners (meanage = 28.71; 66.7% male) recruited from online BDSM‐related groups, cross‐sectionally. Results Among males, the total indirect effect of acquired capability components in the relation between BDSM‐related sexual behaviors and suicide attempt status was significant. The specific indirect effect of perceived pain tolerance in the relation between both BDSM‐related sexual behaviors and BDSM identification and suicide attempt status was significant. There were no significant effects for females. Additionally, 12% reported a suicide attempt history. Conclusion Among males, BDSM‐related sexual behaviors and BDSM identification were associated with increased acquired capability components, which were positively associated with suicide attempt status.
    March 10, 2017   doi: 10.1002/jclp.22461   open full text
  • Randomized Controlled Trial of Inner Resources Meditation for Family Dementia Caregivers.
    Lynn C. Waelde, Hilary Meyer, Jason M. Thompson, Larry Thompson, Dolores Gallagher‐Thompson.
    Journal of Clinical Psychology. March 06, 2017
    Objective This randomized controlled trial examined the comparative effectiveness of 2 interventions for improving diurnal cortisol slope and life satisfaction and reducing stress symptoms among older female dementia family caregivers. Method Thirty‐one family dementia caregivers were randomized to 8 weeks of Inner Resources for Stress mindfulness meditation and mantra training (IR) or psychoeducation and telephone support (PTS). Results Intention‐to‐treat analyses revealed statistically significant pre‐post improvements in diurnal cortisol slope and overall life satisfaction, but not depression or self‐efficacy, in the IR relative to the PTS group. Adherence to between‐session meditation practice was significantly associated with decreases in depression and self‐reported improvements in ability to cope with stress. In addition, IR participants rated the overall benefits of the program more highly than the PTS group. Conclusion These results indicate that mindfulness meditation and mantra has promise as a feasible and effective caregiver intervention for quality of life and physiological responding to stress.
    March 06, 2017   doi: 10.1002/jclp.22470   open full text
  • Feeling Thanks and Saying Thanks: A Randomized Controlled Trial Examining If and How Socially Oriented Gratitude Journals Work.
    Brenda H. O'Connell, Deirdre O'Shea, Stephen Gallagher.
    Journal of Clinical Psychology. March 06, 2017
    Objective This study examined the effect of a reflective interpersonal gratitude journal, a reflective‐behavioral interpersonal gratitude journal and an active control journal, on primary qualities of well‐being and depression. Method Participants (n = 192; 67.2% female) completed this 3‐month longitudinal randomized controlled design. Results Participants in the reflective‐behavioral condition experienced the greatest improvements in affect balance and reductions in depression at immediate posttest. Both gratitude interventions improved affect balance at 1 month, compared to the control. Changes in affect balance for those in the reflective‐behavioral condition were mediated by the rate at which people expressed gratitude in their existing relationships. This effect was moderated by participant's baseline depressive status. Conclusion Expressing felt gratitude to others appears to be a crucial step in deriving benefits, and these benefits may not be limited to the emotionally healthy. Given the applied popularity of gratitude interventions, understanding not only if but also how they work is essential.
    March 06, 2017   doi: 10.1002/jclp.22469   open full text
  • A Controlled Randomized Preliminary Trial of a Modified Dissonance‐Based Eating Disorder Intervention Program.
    M. A. Green, M. Willis, K. Fernandez‐Kong, S. Reyes, R. Linkhart, M. Johnson, T. Thorne, J. Lindberg, E. Kroska, H. Woodward.
    Journal of Clinical Psychology. March 01, 2017
    Objective We conducted a controlled randomized preliminary trial of a modified dissonance‐based eating disorder program (n = 24) compared to an assessment‐only control condition (n = 23) via a longitudinal design (baseline, postintervention, 2‐month follow‐up) in a community sample of women (N = 47) with clinical (n = 22) and subclinical (n = 25) eating disorder symptoms. Method The traditional content of the Body Project, a dissonance‐based eating disorder prevention program, was modified to include verbal, written, and behavioral exercises designed to dissuade self‐objectification and maladaptive social comparison. Women with clinical and subclinical symptoms were included in the target audience to investigate both the treatment and the indicated prevention utility of the modified dissonance program. Body dissatisfaction, self‐esteem, self‐objectification, thin‐ideal internalization, maladaptive social comparison, trait anxiety, and eating disorder symptoms were evaluated in the control and the modified dissonance condition at baseline, postintervention, and 2‐month follow‐up. Results We predicted a statistically significant 2 (condition: control, modified dissonance) x 3 (time: baseline, postintervention, 2‐month follow‐up) interaction in the mixed factorial multivariate analyses of variance results. Results confirmed this hypothesis. Eating disorder risk factors and symptoms decreased significantly among participants in the modified dissonance condition at postintervention and 2‐month follow‐up compared to baseline; symptom improvement was greater among participants in the modified compared to the control condition. A secondary analysis indicated symptom improvement did not vary as a function of symptom status (clinical, subclinical), suggesting the program is efficacious in both indicated prevention and treatment applications. Conclusion Results provide preliminary support for the modified dissonance program.
    March 01, 2017   doi: 10.1002/jclp.22468   open full text
  • Can Trainees Effectively Deliver Dialectical Behavior Therapy for Individuals With Borderline Personality Disorder? Outcomes From a Training Clinic.
    Shireen L. Rizvi, Christopher D. Hughes, Alexandra D. Hittman, Pedro Vieira Oliveira.
    Journal of Clinical Psychology. February 21, 2017
    Objective The aim of the current study was to evaluate the effectiveness of a 6‐month course of comprehensive dialectical behavior therapy (DBT) provided in a training clinic with doctoral students as therapists and assessors. Method Clinical outcomes for 50 individuals with borderline personality disorder (80% female, Mage = 29.52 [SD = 9.64]) are reported. Reliable change indices and clinical significance were calculated for measures. Finally, our results were benchmarked against a “gold standard” randomized clinical trial (RCT; McMain et al., 2009). Results Analyses with both the full sample and the treatment completers indicate significant reductions in mental health symptomatology that were reliable, clinically and statistically significant, and comparable in effect size to the benchmarked RCT. Conclusion This DBT training clinic produced good outcomes, comparable to that of a large RCT. Results have implications for who can provide DBT treatment, as well as improving access to DBT in community settings where training clinics may be located.
    February 21, 2017   doi: 10.1002/jclp.22467   open full text
  • Applying the Unified Protocol Transdiagnostic Treatment to Nonsuicidal Self‐Injury and Co‐Occurring Emotional Disorders: A Case Illustration.
    Kate H. Bentley.
    Journal of Clinical Psychology. February 21, 2017
    This article presents the use of a transdiagnostic, emotion‐focused treatment with a young woman with nonsuicidal self‐injury (NSSI), social anxiety disorder, and generalized anxiety disorder. The patient also presented with subclinical depressive, posttraumatic stress, and eating disorder symptoms. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Barlow et al., 2011), a cognitive‐behavioral intervention designed to be applicable across anxiety, depressive, and related disorders with strong emotional components, was used to address the range of Laura's presenting concerns. After 16 individual treatment sessions, Laura experienced significant reductions in NSSI (and urges to engage in NSSI) as well as observable improvements in her self‐reported ability to respond more adaptively to intense emotion. She also reported moderate reductions in her anxiety disorder symptoms. This case illustration demonstrates how a short‐term, transdiagnostic treatment approach can be flexibly applied to a variety of problems maintained by aversive and avoidant reactions to intense emotion.
    February 21, 2017   doi: 10.1002/jclp.22452   open full text
  • Validity and Utility of the Patient Health Questionnaire (PHQ)‐2 and PHQ‐9 for Screening and Diagnosis of Depression in Rural Chiapas, Mexico: A Cross‐Sectional Study.
    Jafet Arrieta, Mercedes Aguerrebere, Giuseppe Raviola, Hugo Flores, Patrick Elliott, Azucena Espinosa, Andrea Reyes, Eduardo Ortiz‐Panozo, Elena G. Rodriguez‐Gutierrez, Joia Mukherjee, Daniel Palazuelos, Molly F. Franke.
    Journal of Clinical Psychology. February 13, 2017
    Background Depressive disorders are frequently under diagnosed in resource‐limited settings because of lack of access to mental health care or the inability of healthcare providers to recognize them. The Patient Health Questionnaire (PHQ)‐2 and the PHQ‐9 have been widely used for screening and diagnosis of depression in primary care settings; however, the validity of their use in rural, Spanish‐speaking populations is unknown. Method We used a cross‐sectional design to assess the psychometric properties of the PHQ‐9 for depression diagnosis and estimated the sensitivity and specificity of the PHQ‐2 for depression screening. Data were collected from 223 adults in a rural community of Chiapas, Mexico, using the PHQ‐2, the PHQ‐9, and the World Health Organization Quality of Life BREF Scale (WHOQOL‐ BREF). Results Confirmatory factor analysis suggested that the 1‐factor structure fit reasonably well. The internal consistency of the PHQ‐9 was good (Cronbach's alpha > = 0.8) overall and for subgroups defined by gender, literacy, and age. The PHQ‐9 demonstrated good predictive validity: Participants with a PHQ‐9 diagnosis of depression had lower quality of life scores on the overall WHOQOL‐BREF Scale and each of its domains. Using the PHQ‐9 results as a gold standard, the optimal PHQ‐2 cutoff score for screening of depression was 3 (sensitivity 80.00%, specificity 86.88%, area under receiver operating characteristic curve = 0.89; 95% confidence interval [0.84, 0.94]). Conclusion The PHQ‐2 and PHQ‐9 demonstrated good psychometric properties, suggesting their potential benefit as tools for depression screening and diagnosis in rural, Spanish‐speaking populations.
    February 13, 2017   doi: 10.1002/jclp.22390   open full text
  • Introduction: Applying Clinical Psychological Science to Practice.
    Christine B. Cha, Katherine A. DiVasto.
    Journal of Clinical Psychology. February 10, 2017
    Mental illness is a prevalent and extraordinarily complex phenomenon. Psychologists have developed distinct approaches toward understanding and treating mental illness, rooted in divergent epistemology. This introduction to the Special Issue on Clinical Psychological Science and Practice provides a brief overview of the scientist‐practitioner gap, and explores one step (of many) toward bridging this divide. Seven compelling case illustrations featured in this Special Issue apply empirical findings to case formulation, treatment selection, and assessment across complex and varied clinical presentations. This issue thereby demonstrates the feasibility of integrating research and clinical expertise in mental healthcare.
    February 10, 2017   doi: 10.1002/jclp.22448   open full text
  • Psychotherapy Utilization and Retention in a National Sample of Veterans With PTSD.
    Jennifer M. Doran, Robert H. Pietrzak, Rani Hoff, Ilan Harpaz‐Rotem.
    Journal of Clinical Psychology. February 10, 2017
    Objective This study examines the demographic, diagnostic, and military variables associated with psychotherapy utilization and retention in a national Veteran sample. Method A large administrative VA dataset (142,620 Veterans) was utilized. Logistic regression was used to determine predictors of psychotherapy utilization and retention. Results Female gender was associat ed with increased psychotherapy utilization and retention. Geriatric age was associated with less retention in individual psychotherapy. Being a racial minority was associated with decreased utilization, but increased retention in group therapy. The majority of comorbid diagnoses were associated with longer retention in treatment. Depression was associated with decreased utilization but longer treatment duration. Dimensional symptom assessment demonstrated relationships with the dependent variables. Avoidance symptoms did not emerge as a barrier to treatment. Conclusion Differences in psychotherapy utilization and retention emerged across demographic, diagnostic and military variables, suggesting that these variables should inform outreach and treatment retention efforts for Veterans with PTSD.
    February 10, 2017   doi: 10.1002/jclp.22445   open full text
  • Perceived Burdensomeness, Thwarted Belongingness, and Fearlessness about Death: Associations With Suicidal Ideation among Female Veterans Exposed to Military Sexual Trauma.
    Lindsey L. Monteith, Nazanin H. Bahraini, Deleene S. Menefee.
    Journal of Clinical Psychology. February 10, 2017
    Objective Military sexual trauma (MST) is prevalent among female Veterans and is associated with increased risk for suicidal self‐directed violence. Yet research examining processes which contribute to suicidal ideation and attempts among MST survivors has been sparse, focusing primarily on psychiatric symptoms or diagnoses, rather than employing a theory‐driven approach. The interpersonal‐psychological theory (Joiner, 2005) is a leading theory of suicide that may be particularly relevant for understanding suicidal ideation among female Veterans who have experienced MST. We examined whether constructs derived from the interpersonal‐psychological theory of suicide (perceived burdensomeness, thwarted belongingness, and fearlessness about death; Joiner, 2005) were associated with suicidal ideation among female Veterans who had experienced MST, when adjusting for known risk factors for suicide. Method Ninety‐two female Veterans with a history of MST completed the Interpersonal Needs Questionnaire, Acquired Capability for Suicide Scale ‐ Fearlessness about Death Scale, and Beck Scale for Suicide Ideation. Results Perceived burdensomeness, thwarted belongingness, and fearlessness about death were each associated with suicidal ideation in the past week, adjusting for prior suicide attempts, current depressive symptoms, and current symptoms of posttraumatic stress disorder. When including all three interpersonal‐psychological constructs in the model, only perceived burdensomeness and fearlessness about death were significantly associated with suicidal ideation. Conclusion These findings provide knowledge regarding interpersonal processes that may contribute to suicidal ideation among this high‐risk, yet understudied, population. These results also underscore the importance of assessing for interpersonal‐psychological constructs–particularly perceived burdensomeness and fearlessness about death–when working with female Veterans who have experienced MST.
    February 10, 2017   doi: 10.1002/jclp.22462   open full text
  • Maintaining Mental Health Through Positive Writing: Effects of a Resource Diary on Depression and Emotion Regulation.
    M. Suhr, A.K. Risch, G. Wilz.
    Journal of Clinical Psychology. February 10, 2017
    Objective The present study investigated the beneficial effects of the resource‐oriented positive writing intervention resource diary (RD) on mental health variables among patients recently discharged from psychiatric inpatient treatment. Method Eighty‐nine patients were randomly assigned to either an intervention group completing RD over the course of 4 weeks (n = 45) or a control group receiving no intervention (n = 44). To measure changes in mental health, patients filled out a number of self‐report questionnaires on depression, emotion regulation, and resource activation before and after the intervention.  Results Participants completing RD had significantly lower depression scores than controls and reported an increased use of the functional emotion regulation strategy “reappraisal” 5 weeks after discharge. A decreased use of the dysfunctional strategy “expressive suppression” was found in the female subsample. No differences were found for resource activation. Conclusion These findings suggest that a resource‐oriented positive writing intervention has potential for stabilizing mental health after psychiatric discharge and could therefore present an economical alternative or addition to established aftercare programs.
    February 10, 2017   doi: 10.1002/jclp.22463   open full text
  • An Empirical Model and Ethnic Differences in Cultural Meanings Via Motives for Suicide.
    Joyce Chu, Oula Khoury, Johnson Ma, Francesca Bahn, Bruce Bongar, Peter Goldblum.
    Journal of Clinical Psychology. February 07, 2017
    Objective The importance of cultural meanings via motives for suicide – what is considered acceptable to motivate suicide – has been advocated as a key step in understanding and preventing development of suicidal behaviors. There have been limited systematic empirical attempts to establish different cultural motives ascribed to suicide across ethnic groups. Method We used a mixed methods approach and grounded theory methodology to guide the analysis of qualitative data querying for meanings via motives for suicide among 232 Caucasians, Asian Americans, and Latino/a Americans with a history of suicide attempts, ideation, intent, or plan. We used subsequent logistic regression analyses to examine ethnic differences in suicide motive themes. Results This inductive approach of generating theory from data yielded an empirical model of 6 cultural meanings via motives for suicide themes: intrapersonal perceptions, intrapersonal emotions, intrapersonal behavior, interpersonal, mental health/medical, and external environment. Logistic regressions showed ethnic differences in intrapersonal perceptions (low endorsement by Latino/a Americans) and external environment (high endorsement by Latino/a Americans) categories. Conclusion Results advance suicide research and practice by establishing 6 empirically based cultural motives for suicide themes that may represent a key intermediary step in the pathway toward suicidal behaviors. Clinicians can use these suicide meanings via motives to guide their assessment and determination of suicide risk. Emphasis on environmental stressors rather than negative perceptions like hopelessness should be considered with Latino/a clients.
    February 07, 2017   doi: 10.1002/jclp.22425   open full text
  • Enhancement of Self‐Conducted Exposure for OCD Using Cognitive Bias Modification: A Case Study.
    Sadia Najmi, Nader Amir.
    Journal of Clinical Psychology. February 07, 2017
    The psychological treatment of choice for obsessive‐compulsive disorder (OCD) is exposure and response prevention (ERP). However, the training required for practitioners to be proficient in delivering ERP is not readily available, thereby rendering the treatment inaccessible to most patients. Self‐directed ERP (sERP) programs designed to increase the accessibility of ERP have not proven effective, perhaps because patients find it difficult to comply with exposure exercises without the guidance of a clinician. Research on cognitive bias modification (CBM) suggests that CBM may help individuals approach feared situations. In this case study, a patient with OCD completed a 7‐week treatment program that combines sERP with CBM. Treatment led to a significant decrease in OCD symptoms and functional impairment. Results suggest that this novel treatment, which requires only an initial couple of sessions with a clinician trained in ERP, has the potential to increase the accessibility of ERP for patients with OCD.
    February 07, 2017   doi: 10.1002/jclp.22451   open full text
  • Enhancing Social Support Postincarceration: Results From a Pilot Randomized Controlled Trial.
    Carrie Pettus‐Davis, Allison Dunnigan, Christopher A. Veeh, Matthew Owen Howard, Anna M. Scheyett, Amelia Roberts‐Lewis.
    Journal of Clinical Psychology. February 07, 2017
    Objective Over 50% of released prisoners are reincarcerated within 3 years. Social support from loved ones postincarceration significantly reduces the likelihood of reincarceration. Increasingly, intervention developers aim to implement interventions that will enhance the stability of support available. This study responds to gaps in knowledge. Method The current efficacy study reports findings from a randomized controlled trial (n = 57) of a social support intervention. A priori power analysis indicated moderate effect sizes could be detected. Participants were men, average age was 25 years, and over 90% were African American. Preliminary effects on social support, cognitions, substance use, and rearrest were assessed. Recruitment and consent occurred in prison; the intervention and 4 follow‐ups occurred postrelease. Results Findings converge with research indicating declines in social support (b = −.70, p < .05) and perceived quality of support (b = .05, p < .01) over time. Age showed inverse relationships with support (b = −1.77, p < .05). There were no statistically significant group effects for social support, cognitions, substance use (with the exception of marijuana), or recidivism. Clinical implications are discussed. Conclusion This study advances research on intervention dosage, potency, and measurement considerations.
    February 07, 2017   doi: 10.1002/jclp.22442   open full text
  • Brightening the Day With Flashes of Positive Mental Imagery: A Case Study of an Individual With Depression.
    Simon E. Blackwell, Emily A. Holmes.
    Journal of Clinical Psychology. February 02, 2017
    This article presents a case example of an individual with current major depression engaging in a positive mental imagery intervention, specifically a computerized cognitive training paradigm involving repeated practice in generating positive imagery in response to ambiguous scenarios. The patient's reported experience of the intervention suggests the potential of the positive imagery intervention to “brighten” everyday life via promoting involuntary “flashes” of positive mental imagery in situations related to the scenarios, with associated beneficial effects on positive affect, future expectations, and behavior. Enhancing this aspect of the training–i.e., involuntary positive imagery in contexts where it is adaptive–may hold particular promise for reducing anhedonic symptoms of depression. Developing simple computerized interventions to increase the experience of positive mental imagery in everyday life could therefore provide a useful addition to the drive to improve treatment outcomes.
    February 02, 2017   doi: 10.1002/jclp.22455   open full text
  • Initial and Follow‐Up Evaluations of Integrated Psychological Services for Anxiety and Depression in a Safety Net Primary Care Clinic.
    Elizabeth Sadock, Paul B. Perrin, Renée M. Grinnell, Bruce Rybarczyk, Stephen M. Auerbach.
    Journal of Clinical Psychology. February 02, 2017
    Objective Despite the recognized importance of integrated behavioral health, particularly in safety net primary care, its effectiveness in real world settings has not been extensively evaluated. This article presents 2 successive studies examining the effectiveness of integrated behavioral care in a safety net setting. Method Study 1 compared the depression and anxiety scores of predominately low‐income and minority patients who underwent brief interventions (N = 147) to those of patients from a demographically similar comparison clinic without integrated psychological services, matched on baseline levels of anxiety and depression and length of time between assessments (N = 139). Study 2 did not include a control group but served as a long‐term follow‐up assessment of anxiety and depression for a subset of 47 patients who finished treatment and could be reached by telephone within 6–18 months of their last session. Results Study 1 found that patients from the clinic with integrated psychology services experienced greater decreases in depression and anxiety scores than patients in the control clinic. These effects did not differ as a function of age, gender, or race. Study 2 found that patients continued to decline in depression and anxiety over time, with lower scores at the last session and even lower scores after longer‐term follow‐up ranging from 6 to18 months. These improvements remained significant when controlling for other interim mental health treatments. Conclusion These results support the short‐ and long‐term treatment effects of brief primary care behavioral interventions, further strengthening the case for integrated behavioral healthcare in safety net settings.
    February 02, 2017   doi: 10.1002/jclp.22459   open full text
  • Effectiveness of Brief Abstinence for Modifying Problematic Internet Gaming Cognitions and Behaviors.
    Daniel L. King, Dean Kaptsis, Paul H. Delfabbro, Michael Gradisar.
    Journal of Clinical Psychology. February 02, 2017
    Objective This pilot study tested the efficacy of a voluntary 84‐hour abstinence protocol for modifying problematic Internet gaming cognitions and behaviors Method Twenty‐four adults from online gaming communities, including 9 individuals who screened positively for Internet gaming disorder (IGD), abstained from Internet games for 84 hours. Surveys were collected at baseline, at daily intervals during abstinence, and at 7‐day and 28‐day follow‐up Results Brief voluntary abstinence was successful in reducing hours of gaming, maladaptive gaming cognitions, and IGD symptoms. Abstinence was highly acceptable to participants with total compliance and no study attrition. Clinically significant improvement in IGD symptoms occurred in 75% of the IGD group at 28‐day follow‐up. Reliable improvement in maladaptive gaming cognitions occurred in 63% of the IGD group, whose cognition score reduced by 50% and was comparable to the non‐IGD group at 28‐day follow‐up Conclusions Despite limitations of sample size, this study provides promising support for brief abstinence as a simple, practical, and cost‐effective treatment technique for modifying unhelpful gaming cognitions and reducing Internet gaming problems.
    February 02, 2017   doi: 10.1002/jclp.22460   open full text
  • Benefits of a Psychodynamic Group Therapy (PGT) Model for Treating Veterans With PTSD.
    Ofir Levi, Yael Shoval‐Zuckerman, Eyal Fruchter, Arie Bibi, Yair Bar‐Haim, Ilan Wald.
    Journal of Clinical Psychology. January 24, 2017
    Objective To examine the effectiveness of a treatment model of psychodynamic group therapy (PGT) for combat Veterans with posttraumatic stress disorder (PTSD). Method A total of 158 male Veterans with PTSD (mean age = 30.09 years) were assigned to 15 treatment groups of 7–13 patients each. PGT was a 1‐year therapy, 1.5 hour, once‐a‐week sessions administered in the following stages: group building activities, differentiation of group members, intimacy building, and termination. Levels of PTSD and depression symptoms, functioning, and hope were assessed at pretreatment baseline, posttreatment, and 12‐month follow‐up. Results Multilevel modeling analyses indicate that our group therapy is associated with reductions in PTSD and depressive symptoms at posttreatment, and that these effects were maintained at 12‐month follow‐up. The results also showed significantly improved patients' functioning by the end of therapy and at the 12‐month follow‐up point, and that the patients’ hope level had increased. Conclusion The findings show that our model of psychodynamic group therapy is associated with mental improvements in Veterans with PTSD. However, further randomized controlled trials are recommended to establish the advantages of our therapeutic method compared to other modes of therapy.
    January 24, 2017   doi: 10.1002/jclp.22443   open full text
  • The Journey Through and Beyond Mental Health Services in the United Kingdom: A Typology of Parents’ Ways of Managing the Crisis of Their Teenage Child's Depression.
    Emily Stapley, Mary Target, Nick Midgley.
    Journal of Clinical Psychology. January 24, 2017
    Objective Depression is a common mental illness experienced by young people. Yet we know little about how their parents manage their symptoms at home, and how parents may experience their treatment at child and adolescent mental health services (CAMHS). Thus, the aim of our study was to create a typology of parents’ experiences over a 2‐year period, beginning with their teenage child's referral to CAMHS in the United Kingdom. Method A total of 85 semistructured interviews were conducted with one or both parents of 28 adolescents at 3 time points, and qualitatively analyzed using ideal type analysis. Results Three distinct types or patterns of parental experience were identified: the learning curve parents, the finding my own solutions parents, the stuck parents. Conclusion These patterns of parental experience could perhaps provide a basis for clinicians working in CAMHS to reflect on the families that they see and to adapt their ways of working accordingly to best support these families.
    January 24, 2017   doi: 10.1002/jclp.22446   open full text
  • How to Implement Therapeutic Evaluative Conditioning in a Clinical Setting.
    Joseph C. Franklin, Kathryn R. Fox, Jessica D. Ribeiro.
    Journal of Clinical Psychology. January 23, 2017
    Self‐injurious behaviors (SIBs), including both suicidal and nonsuicidal self‐injury, are major public health problems that have been on the rise in recent decades. There are few effective SIB interventions, and those that are effective cannot reach most people who are in need of help–that is, these interventions are not scalable. To address this need, we recently developed a scalable, app‐based treatment called Therapeutic Evaluative Conditioning (TEC) that preliminary studies have shown causes reductions in SIBs (Franklin et al., 2016). Although TEC was developed and evaluated as a standalone, self‐administered intervention, it may also be a valuable therapeutic tool within traditional clinical settings. Here we provide a case illustration of a young adult female who presented at an outpatient clinic with a long history of self‐injurious behaviors and multiple failed treatment attempts. In discussing this case, we describe how to implement TEC within such a setting and what might be expected as a result.
    January 23, 2017   doi: 10.1002/jclp.22453   open full text
  • Perceived Criticism in the Treatment of a High‐Risk Adolescent.
    Jill M. Hooley, David J. Miklowitz.
    Journal of Clinical Psychology. January 23, 2017
    Perceived criticism (PC) is a construct that plays a key role in family relationships of persons with psychiatric disorders. It can be assessed in a brief and simple way using the Perceived Criticism Measure. PC ratings made by patients about their caregivers predict adverse clinical outcomes including increases in symptoms and relapse across a broad range of psychiatric diagnoses. Although research supports the concurrent and predictive validity of PC, the measure is not widely used in clinical practice. Here, we describe the construct of PC and review evidence supporting its clinical utility. We then illustrate how criticism and perceptions of criticism can be addressed in a clinical context, describing a family focused treatment approach used with a depressed adolescent at high risk for bipolar disorder.
    January 23, 2017   doi: 10.1002/jclp.22454   open full text
  • Thematic Mapping in Case Conceptualization: An Introduction to the Special Section.
    Charles R. Ridley, Christina E. Jeffrey.
    Journal of Clinical Psychology. January 13, 2017
    Case conceptualization is an essential clinical activity in which clinicians, in one form or another, gather and synthesize data about their clients in order to formulate clinical pictures and maximize therapeutic gains. However, a myriad of methods of case conceptualization that vary in complexity and theoretical bases currently reflects an almost complete lack of standardization in this most fundamental activity of mental health treatment. The lack of standardization in case conceptualization is especially daunting to trainees and clinicians who are early in their careers. This special section, comprising 5 articles, introduces thematic mapping, a transtheoretical and transdiagnostic method of case conceptualization. The method aims to overcome or minimize many of the problems inherent in current practice. In this first article, we provide a rationale for the special section and lay the groundwork for the subsequent four articles. Overall, we assert that thematic mapping holds promise as a systematic method of case conceptualization.
    January 13, 2017   doi: 10.1002/jclp.22355   open full text
  • The Process of Thematic Mapping in Case Conceptualization.
    Charles R. Ridley, Christina E. Jeffrey, Richard B. Roberson.
    Journal of Clinical Psychology. January 13, 2017
    This article, the 4th in a series of 5, introduces the 3‐stage process of thematic mapping: theme identification, theme interpretation, and theme intervention. Theme identification is based on inductive reasoning, in which clinicians seek to discover and describe behavioral patterns in emotionally charged episodes. Theme interpretation subsequently initiates a process of deductive reasoning, wherein clinicians distill the generalized pattern into dominant and subthemes. Each theme is then labeled with a compelling metaphor that is representative of the theme interpretation. In the 3rd stage, theme intervention, clinicians seek to change the dysfunctional dominant and subthemes through collaboration with the clients. The process unfolds within 5 overarching parameters: a focus on comprehensiveness, simplification, maximal objectivity/impartial subjectivity, observation and inference, and an idiographic approach. Alternative models of case formulation are offered in comparison to thematic mapping.
    January 13, 2017   doi: 10.1002/jclp.22351   open full text
  • A Case Conceptualization Using Thematic Mapping.
    Christina E. Jeffrey, Charles R. Ridley.
    Journal of Clinical Psychology. January 13, 2017
    This article, the last in a series of 5, presents a detailed case summary in which thematic mapping, a novel method of case conceptualization, was used to conceptualize an adult struggling with chronic depression. The case illustrates the process and therapeutic outcomes that resulted from the therapist's use of the 3‐stage thematic mapping model: theme identification, theme interpretation, and theme intervention. The article also demonstrates how the case formulation guided the therapist in selecting therapeutic techniques that matched to the client's goals, needs, and interpersonal style. Overall, this article aims to demonstrate how thematic mapping utilizes transtheoretical and transdiagnostic approaches to create a case formulation that is client‐centered, process‐oriented, and useful across a broad spectrum of training.
    January 13, 2017   doi: 10.1002/jclp.22352   open full text
  • The Conceptual Framework of Thematic Mapping in Case Conceptualization.
    Charles R. Ridley, Christina E. Jeffrey.
    Journal of Clinical Psychology. January 13, 2017
    This article, the 3rd in a series of 5, introduces the conceptual framework for thematic mapping, a novel approach to case conceptualization. The framework is transtheoretical in that it is not constrained by the tenets or concepts of any one therapeutic orientation and transdiagnostic in that it conceptualizes clients outside the constraints of diagnostic criteria. Thematic mapping comprises 4 components: a definition, foundational principles, defining features, and core concepts. These components of the framework, deemed building blocks, are explained in this article. Like the foundation of any structure, the heuristic value of the method requires that the building blocks have integrity, coherence, and sound anchoring. We assert that the conceptual framework provides a solid foundation, making thematic mapping a potential asset in mental health treatment.
    January 13, 2017   doi: 10.1002/jclp.22353   open full text
  • Case Mis‐Conceptualization in Psychological Treatment: An Enduring Clinical Problem.
    Charles R. Ridley, Christina E. Jeffrey, Richard B. Roberson.
    Journal of Clinical Psychology. January 13, 2017
    Case conceptualization, an integral component of mental health treatment, aims to facilitate therapeutic gains by formulating a clear picture of a client's psychological presentation. However, despite numerous attempts to improve this clinical activity, it remains unclear how well existing methods achieve their purported purpose. Case formulation is inconsistently defined in the literature and implemented in practice, with many methods varying in complexity, theoretical grounding, and empirical support. In addition, many of the methods demand a precise clinical acumen that is easily influenced by judgmental and inferential errors. These errors occur regardless of clinicians’ level of training or amount of clinical experience. Overall, the lack of a consensus definition, a diversity of methods, and susceptibility of clinicians to errors are manifestations of the state of crisis in case conceptualization. This article, the 2nd in a series of 5 on thematic mapping, argues the need for more reliable and valid models of case conceptualization.
    January 13, 2017   doi: 10.1002/jclp.22354   open full text
  • A Prospective Examination of Perceived Burdensomeness and Thwarted Belongingness As Risk Factors for Suicide Ideation In Adult Outpatients Receiving Cognitive‐Behavioral Therapy.
    Tobias Teismann, Heide Glaesmer, Ruth Brachel, Paula Siegmann, Thomas Forkmann.
    Journal of Clinical Psychology. January 13, 2017
    Objective The interpersonal‐psychological theory of suicidal behavior posits that 2 proximal, causal, and interactive risk factors must be present for someone to desire suicide: perceived burdensomeness and thwarted belongingness. The purpose of the present study was to evaluate the predictive power of these 2 risk factors in a prospective study. Method A total of 231 adult outpatients (age: mean = 38.1, standard deviation = 12.3) undergoing cognitive‐behavioral therapy took part in a pretreatment and a midtreatment assessment after the 10th therapy session. Results Perceived burdensomeness, thwarted belongingness, and the interaction between these 2 risk factors did not add incremental variance to the prediction of midtreatment suicide ideation after controlling for age, gender, depression, hopelessness, impulsivity, lifetime suicide attempts, and pretreatment suicide ideation. The best predictor of midtreatment suicide ideation was pretreatment suicide ideation. Conclusion Results offer only limited support to the assumptions of the interpersonal theory of suicide.
    January 13, 2017   doi: 10.1002/jclp.22441   open full text
  • “Are You Having Thoughts of Suicide?” Examining Experiences With Disclosing and Denying Suicidal Ideation.
    Melanie A. Hom, Ian H. Stanley, Matthew C. Podlogar, Thomas E. Joiner.
    Journal of Clinical Psychology. January 13, 2017
    Objective To characterize individuals’ prior experiences with being asked whether they are having thoughts of suicide and to understand factors that affected their response accuracy. Method Undergraduates (N = 306) reporting a lifetime history of suicidal ideation completed a web‐based survey about their experiences being probed about suicidal thoughts. Results Nearly two‐thirds of participants (63.1%) reported having been previously asked whether they were having thoughts of suicide, with health care providers comprising the plurality of probers. Individuals reported the greatest accuracy of ideation disclosure to mental health professionals. Stigma‐related concerns were the most common barriers to accurate disclosure of ideation, whereas wanting emotional support and the prober to understand them were cited as facilitators for accurately responding. Conclusion A number of factors influence the accurate and inaccurate disclosure of suicidal ideation. Further research is needed to understand how to facilitate accurate disclosure of suicidal ideation across settings and populations.
    January 13, 2017   doi: 10.1002/jclp.22440   open full text
  • Client Retrospective Accounts of Corrective Experiences in Motivational Interviewing Integrated With Cognitive Behavioral Therapy for Generalized Anxiety Disorder.
    Christianne Macaulay, Lynne Angus, Jasmine Khattra, Henny Westra, Jennifer Ip.
    Journal of Clinical Psychology. January 10, 2017
    A corrective experience (CE) is one “in which a person comes to understand or experience affectively an event or relationship in a different and unexpected way” (Castonguay & Hill, 2012, p. 5). CEs disconfirm clients’ expectations based on past problematic experiences, and can be emotional, relational, behavioral, and/or cognitive. This qualitative study explored corrective shifts among recovered participants (N = 8) who had received motivational interviewing (MI) integrated with cognitive behavioral therapy (CBT) in a randomized controlled trial comparing CBT alone to MI‐CBT for generalized anxiety disorder (Westra, Constantino, & Antony, 2016). We administered a posttherapy interview querying their experience of, and explanations for, any shifts in therapy. Grounded theory analysis yielded three core themes: in command of the worry train, experiencing myself in new ways in therapy, and oriented toward change. Findings are discussed in terms of MI theory, and clinical implications for therapists are provided.
    January 10, 2017   doi: 10.1002/jclp.22430   open full text
  • A Cross‐Lagged Panel Study of Dissociation and Posttraumatic Stress in a Treatment‐Seeking Sample of Survivors of Childhood Sexual Abuse.
    Siobhan Murphy, Ask Elklit, Jamie Murphy, Philip Hyland, Mark Shevlin.
    Journal of Clinical Psychology. January 10, 2017
    Objective The current prospective study assessed the temporal relations between dissociation and posttraumatic stress (PTS) in a sample of treatment‐seeking female survivors of childhood sexual abuse. PTS refers to symptoms associated with posttraumatic stress disorder (PTSD) in the absence of a clinical diagnosis of PTSD. Method Initial assessment was on average 23 years after the onset of abuse (N = 405), and participants were followed‐up after 6 months (N = 245) and 12 months (N = 119). Results Findings indicated that dissociative experiences and PTS were highly correlated within each wave of data collection. Cross‐lagged panel analysis revealed that at each assessment period dissociative symptoms and PTS levels, respectively, were primarily explained by scores on the same variable at the previous assessment period. Although further reciprocal relations between dissociation and PTS were evident, these associations were relatively weak in magnitude. Conclusion Current results provide important insights into the temporal relations between dissociative symptoms and PTS. The high correlations between dissociative experiences and PTS several years after trauma exposure have important clinical implications that may affect their treatment and trauma recovery.
    January 10, 2017   doi: 10.1002/jclp.22439   open full text
  • Understanding Outcomes in a Randomized Controlled Trial of a Ward‐based Intervention on Psychiatric Inpatient Wards: A Qualitative Analysis of Staff and Patient Experiences.
    Katherine Berry, Gillian Haddock, Stephen Kellett, Yvonne Awenat, Karolina Szpak, Christine Barrowclough.
    Journal of Clinical Psychology. December 27, 2016
    Objective Team formulation is advocated to improve quality of care in mental health care and evidence from a recent U.K.‐based trial supports its use in inpatient settings. This study aimed to identify the effects of formulation on practice from the perspectives of staff and patient participating in the trial, including barriers and enhancers to implementing the intervention. Method We carried out semistructured interviews with 57 staff and 20 patients. Data were analyzed using thematic analysis. Results Main outcomes were: improved staff understanding of patients, better team collaboration and increased staff awareness of their own feelings. Key contextual factors were as follows: overcoming both staff and patient anxiety, unwelcome expert versus collaborative stance, competing demands, and management support. Conclusion Team formulation should be implemented to improve quality of care in inpatient settings and larger definitive trials should be carried out to assess the effect of this intervention on patient outcomes.
    December 27, 2016   doi: 10.1002/jclp.22434   open full text
  • Alexithymia and Emotional Processing: A Mediation Model.
    Ana Nunes da Silva, António Branco Vasco, Jeanne C. Watson.
    Journal of Clinical Psychology. December 27, 2016
    Objective Although alexithymia has been associated with difficulties in emotional regulation, both constructs are complex and this association remains unclear. This research attempts to study the relation between both constructs to identify better ways to guide clinical intervention. Method Emotion awareness, differentiation, and regulation were tested as mediators of the associations between alexithymia and severity of symptoms. The model was tested in a clinical (121 participants) and a nonclinical sample (188 participants). Results Mediation effects were found in both samples with respect to different alexithymia factors, with the effects being higher in the clinical sample. Conclusion Emotional awareness and emotional differentiation mediate the relationship between alexithymia and emotion regulation. The similarities between samples suggest that emotional processing may be better thought of as being on a continuum. Being aware of the differential effect each alexithymia factor has on emotional processing may be helpful to guide intervention.
    December 27, 2016   doi: 10.1002/jclp.22422   open full text
  • The Relationship Between Perfectionism and Psychopathology: A Meta‐Analysis.
    Karina Limburg, Hunna J. Watson, Martin S. Hagger, Sarah J. Egan.
    Journal of Clinical Psychology. December 27, 2016
    Objective The clinical significance of 2 main dimensions of perfectionism (perfectionistic strivings and perfectionistic concerns) was examined via a meta‐analysis of studies investigating perfectionism in the psychopathology literature. Method We investigated relationships between psychopathology outcomes (clinical diagnoses of depression, anxiety disorders, obsessive‐compulsive disorder, and eating disorders; symptoms of these disorders; and outcomes related to psychopathology, such as deliberate self‐harm, suicidal ideation, and general distress) and each perfectionism dimension. The relationships were examined by evaluating (a) differences in the magnitude of association of the 2 perfectionism dimensions with psychopathology outcomes and (b) subscales of 2 common measures of perfectionism. Results A systematic literature search retrieved 284 relevant studies, resulting in 2,047 effect sizes that were analysed with meta‐analysis and meta‐regression while accounting for data dependencies. Conclusion Findings support the notion of perfectionism as a transdiagnostic factor by demonstrating that both dimensions are associated with various forms of psychopathology.
    December 27, 2016   doi: 10.1002/jclp.22435   open full text
  • Corrective Experiences of Psychotherapists in Training.
    Kathrin Moertl, Himanshu Giri, Lynne Angus, Michael J. Constantino.
    Journal of Clinical Psychology. December 27, 2016
    Although the concept of corrective experiences (CEs) is usually linked to the process of change in psychotherapy patients, we investigated them in the professional development of therapists‐in‐training. Inasmuch as psychotherapy is a relational process, it is important to look closely at how therapists reach the position of a competent partner in corrective experiencing. In this study, we interviewed 10 therapists‐in‐training undergoing their own training therapy. Responses to these semistructured interviews were analyzed using a computer‐assisted grounded theory method. The 499 first‐level categories were grouped into 5 main themes: therapist characteristics, therapist technical interventions, therapist relational interventions, relationship experience, and outcome experience. Two core categories representing corrective experiencing were (a) unexpected unconditional support from and trust in their own therapist and (b) unexpected confrontation and limitation with their therapist as well as awareness of self–other boundaries. Results are discussed in the broader context of the CE literature, relational theory, and relational practice.
    December 27, 2016   doi: 10.1002/jclp.22431   open full text
  • Relative Impact of Risk Factors, Thwarted Belongingness, and Perceived Burdensomeness on Suicidal Ideation in Veteran Service Members.
    Stephen S. O'Connor, Erin Carney, Keith W. Jennings, Lora L. Johnson, Peter M. Gutierrez, David A. Jobes.
    Journal of Clinical Psychology. December 16, 2016
    Objective We tested the associations between individualized risk factors, empirically validated constructs specific to suicide risk (i.e., thwarted belongingness and perceived burdensomeness, and two methods for conceptualizing suicidal ideation based on Suicide Index Score (SIS) and overall severity score of the Beck Scale for Suicide Ideation [BSS]). Method The current study included a sample of 134 suicidal Veterans who were recruited from an inpatient psychiatry unit of a Veterans Affairs Medical Center. Participants completed the BSS, Interpersonal Needs Questionnaire, Outcome Questionnaire‐45.2, Alcohol Use Disorder Identification Test, Drug Abuse Screening Test, and abbreviated versions of the Posttraumatic Stress Disorder Checklist‐Military version (PCL‐M) and Insomnia Severity Index. We used ordinary least squares regression with bootstrapping to conduct analyses due to the skewed distributions observed in the suicidal ideation outcomes. Results Thwarted belongingness was the only statistically significant correlate of the SIS, indicating a stronger desire to be dead than alive as Veterans perceived themselves as being increasingly disconnected and isolated from others (B = 0.36, standard error [SE] = 0.01, p = 0.005). In contrast, greater overall severity scores on the BSS were associated with higher ratings on the PCL‐M (B = 0.21, SE = 0.07, p = 0.02) and for thwarted belongingness (B = 0.27, SE = 0.09, p = 0.04). Problematic alcohol use was significantly associated with lower overall severity scores (B = −.27, SE = 1.17, p < 0.001). Conclusion Findings may inform clinical strategies for conceptualizing and targeting factors associated with suicidal risk.
    December 16, 2016   doi: 10.1002/jclp.22426   open full text
  • “For Me It Was a Key Moment of Therapy”: Corrective Experience From the Client's Perspective.
    Andrés Roussos, Malena Braun, Julieta Olivera.
    Journal of Clinical Psychology. December 16, 2016
    Despite recent attempts to develop a consensus definition, questions still remain as to what constitutes corrective experiences (CEs) in psychotherapy and how clients perceive them. This qualitative study assessed clients’ first person accounts of CEs associated with their own treatment‐related changes. Participants were 8 clients in private psychotherapy in Buenos Aires. Treatment, by therapists from diverse theoretical backgrounds, varied from 4 to 24 months. The Patients’ Perceptions of Corrective Experiences in Individual Therapy interview protocol was used to assess clients’ perceptions of CEs at posttreatment. All interviews were audiorecorded and transcribed and submitted to a 2‐stage thematic analysis to assess CEs and the contextual factors that contributed to them. Of the 8 participants, 5 narrated stories about CEs that changed the way they thought about themselves and their behavior. Additionally, clients highlighted disconfirmation of therapist role expectations and surprise regarding therapists’ actions and behaviors as mechanisms of these corrective moments.
    December 16, 2016   doi: 10.1002/jclp.22429   open full text
  • Cognitive Coping as a Mechanism of Change in Cognitive‐Behavioral Therapy for Fear of Flying: A Longitudinal Study With 3‐Year Follow‐Up.
    Bert Busscher, Philip Spinhoven.
    Journal of Clinical Psychology. December 16, 2016
    Objective To examine the predictive value of cognitive coping strategies at pretreatment and the value of changes in these strategies during cognitive‐behavioral treatment for aviophobia for long‐term therapy results. Method Data from baseline, after therapy at 2 months, short‐term follow‐up at 5 months, and long‐term follow‐up at 41 months were analyzed (N = 59). Results Participants were in a long‐term process of change, which continued positively after therapy for maladaptive cognitive coping strategies. The use of cognitive coping strategies at baseline was not predictive of long‐term outcome. However, a greater increase in the use of adaptive coping strategies, and more importantly, a greater decrease in the use of maladaptive coping strategies were predictive of improvements indicated in self‐report of flight anxiety and actual flight behavior at long‐term follow‐up. Conclusion Improvement of maladaptive cognitive coping strategies is possibly a key mechanism of change in cognitive‐behavioral therapy for aviophobia.
    December 16, 2016   doi: 10.1002/jclp.22424   open full text
  • Perceived Burdensomeness in Older and Younger Adults: Evaluation of the Psychometric Properties of the Interpersonal Needs Questionnaire.
    Julie Lutz, Amy Fiske.
    Journal of Clinical Psychology. December 15, 2016
    Objectives We evaluated measurement invariance of the Interpersonal Needs Questionnaire (INQ‐15) Perceived Burdensomeness subscale across younger and older adult age groups as well as the construct validity of the Perceived Burdensomeness subscale by comparing nomological networks across age groups. Method We used nested multigroup confirmatory factor analyses to address measurement invariance and Fisher's r‐to‐z transformations to compare correlations between perceived burdensomeness and other constructs in younger and older samples. Results Results generally supported measurement invariance, but signals of differences in fit in older adults were present. The INQ‐15 Perceived Burdensomeness subscale exhibited a significantly lower correlation with depressive symptoms in older adults compared to younger adults. Correlations between perceived burdensomeness and all other constructs were similar across age groups. Conclusion This study provides marginal support for measurement invariance of the INQ‐15 Perceived Burdensomeness subscale across younger and older adults, but results also suggest age differences in the perceived burdensomeness construct.
    December 15, 2016   doi: 10.1002/jclp.22415   open full text
  • Function of Personal Growth Initiative on Posttraumatic Growth, Posttraumatic Stress, and Depression Over and Above Adaptive and Maladaptive Rumination.
    Yuki Shigemoto, Blakely Low, Dominika Borowa, Christine Robitschek.
    Journal of Clinical Psychology. December 06, 2016
    Objectives The current study examined whether various types of rumination are distinguishable and the effects of personal growth initiative (PGI) on posttraumatic growth, posttraumatic stress, and depression through adaptive and maladaptive rumination. Method Sample included 292 college students who experienced a potentially traumatic event (PTE). Results Intrusive and deliberative rumination were found to be distinct factors. However, brooding and reflection, thought to be separate aspects of depression, were a single factor. PGI was positively associated with growth and negatively associated with depression for both genders, and a negative relationship was found between PGI and posttraumatic stress among women. Indirect effects of PGI were found on posttraumatic stress and growth through different forms of rumination. These relations did not change after including the covariates (i.e., time since the trauma, direct exposure, and intentional harm). Conclusion The study provides new insight integrating rumination from the depression literature in the context of trauma and a potential benefit in applying PGI in alleviating pathology after a PTE and facilitating growth.
    December 06, 2016   doi: 10.1002/jclp.22423   open full text
  • Resilience and Traumatic Brain Injury Among Iraq/Afghanistan War Veterans: Differential Patterns of Adjustment and Quality of Life.
    Timothy R. Elliott, Yu‐Yu Hsiao, Nathan A. Kimbrel, Eric Meyer, Bryann B. DeBeer, Suzy Bird Gulliver, Oi‐Man Kwok, Sandra B. Morissette.
    Journal of Clinical Psychology. December 06, 2016
    Objective We examined the degree to which a resilient personality prototype predicted adjustment among war Veterans with and without a traumatic brain injury (TBI) while covarying the level of combat exposure. Method A total of 127 war Veterans (107 men, 20 women; average age = 37 years) participated. Personality prototypes were derived from the Multidimensional Personality Questionnaire (Patrick, Curtain, & Tellegen, 2002). Measures were administered at baseline, and a subset was administered at 4‐ and 8‐month follow‐ups. Results Veterans with resilient personalities reported less sleep disturbance, more health‐promoting behaviors, psychological flexibility, and emotional distress tolerance than Veterans with undercontrolled or overcontrolled prototypes. Path models revealed that resilience significantly predicted posttraumatic stress disorder (PTSD), depression, quality of life, and social support over time. TBI had unique and consistent effects only on PTSD. Conclusion Personality characteristics influence distress and quality of life among war Veterans with and without TBI. Implications for assessment, interventions, and research are discussed.
    December 06, 2016   doi: 10.1002/jclp.22414   open full text
  • An Exploratory Investigation of Animal Hoarding Symptoms in a Sample of Adults Diagnosed With Hoarding Disorder.
    Jennifer E. Ung, Mary E. Dozier, Christiana Bratiotis, Catherine R. Ayers.
    Journal of Clinical Psychology. December 06, 2016
    Objective The extant research on animal hoarding has a dearth of information on animal hoarding tendencies in adults diagnosed with hoarding disorder (HD). In the present study, we investigated possible recurrent animal hoarding behavioral and symptom patterns in individuals diagnosed with hoarding disorder. Methods Hoarding severity scores from baseline assessments for 65 community‐dwelling adults diagnosed with HD were analyzed with respect to their present and past animal ownership characteristics. Results Approximately half of participants reported currently owning pets, and pet owners in the sample reported currently owning an average of two pets. Of the participants who reported currently owning animals, 10% reported having no rules for their pets’ behaviors, 51% reported having made at least one sacrifice for their pets, 54% reported having had at least one pet in childhood, and 29% reported that they believed they have a “special ability” to communicate with their pets. The results of the present study suggest that animal hoarding is not necessarily present in individuals diagnosed with HD. Conclusion No significant associations of current pet ownership characteristics with present hoarding severity were observed. Reported maximum number of pets owned in childhood was significantly correlated with present object hoarding symptom severity.
    December 06, 2016   doi: 10.1002/jclp.22417   open full text
  • Posttraumatic Rumination: Content, Correlates, and Processes.
    Christine E. Valdez, Michelle M. Lilly.
    Journal of Clinical Psychology. December 01, 2016
    Objective Trauma‐related rumination (i.e., repetitive and recurrent thinking about trauma and its consequences) has shown to predict the development and maintenance of posttraumatic stress disorder symptoms, though little is known about its characteristics. The purpose of this study was to examine trauma‐related ruminative content, correlates, and processes during a trauma‐specific repetitive thinking interview. Method A total of 63 female survivors of violence completed questionnaires assessing trauma‐related pathology and participated in a trauma‐specific repetitive thinking interview, which was qualitatively coded. Results Most participants expressed problematic (i.e., assimilated and overaccommodated) trauma beliefs during the interview, which were associated with baseline posttraumatic sequelae. Reexperiencing symptoms mediated the relation between a brooding response style and expressed problematic trauma beliefs. State negative emotions were associated with ruminative processes during the interview and predicted negative emotions after the interview. Conclusion Maladaptive trauma‐related rumination is characterized by perseveration on problematic trauma beliefs. Implications for treatment are discussed.
    December 01, 2016   doi: 10.1002/jclp.22371   open full text
  • Validation of the Parental Facilitation of Mastery Scale–II.
    Alyson K. Zalta, Kelly M. Allred, Eranda Jayawickreme, Laura E. R. Blackie, Dianne L. Chambless.
    Journal of Clinical Psychology. December 01, 2016
    Objective To develop a more reliable and comprehensive version of the Parental Facilitation of Mastery Scale (PFMS) Method In Study 1, 387 undergraduates completed an expanded PFMS (PFMS‐II) and measures of parenting, perceived control, responses to early life challenges, and psychopathology. In Study 2, 182 trauma‐exposed community participants completed the PFMS‐II and measures of perceived control, psychopathology, and well‐being Results In Study 1, exploratory factor analysis of the PFMS‐II revealed two factors. These factors replicated in Study 2; one item was removed to achieve measurement invariance across race. The final PFMS‐II comprised a 10‐item overprotection scale and a 7‐item challenge scale. In both samples, this measure demonstrated good convergent and discriminant validity and was more reliable than the original PFMS. Parental challenge was a unique predictor of perceived control in both samples Conclusion The PFMS‐II is a valid measure of important parenting behaviors not fully captured in other measures.
    December 01, 2016   doi: 10.1002/jclp.22416   open full text
  • Client Accounts of Corrective Experiences in Psychotherapy: Implications for Clinical Practice.
    Lynne Angus, Michael J. Constantino.
    Journal of Clinical Psychology. November 28, 2016
    The Patient Perceptions of Corrective Experiences in Individual Therapy (PPCEIT; Constantino, Angus, Friedlander, Messer, & Moertl, 2011) posttreatment interview guide was developed to provide clinical researchers with an effective mode of inquiry to identify and further explore clients’ firsthand accounts of corrective and transformative therapy experiences and their determinants. Not only do findings from the analysis of client corrective experience (CE) accounts help identify what and how CEs happen in or as a result of psychotherapy, but the measure itself may also provide therapists with an effective tool to further enhance clients’ awareness, understanding, and integration of transformative change experiences. Accordingly, we discuss in this afterword to the series the implications for clinical practice arising from (a) the thematic analysis of client CE accounts, drawn from a range of clinical samples and international research programs and (b) the clinical effect of completing the PPCEIT posttreatment interview inquiry. We also identify directions for future clinical training and research.
    November 28, 2016   doi: 10.1002/jclp.22432   open full text
  • Clients’ Retrospective Accounts of Corrective Experiences in Psychotherapy: An International, Multisite Collaboration.
    Michael J. Constantino, Lynne Angus.
    Journal of Clinical Psychology. November 23, 2016
    This article introduces a series of 4 original research reports that used varied qualitative methods for understanding an internationally diverse sample of clients’ own accounts of corrective experiences (CEs), as they looked back on their completed psychotherapy. The basis for all studies, which were conducted across 4 different countries, was the Patients’ Perceptions of Corrective Experiences in Individual Therapy (PPCEIT) semistructured interview protocol (Constantino, Angus, Friedlander, Messer, & Moertl, 2011). The PPCEIT interview assesses clients’ retrospective accounts of aspects of self, other, and/or relationships that may have been corrected, and what they perceived as corrective experiences that facilitated such transformations. It also asks for specific, detailed examples of these accounts and experiences. Across all studies, the PPCEIT interview generated rich clinical material and resulting empirically generated themes that may inform clinical practice. After briefly defining the CE construct and highlighting a lack of research on clients’ own accounts of such experiences, we describe the development of the PPCEIT interview (and provide the full interview manual and question protocol as appendices). We then summarize the foci of the culturally diverse reports in this series.
    November 23, 2016   doi: 10.1002/jclp.22427   open full text
  • Predictors and Outcomes of Growth Mixture Modeled Trajectories Across an Exposure‐Based PTSD Intervention With Veterans.
    Nicholas P. Allan, Daniel F. Gros, Ursula S. Myers, Kristina J. Korte, Ron Acierno.
    Journal of Clinical Psychology. November 23, 2016
    Objectives Exposure‐based psychotherapies for posttraumatic stress disorder (PTSD) are effective for many, but not all patients. It is important to determine for whom these treatments work and to examine predictors of success. Method An 8‐week modified prolonged exposure (PE) treatment, including components of behavioral activation and reducing the number of imaginal exposure sessions, was administered to a sample of 231 Veterans (mean age = 45.7 years, standard deviation = 14.89). Growth mixture modeling was used to model PTSD symptom trajectories across the 8‐week intervention and a postintervention appointment. Further, baseline demographics, social support, clinician‐rated PTSD symptoms, anxiety, and depression were examined as predictors of trajectories. Results Three classes emerged, labeled responders (n = 35), nonresponders (n = 190), and immediate responders (n = 6). The only significant baseline difference between responders and nonresponders was higher anxiety symptoms in the nonresponders. At follow‐up time points, there were higher levels of clinician‐rated PTSD, anxiety, and depression symptoms and lower social support in the nonresponders compared to the responders. Conclusion Findings suggest that modifying standard PE treatments by reducing imaginal exposure sessions while adding behavioral activation may not be advisable for most Veterans with PTSD.
    November 23, 2016   doi: 10.1002/jclp.22408   open full text
  • Patients’ Perceptions of Corrective Experiences in Naturalistically Delivered Psychotherapy.
    Michael J. Constantino, Nicholas R. Morrison, Alice E. Coyne, Brien J. Goodwin, Gennarina D. Santorelli, Lynne Angus.
    Journal of Clinical Psychology. November 23, 2016
    Corrective experiences (CEs), which suggest transformative experience(s) for the psychotherapy patient, have a rich theoretical history; yet there is little empirical information on patients’ own perceptions of what gets “corrected” from therapy, and what is “corrective” (i.e., the mechanisms driving the CE). To address this gap, we investigated 14 patients’ posttreatment accounts of both CE elements in the context of naturalistically delivered individual psychotherapy, using a consensual qualitative research methodology. Extending prior research focused on patients’ accounts of CEs while still engaged in treatment (Heatherington et al., 2012), the present results revealed that patients retrospectively identified an array of categories that were deemed corrected, such as positive changes in cognitions, interpersonal problems, self‐concepts, symptoms, and behaviors. Patients also identified CEs that may have led to those shifts/transformations, including their therapist's actions (especially giving feedback), their own agentic actions (especially engaging in the therapeutic process), and the patient–therapist collaborative and engaged relationship. Clinical practice implications are discussed.
    November 23, 2016   doi: 10.1002/jclp.22428   open full text
  • Effects of Interactions With Animals On Human Psychological Distress.
    Molly K. Crossman.
    Journal of Clinical Psychology. November 03, 2016
    Context Human–animal interaction (HAI) is widely used as a method of reducing psychological distress. However, research findings in support of HAI have not kept pace with the widespread prevalence in practice. Objective I review and synthesize the quantitative evidence for the influence of HAI on psychological distress and outline future directions for research. Results The evidence suggests that HAI has a small‐to‐medium effect on distress but does not clarify whether animals account for the treatment effects. Research also has not determined whether positive effects observed in circumscribed HAI programs extend to companion animal ownership. Conclusion HAI research needs to address methodological limitations and expand the focus beyond treatment outcome studies. By increasing our understanding of the processes through which HAI reduces distress, the circumstances under which it is most effective at doing so, and the influence HAI has on the animals, we can enhance the impact of HAI.
    November 03, 2016   doi: 10.1002/jclp.22410   open full text
  • Do Concepts of Depression Predict Treatment Pathways? A Closer Look at Explanatory Models Among Clinical and Nonclinical Samples in Uganda.
    Laura Renee Johnson, Eu Gene Chin, Mayanja Kajumba, Erin Buchanan, Simon Kizito, Paul Bangirana.
    Journal of Clinical Psychology. November 02, 2016
    Objective Explanatory models (EMs) are a collection of beliefs about a disorder that can help us understand help‐seeking and treatment pathways in diverse contexts. In 2 related studies, we explore EMs about depression held among both clinical and nonclinical samples in Uganda. To explore the potential of EMs to predict help seeking, we assessed the relationship between 2 main aspects of the EM: problem conceptualization and treatment. Method In Study 1, we interviewed and assessed EMs of depression for 135 lay community members and 111 professional practitioners using a vignette. In Study 2, we assessed actual EMs among 33 clinically depressed adults. We transcribed all interviews and analyzed and coded the content. In Study 1, we used logistic regression to examine the relationship of problem conceptualization and stigma to treatment choice; in Study 2, we used Fisher's exact tests to examine the relationship between conceptualization and treatment. Sociodemographics such as age, income, and language were also examined. Results Interviews elicited a diverse range of beliefs about the nature of depression and the types of treatment needed. However, problem conceptualization did not predict treatment in either group. Instead, education and interview language predicted treatment in clinical and nonclinical samples. Conclusion Although EMs can be useful for both exploring mental health and treatment‐related beliefs in clinical settings and developing mental health services, contextual factors may be more significant predictors of help seeking.
    November 02, 2016   doi: 10.1002/jclp.22378   open full text
  • Therapist and Client Interactions in Motivational Interviewing for Social Anxiety Disorder.
    Mia Romano, Jelena Arambasic, Lorna Peters.
    Journal of Clinical Psychology. October 31, 2016
    Objective The aim of the present study is to assess the bidirectional associations between therapist and client speech during a treatment based on motivational interviewing (MI) for social anxiety disorder. Method Participants were 85 adults diagnosed with social anxiety who received MI prior to entering cognitive behavioral therapy. MI sessions were sequentially coded using the Motivational Interviewing Skill Code 2.5. Results Therapist MI‐consistent behaviors, including open questions as well as positive and negative reflections, were more likely to be followed by client change exploration (change talk and counter‐change talk). Therapist MI‐inconsistent behaviors were more likely to precede client neutral language. Client language was also found to influence therapist likelihood of responding in an MI‐consistent manner. Conclusion The findings support the first step of the MI causal model in the context of social anxiety and direct future research into the effect of therapist and client behaviors on MI treatment outcome.
    October 31, 2016   doi: 10.1002/jclp.22405   open full text
  • Self‐Compassion Online: A Pilot Study of an Internet‐Based Self‐Compassion Cultivation Program for Psychology Trainees.
    Amy Finlay‐Jones, Robert Kane, Clare Rees.
    Journal of Clinical Psychology. October 27, 2016
    Objective The current study sought to conduct a preliminary investigation of the effectiveness and feasibility of a novel, self‐guided online self‐compassion training for reducing psychological distress and increasing self‐compassion and happiness among psychology trainees. Method A 6‐week online self‐compassion cultivation program was developed and delivered to Australian psychology trainees (n = 37), and a pre‐experimental repeated‐measures design was used to collect change data on self‐compassion, happiness, perceived stress, emotion regulation difficulties as well as symptoms of depression, anxiety, and stress. Results Participants reported significant increases in self‐compassion and happiness and significant decreases in depression, stress, and emotion regulation difficulties between pretest and posttest, with the majority of changes maintained at 3‐month follow up. Conclusion  This study provides preliminary evidence supporting the effectiveness and acceptability of online self‐compassion training as a positive, integrated, and meaningful way of reducing distress and promoting self‐compassion and happiness among trainee psychologists.
    October 27, 2016   doi: 10.1002/jclp.22375   open full text
  • Properties of the DASS‐21 in an Australian Community Adolescent Population.
    T. Shaw, M.A. Campbell, K.C. Runions, S. R. Zubrick.
    Journal of Clinical Psychology. October 23, 2016
    Background Although developed for adults, the Depression Anxiety Stress Scales‐Short Version (DASS‐21) has been used in many research studies with adolescent samples. Evidence as to the applicability of the DASS subscale scores to represent the distinct states of depression, anxiety, and stress as experienced by adolescents is mixed, and the age at which it may be possible to differentiate these 3 states using the DASS‐21 has not yet been determined. Objective This study evaluated evidence for a multifactor structure in the DASS‐21 in adolescents and the specificity of the 3 subscales for adolescents in general and at different ages. Method Data were from a large cross‐sectional survey of 2,873 school students in Grades 6–12 (aged 12–18 years) in Australia. We conducted confirmatory bifactor analyses testing a general mental health distress factor and 3 domain‐specific factors for anxiety, depression, and stress for the whole sample and across gender by age groups. The internal consistency reliability of the DASS total and subscale scores was determined using omega coefficients. Results Analyses identified that most of the variation in the items was explained by the dominance of a single, general factor and the subscales lacked specificity across all age groups. Conclusion The DASS‐21 can be reliably used to measure general distress in adolescents, but the subscales fail to discriminate between the 3 states. Our results indicate that this lack of discrimination does not reduce with increasing age. These findings caution against the use of adult theoretical models and measures within adolescent populations.
    October 23, 2016   doi: 10.1002/jclp.22376   open full text
  • Which Homeless Veterans Benefit From a Peer Mentor and How?
    Linda Resnik, Sarah Ekerholm, Erin E. Johnson, Marsha L. Ellison, Thomas P. O'Toole.
    Journal of Clinical Psychology. October 20, 2016
    Objective Veterans Affairs (VA) is expanding peer support. Research is limited on Veterans’ perspective on benefits from peer services. We describe homeless Veteran perceptions of value and examine characteristics associated with benefit. Method From a sample of Veterans in a multisite randomized control trial, we studied addition of peers in VA Primary Care and homeless‐oriented primary care clinics. We used qualitative methods to study the perceptions of peer services among a subsample of homeless Veterans. Quantitative methods were used to validate findings in both samples. Results Sixty‐five percent of the subsample and 83% of the full sample benefited from a peer mentor. Participants who benefited had more peer visits and minutes of intervention (p<.05), were more likely to be minority, and were less likely to have posttraumatic stress disorder. Conclusion The majority of Veteran participants in this study benefited from receiving peer mentor intervention. African American Veterans were more likely to benefit and Veterans with PTSD were less likely to benefit. Client endorsement of the peer's role influenced outcomes.
    October 20, 2016   doi: 10.1002/jclp.22407   open full text
  • Sluggish Cognitive Tempo is Associated With Poorer Study Skills, More Executive Functioning Deficits, and Greater Impairment in College Students.
    Andrew J. Flannery, Aaron M. Luebbe, Stephen P. Becker.
    Journal of Clinical Psychology. October 20, 2016
    Objectives Few studies have examined sluggish cognitive tempo (SCT) in college students even though extant research suggests a higher prevalence rate of SCT symptoms in this population compared to general adult or youth samples. The current study examined SCT symptoms in relation to two domains related to college student's academic success, study skills and daily life executive functioning (EF), as well as specific domains of functional impairment. Method 158 undergraduate students (Mage = 19.05 years; 64% female) completed measures of psychopathology symptoms, study skills, daily life EF, and functional impairment. Results After controlling for demographics and symptoms of attention‐deficit/hyperactivity disorder (ADHD), anxiety, and depression, SCT remained significantly associated with poorer study skills, greater daily life EF deficits, and global impairment and with greater functional impairment in the specific domains of educational activities, work, money/finances, managing chores and household tasks, community activities, and social situations with strangers and friends. In many instances, ADHD inattentive symptoms were no longer significantly associated with study skills or impairment after SCT symptoms were added to the model. Conclusion SCT is associated with poorer college student functioning. Findings highlight the need for increased specificity in studies examining the relation between SCT and adjustment.
    October 20, 2016   doi: 10.1002/jclp.22406   open full text
  • Online Evaluative Conditioning Did Not Alter Internalized Homonegativity or Self‐Esteem in Gay Men.
    John B. Fleming, Michelle Nicole Burns.
    Journal of Clinical Psychology. October 18, 2016
    Objective Internalized homonegativity is linked to psychological distress in sexual minorities and is thus a potential treatment target in this population. Previous studies have shown that evaluative conditioning (EC) can modify self‐esteem, another self‐directed attitude. The present study aimed to determine if EC deployed over the Internet could modify self‐esteem and internalized homonegativity. Method Gay men recruited online (N = 184) were randomly assigned to a control group or an experimental condition. Participants completed self‐reports and measures of implicit attitudes before and after being exposed to control or experimental tasks. The study was administered online. Results There were no significant between‐group differences on implicit or explicit self‐esteem (ps > .49) or internalized homonegativity (ps > .28). Conclusion Despite past laboratory success, Internet‐based EC did not produce significant effects in implicit or explicit self‐directed attitudes. Post hoc analyses did not support any of several potential explanations for these results. Alternative explanations are discussed.
    October 18, 2016   doi: 10.1002/jclp.22388   open full text
  • Mediators of Outcome in Complicated Grief Treatment.
    Kim Glickman, M. Katherine Shear, Melanie M. Wall.
    Journal of Clinical Psychology. October 18, 2016
    Objective In this study, we examined the mechanisms of action of complicated grief treatment (CGT), an efficacious psychotherapy for complicated grief. Method We explored 3 putative mediators (guilt/self‐blame related to the deceased, negative thoughts about the future, and avoidance) among treatment completers assigned to either CGT (n = 35) or interpersonal psychotherapy (n = 34) in a previously reported randomized controlled trial. Antidepressant use was examined as a moderator of mediation effects. Results A reduction in guilt/self‐blame, negative thoughts about the future, and avoidance behavior each mediated the relationship between treatment group and complicated grief outcomes. Reduction in avoidance emerged as an independent mediator after controlling for all mediators. Conclusion Reducing avoidance of situations and emotions connected to the loss seems to be a key mechanism of change in CGT. Revising counterfactual thinking around troubling aspects of the death may also play a role in facilitating effective adaptation to loss.
    October 18, 2016   doi: 10.1002/jclp.22384   open full text
  • Cognitive‐Behavioral Treatment of Hoarding in Youth: A Case Illustration.
    Dean McKay.
    Journal of Clinical Psychology. October 14, 2016
    Hoarding in children is associated with more severe ancillary psychopathology, and has poor treatment outcome. At present, there are no empirically established procedures for treating hoarding in youth. The present case illustration is of a 10‐year old child (“Grace”) who presented for treatment with significant hoarding related to academic concerns and additional unrelated symptoms of obsessive‐compulsive disorder (OCD). Grace was treated with cognitive behavior therapy (CBT) primarily comprising exposure with response prevention, behavioral experiments, and cognitive therapy, along with a program of reinforcement delivered by her parents to maintain her motivation for therapy. After 23 sessions and one booster session, Grace's symptoms improved significantly, with gains maintained at 1‐year follow‐up. In addition to the benefits of the specific interventions chosen, the role of therapist–patient/parent alliance as a contributory factor for good outcome is emphasized. As hoarding is underinvestigated in youth, suggestions for further investigation are offered.
    October 14, 2016   doi: 10.1002/jclp.22400   open full text
  • A Brazilian Investigation of the 36‐ and 16‐Item Difficulties in Emotion Regulation Scales.
    Fabiano Koich Miguel, Luciano Giromini, Maíra Stivaleti Colombarolli, Ana Carolina Zuanazzi, Alessandro Zennaro.
    Journal of Clinical Psychology. October 07, 2016
    Objective About 10 years ago, Gratz and Roemer (2004) introduced the Difficulties in Emotion Regulation Scale (DERS), a 36‐item self‐report instrument measuring 6 areas of emotion regulation problems. Recently, Bjureberg et al. (2015) have introduced a new, briefer version of the DERS comprising only 16 of the 36 items included in the original version. Because no studies have yet cross‐validated the recently introduced 16‐item DERS and the 36‐item DERS has never been tested in Brazil, we sought to inspect the psychometric properties of scores from both DERS versions with a nonclinical Brazilian sample. Method Participants were 725 adult volunteers aged 18–70 years (mean = 30.54, standard deviation = 10.59), 82.3% of whom were women. All were administered the DERS along with a number of other self‐report and performance‐based instruments. Data analyses inspected internal consistency, factor structure, and convergent as well as divergent validity of scores from both DERS versions. Results Results show that scores from both DERS versions possess good psychometric properties. Interestingly, both versions correlated, in the expected direction, with psychopathology and showed no significant correlations with cognitive measures. Like in other studies, however, the Awareness factor of the 36‐item DERS did not produce optimal validity and reliability indexes. Conclusion Taken together, our findings indicate that the 16‐item DERS may be preferred over the 36‐item version and provide additional support to the differentiation between emotion regulation and cognitive tasks of emotional perception and abstract and verbal reasoning.
    October 07, 2016   doi: 10.1002/jclp.22404   open full text
  • Treating Trichotillomania (Hair‐Pulling Disorder) in a Child.
    Ivar Snorrason, Michael R. Walther, T. David Elkin, Douglas W. Woods.
    Journal of Clinical Psychology. October 04, 2016
    Although cognitive behavioral treatments (CBTs) have been recommended as first‐line interventions for trichotillomania (hair‐pulling disorder [HPD]), research on CBT for young children with HPD is limited. We illustrate the use of family‐based CBT for HPD in an 8‐year‐old boy. The client had a 5‐year history of chronic HPD and several large bald spots on the crown of his head. Treatment primarily comprised habit reversal training (HRT) and function‐based interventions. The child showed significant improvement in HPD severity and impairment after 8 weekly sessions, although complete abstinence was not achieved. The findings underscore the importance of parental involvement in the treatment and show that children as young as 8 years of age can successfully use strategies taught in HRT.
    October 04, 2016   doi: 10.1002/jclp.22399   open full text
  • Emotional Awareness Moderates the Relationship Between Childhood Abuse and Borderline Personality Disorder Symptom Factors.
    John Westbrook, Howard Berenbaum.
    Journal of Clinical Psychology. October 04, 2016
    Objective To examine pathways to borderline personality disorder (BPD), focusing on childhood abuse and emotional attention and clarity. Method Among 293 community residents (mean age = 43.1; 53.9% female), measured associations between the BPD symptom factors of disturbed relatedness, affective dysregulation, and behavioral dysregulation and (a) childhood abuse (emotional, physical, and sexual); (b) emotional attention and clarity; and (c) negative affect, using structured interviews, the Schedule for Non‐Adaptive and Adaptive Personality‐2, the Trait Meta Mood Scale, and the Positive and Negative Affect Scale, respectively. Results All forms of childhood abuse were associated with BPD symptom factors. Emotional attention and clarity moderated the effects of childhood physical and emotional abuse on behavioral dysregulation and disturbed relatedness. All results held when controlling for negative affect. Conclusion The relations between childhood abuse and BPD are robust. Emotional attention and clarity may help elucidate the links between childhood abuse and BPD.
    October 04, 2016   doi: 10.1002/jclp.22389   open full text
  • Using Family‐Based Exposure With Response Prevention to Treat Obsessive‐Compulsive Disorder in Young Children: A Case Study.
    Jenny Herren, Jennifer Freeman, Abbe Garcia.
    Journal of Clinical Psychology. September 29, 2016
    Cognitive‐behavioral therapy (CBT) using exposure with response prevention (ERP) is the treatment of choice for obsessive‐compulsive disorder (OCD); however, developmental modifications should be considered when treating young children. This article presents a case study illustrating family‐based CBT using ERP with a 7‐year‐old boy. The delivery of ERP for this case was guided by 3 main principles: (a) family involvement with a focus on reducing family accommodation, (b) understanding the functional relation between the client's obsessions and compulsions, and (c) creating conditions to facilitate habituation during exposure. Outcomes for this case indicate significant improvement in functioning and OCD symptoms. Results highlight the importance of family involvement and the applicability of using a function‐based habituation framework when delivering ERP to this unique population.
    September 29, 2016   doi: 10.1002/jclp.22395   open full text
  • Internet‐Based Psychotherapy for Adult Depression: What About the Mechanisms of Change?
    Cristina Mogoașe, Oana Cobeanu, Oana David, Cezar Giosan, Aurora Szentagotai.
    Journal of Clinical Psychology. September 29, 2016
    Introduction Internet‐based cognitive behavioral therapy for depression (iCBT) has been advanced as a valuable alternative treatment option, generating promising results. However, little is known about its underlying mechanisms of change. Objective We aimed to provide an overview of the state of the art regarding the mechanisms of iCBT for adult depression, in the context of iCBT efficacy. Method We conducted a systematic qualitative review of 37 randomized clinical trials, assessed the risk of bias in the included studies, and used a systematic evaluative framework to establish the scientific status of iCBT, based on evidence regarding clinical efficacy and mechanisms of change. Results Findings indicated that iCBT mechanisms of change are clearly underinvestigated, although iCBT is relatively efficacious, at least in the short term. The quality of iCBT randomized clinical trials proved to be suboptimal. Conclusions The iCBT theory should be clearly specified and adequately investigated to design and implement highly efficacious therapeutic packages. Without considering the iCBT mechanisms of change along with iCBT efficacy, the extent to which iCBT is an empirically validated treatment remains questionable.
    September 29, 2016   doi: 10.1002/jclp.22326   open full text
  • Behavior Therapy for Youth With Tourette Disorder.
    Joseph F. McGuire.
    Journal of Clinical Psychology. September 27, 2016
    Persistent tic disorders and Tourette disorder (TD) are neuropsychiatric conditions that commonly co‐occur among youth with obsessive‐compulsive disorder. Although historically managed with pharmacological agents such as antipsychotics and alpha‐2 agonists, behavioral interventions like habit reversal training (HRT) and the comprehensive behavioral intervention for tics have demonstrated considerable efficacy in reducing tic symptom severity. This case study illustrates the implementation of behavior therapy in reducing tic symptom severity of an adolescent with TD. Arlene was a 14‐year‐old girl with TD who presented with moderate tic symptom severity that caused her physical, academic, and social impairment. In addition to concurrent pharmacotherapy, Arlene completed a 20‐session weekly course of HRT, and experienced a clinically meaningful reduction in tic symptom severity and tic‐related impairment. This example provides further evidence of the benefit of behavior therapy in reducing tic symptom severity and highlights key considerations for treatment of youth with TD.
    September 27, 2016   doi: 10.1002/jclp.22398   open full text
  • Understanding the Association Between Negative Life Events and Suicidal Risk in College Students: Examining Self‐Compassion as a Potential Mediator.
    Edward C. Chang, Tina Yu, Alexandria S.‐M. Najarian, Kaitlin M. Wright, Wenting Chen, Olivia D. Chang, Yifeng Du, Jameson K. Hirsch.
    Journal of Clinical Psychology. September 22, 2016
    Objective We tested a hypothesized model consistent with the notion that self‐compassion mediates the association between negative life events and suicidal risk (viz., depressive symptoms and suicidal behaviors) in college students Method The sample was comprised of 331 college students. Self‐compassion facets (viz., self‐kindness, self‐judgment, common humanity, isolation, mindfulness, and overidentification) were used in testing for multiple mediation, controlling for sex. Results Common humanity, mindfulness, and overidentification were found to mediate the association between negative life events (NLE) and depressive symptoms. However, common humanity was found to be the only mediator of the association between NLE and suicidal behaviors. Conclusion These findings suggest that there are specific facets of self‐compassion that account for the association between NLE and suicidal risk in college students and that (loss of) common humanity plays a central role in this process.
    September 22, 2016   doi: 10.1002/jclp.22374   open full text
  • Treatment of a Child With Obsessive‐Compulsive Disorder With Limited Motivation: Course and Outcome of Cognitive‐Behavior Therapy.
    Bernhard Weidle, Gudmundur Skarphedinsson.
    Journal of Clinical Psychology. September 22, 2016
    Motivation is a key ingredient in the successful treatment of pediatric obsessive‐compulsive disorder (OCD). As a first‐line treatment, cognitive‐behavior therapy (CBT) requires extensive client engagement, including participating in exposures and doing homework tasks. A lack of motivation to comply with these tasks may seriously affect treatment outcome. This case study identifies factors interfering with motivation and illustrates motivational strategies to enhance compliance of a child with OCD. The patient was an 11‐year‐old boy with severe OCD and symptoms of oppositional defiant disorder (ODD). He had extensive OCD‐related avoidance behavior but denied the presence of symptoms or did not acknowledge them as a problem. In this article, we discuss the different techniques used to enhance motivation, which subsequently led to a favorable outcome.
    September 22, 2016   doi: 10.1002/jclp.22394   open full text
  • Modified Cognitive Behavior Therapy for Severe, Treatment‐Resistant Obsessive‐Compulsive Disorder in an Adolescent With Autism Spectrum Disorder.
    Georgina Krebs, Kim Murray, Amita Jassi.
    Journal of Clinical Psychology. September 22, 2016
    There is a high rate of comorbidity between obsessive‐compulsive disorder (OCD) and autism spectrum disorders (ASD). Standard cognitive‐behavior therapy (CBT) protocols have been shown to be less effective in treating OCD in young people with ASD than in typically developing youth. This case study describes the treatment of an adolescent boy with severe, treatment‐resistant OCD and ASD using a modified CBT approach. Modifications to a standard evidence‐based CBT for OCD protocol included extended psychoeducation about anxiety; regular home‐based sessions; and increased involvement of systems, including family and school. Multi‐informant outcome data indicated significant improvements in OCD symptoms over the course of treatment with gains being maintained over a 12‐month follow‐up period. These findings demonstrate the potential efficacy of modified CBT for pediatric OCD in the context of ASD.
    September 22, 2016   doi: 10.1002/jclp.22396   open full text
  • Intensive Treatment of Pediatric OCD: The Case of Sarah.
    Lara J. Farrell, Rachel Sluis, Allison M. Waters.
    Journal of Clinical Psychology. September 22, 2016
    While cognitive behavior therapy (CBT) either alone or in combination with pharmacotherapy (e.g., selective serotonin reuptake inhibitor) has received strong empirical support for obsessive‐compulsive disorder (OCD; Geller & March, 2012), this treatment is often inaccessible for children and their families. Barriers to accessing CBT include a lack of trained therapists, clinician and patient beliefs about CBT, and geographical and financial barriers (Goisman et al., 1993; Marques et al., 2010; Turner, Heyman, Futh, & Lovell, 2009). Furthermore, while the majority of therapists endorse a CBT orientation, exposure therapy is rarely used in routine clinical practice (Whiteside, Deacon, Benito, & Stewart, 2016). This case study therefore describes an intensive 2‐ or 3‐session treatment of childhood OCD (e.g., Farrell et al., 2016) to improve efficient and rapid delivery of evidence‐based treatment. The case of Sarah illustrates this intensive treatment model and highlights clinical considerations for therapists when delivery a concentrated, time‐limited treatment.
    September 22, 2016   doi: 10.1002/jclp.22397   open full text
  • Managing Family Accommodation of OCD in the Context of Adolescent Treatment Refusal: A Case Example.
    Carly Johnco.
    Journal of Clinical Psychology. September 18, 2016
    Family accommodation is a common and widely studied phenomenon in families of youth with obsessive‐compulsive disorder (OCD). Family accommodation has been associated with increased symptom severity, poorer functional outcomes, and reduced treatment response. While family accommodation is increasingly targeted in family‐based treatment of OCD, there are cases where youth refuse treatment. In these circumstances, parent‐focused treatments that target reduction of family accommodation can be used to improve outcomes for youth with OCD. This case study illustrates the conceptualization and treatment of family accommodation in childhood OCD in the context of treatment refusal. Treatment was implemented without explicit involvement of the child. Parents reported moderate improvement in OCD symptoms at the end of treatment and a decrease in overall parent–child conflict. The findings illustrate how exposure and response principles can be implemented without direct involvement of the child in cases where youth show low motivation or refusal of treatment.
    September 18, 2016   doi: 10.1002/jclp.22393   open full text
  • A Case Report of Harm‐Related Obsessions in Pediatric Obsessive‐Compulsive Disorder.
    Monica S. Wu, Eric A. Storch.
    Journal of Clinical Psychology. September 18, 2016
    Harm‐related, or “aggressive,” obsessions are a symptom subtype in obsessive‐compulsive disorder (OCD). Given the violent nature of these thoughts, the stark contrast between the child's character and the content of these obsessions often results in high levels of distress for not only the patient but also the family. This case report illustrates the application of family‐based exposure and response prevention (ERP) for a 15‐year‐old male presenting with harm‐related obsessions and mild depressive symptoms secondary to the OCD. The obsessions primarily revolved around the fear of acting on unwanted impulses (e.g., stabbing a family member, pushing a friend onto oncoming traffic), and the compulsions entailed avoidance (both mental and physical), excessive reassurance seeking, and ritualistic confessions. The client underwent a 14‐week course of ERP involving repeated imaginal and in vivo exposures and behavioral activation to alleviate depressive symptoms. Significant improvements in obsessive‐compulsive symptom severity and depressive symptoms were observed posttreatment, elucidating the efficacy of treating harm‐related obsessions with a course of ERP.
    September 18, 2016   doi: 10.1002/jclp.22392   open full text
  • Symptom Reduction Without Remoralization: A Randomized, Waiting‐List Controlled Study Aimed at Separating Two Beneficial Psychotherapy Outcome Effects.
    Wiede Vissers, Ger P.J. Keijsers, Mirjam Kampman, Gert‐Jan Hendriks, Paul Rijnders, Giel J.M. Hutschemaekers.
    Journal of Clinical Psychology. September 14, 2016
    Objective Treatment effects in psychotherapy outcome research are generally based on the reduction of symptoms. Standard inclusion of other beneficial treatment effects such as remoralization (increase of hope, self‐efficacy, well‐being) might lead to more elaborate findings in the field of psychotherapy. On the other hand, it is also possible that symptom reduction and remoralization always go hand in hand in the experience of patients. The present study sought to experimentally test this assumption. Method A total of 78 patients suffering from panic disorder were randomly assigned to brief remoralization treatment, brief exposure treatment, or waiting list (WL). Results Both treatments increased remoralization and both reduced symptoms of panic disorder as compared to WL. Conclusion It is unlikely that patients experience remoralization without symptom reduction or symptom reduction without remoralization. These findings do not favor the assumption that conclusions within psychotherapy outcome research are flawed because of its heavy reliance on measurements of symptom reduction.
    September 14, 2016   doi: 10.1002/jclp.22380   open full text
  • The Roles of Fathers' Posttraumatic Stress Symptoms and Adult Offspring's Differentiation of the Self in the Intergenerational Transmission of Captivity Trauma.
    Shelly Nicolai, Gadi Zerach, Zahava Solomon.
    Journal of Clinical Psychology. September 13, 2016
    Objectives This prospective study aims to assess the role of fathers' posttraumatic stress disorder (PTSD) symptoms (PTSS), the course of these symptoms over the years, and the relationship between these symptoms and their adult offspring's own PTSS and level of differentiation of self. Method A sample of 123 Israeli father–child dyads (79 ex‐prisoners of war [ex‐POWs] dyads and a comparison group of 44 veterans' dyads) completed self‐report measures. The fathers participated in 2 waves of measurements (1991 and 2008), while the offspring took part in 2013–2014. Results Increase in the fathers' PTSS over the years was related to high levels of his offspring's PTSS. Among ex‐POWs' offspring, self‐differentiation mediated the association between the father's PTSS and offspring's PTSS. Thus, a greater increase in the ex‐POWs' PTSS over time was correlated to lower levels of the offspring's self‐differentiation, which in turn was correlated to higher rates of PTSS. Conclusion Veterans' PTSS as well as offspring's self‐differentiation are mechanisms of the intergenerational transmission of captivity trauma.
    September 13, 2016   doi: 10.1002/jclp.22377   open full text
  • Examining the Psychological Effect of Rape Acknowledgment: The Interaction of Acknowledgment Status and Ambivalent Sexism.
    Laura C. Wilson, Katherine E. Miller, Emma K. Leheney, Alesha D. Ballman, Angela Scarpa.
    Journal of Clinical Psychology. September 09, 2016
    Objective Although the majority of rape survivors do not label their experiences as rape (i.e., unacknowledged rape), the literature is mixed in terms of how this affects survivors’ psychological functioning. To elucidate the discrepancies, the present study examined the interaction between rape acknowledgement and ambivalent sexism in relation to depression and posttraumatic stress disorder (PTSD) symptoms. Method The analyzed sample included 128 female rape survivors who were drawn from a larger college sample of 1,595 participants. The participants completed measures of sexual assault experiences, ambivalent sexism, and depression and PTSD symptoms. Results The results supported a significant interaction between acknowledgement status and benevolent sexism in relation to both depression and PTSD symptoms. Conversely, the present study failed to find support for an interaction between acknowledgment status and hostile sexism. Conclusion The clinical implications suggest that rather than seeing acknowledging rape as essential to the recovery process, clinicians should assess for and take into account other factors that may contribute to psychological functioning. Additionally, the findings support that more complex models of trauma recovery should be investigated with the goal of working toward a more comprehensive understanding of the longitudinal process of rape acknowledgment.
    September 09, 2016   doi: 10.1002/jclp.22379   open full text
  • Effects of Cognitive Distortions on the Link Between Dating Violence Exposure and Substance Problems in Clinically Hospitalized Youth.
    Adam Bryant Miller, Caitlin Williams, Catherine Day, Christianne Esposito‐Smythers.
    Journal of Clinical Psychology. August 23, 2016
    Purpose The purpose of the present study was to examine whether cognitive distortions (e.g., cognitive errors; negative views of self, world, and future) influence the association between dating violence and problematic substance use behaviors in a sample of psychiatrically hospitalized adolescents. Method Participants included 155 adolescents, aged 13–17 years, who had initiated dating. Adolescents completed measures of dating violence, substance‐related problems (alcohol and marijuana), and cognitive distortions. Results Logistic regressions were conducted to examine the direct and interactive effects of dating violence exposure and cognitive distortions on likelihood of recent problematic substance use. Results suggested a main effect of dating violence on problematic alcohol and other drug use as well as an interactive effect of dating violence and cognitive distortions. Specifically, the relationship between dating violence and odds of substance‐related problems was higher among those with greater (vs. fewer) cognitive distortions. Conclusion Study results suggest the need for careful screening of cognitive distortions among adolescent dating violence victims, particularly those in mental health treatment.
    August 23, 2016   doi: 10.1002/jclp.22373   open full text
  • Global Mental Health in Our Own Backyard: An Unaccompanied Immigrant Child's Migration From El Salvador to New York City.
    Charles D. R. Baily, Schuyler W. Henderson, Rachel Tayler.
    Journal of Clinical Psychology. August 23, 2016
    There has been a recent surge in the number of children migrating to the United States without a parent. Despite their vulnerability to extreme adversity at every stage of their migration process, little is known about the psychosocial context and mental health needs of unaccompanied children. This article presents a case study of a 16‐year‐old Salvadoran boy who participated in a larger, mixed‐methods study on the psychosocial context, psychological presentation, and mental health service utilization of unaccompanied children living in New York pending their immigration cases. After the presentation of the case, different models for understanding the experiences and needs of unaccompanied children are discussed.
    August 23, 2016   doi: 10.1002/jclp.22358   open full text
  • Living in the Shadows: Plight of the Undocumented.
    Roy Aranda.
    Journal of Clinical Psychology. August 23, 2016
    The word “immigration” has become a household buzzword. The welcome sign on the Statue of Liberty that reads, “Give me your tired, your poor, your huddled masses yearning to breathe free,” however, is fading and has been replaced by many complicated conditions. What to do with the very large number of undocumented immigrants living in the United States and arriving at the United States every day commands considerable attention and has been the subject of breaking stories in the news. Working in the field of immigration demands an awareness of and sensitivity to diversity and cultural competence. Despite a “hot” sociopolitical climate when it comes to undocumented aliens and what to do with them, there are many ethical tenets that psychologists must be familiar with, among them rendering competent multicultural services. This article offers an overview of immigration law, the challenges of performing culturally competent assessments and consequences of failing to do so, and the plight of a particularly vulnerable group: unaccompanied children. Vignettes offer a personal look into the proceedings of 7 undocumented individuals in 4 major areas: asylum, hardship, U‐Visa, and VAWA.
    August 23, 2016   doi: 10.1002/jclp.22361   open full text
  • Global Mental Health: An Introduction.
    Helen Verdeli.
    Journal of Clinical Psychology. August 17, 2016
    In this introductory paper to the Global Mental Health volume, the inception and development of the filed in the last 15 years is reviewed, placing an emphasis on a series of pivotal turning points. A critical delivery strategy, task‐shifting is briefly described, as well as the fundamental principles of Interpersonal Psychotherapy (IPT), an evidence‐based psychotherapy being adapted and delivered in low‐resource settings. Nine case studies by the trainees, supervisors, or local providers from India, the United States, Haiti, Israel, Colombia, and Kenya, presented in this volume, illustrate the prevention and treatment processes or in‐depth assessment of “psychological distress” as locally defined and expressed.
    August 17, 2016   doi: 10.1002/jclp.22357   open full text
  • Community Norms and Human Rights: Supervising Haitian Colleagues on Interpersonal Psychotherapy (IPT) With a Depressed and Abused Pregnant Woman.
    Helen Verdeli, Tatiana Therosme, Eddy Eustache, Olissaint St Hilaire, Benissois Joseph, Cemile Ceren Sönmez, Giuseppe Raviola.
    Journal of Clinical Psychology. August 17, 2016
    After the 2010 Haiti earthquake, Zanmi Lasante, a local health care organization, implemented a collaborative stepped‐care model to address depression in community and primary care settings in rural Haiti. Specialized community health workers, the ajans santé, collaborate with local psychologists and primary care doctors to offer home‐based evaluation, support, and follow‐up. The services include brief interpersonal psychotherapy (IPT) and/or medication to persons who met locally defined criteria for depression. A cross‐national (Haiti–United States) expert mental health team has been overseeing the program. The present IPT supervision case of a severely depressed, physically abused, and pregnant young woman illustrates the U.S.‐based supervisor's internal struggle to reconcile awareness of and respect for local norms while maintaining a human rights‐based framework. It also highlights the critical role of community health workers in addressing the mental health treatment gap in regions plagued by extreme poverty and adversity.
    August 17, 2016   doi: 10.1002/jclp.22366   open full text
  • Patient Characteristics and Patient Behavior as Predictors of Outcome in Cognitive Therapy and Exposure Therapy for Hypochondriasis.
    Samantha Richtberg, Marion Jakob, Volkmar Höfling, Florian Weck.
    Journal of Clinical Psychology. August 17, 2016
    Objective Psychotherapy for hypochondriasis has greatly improved over the last decades and cognitive‐behavioral treatments are most promising. However, research on predictors of treatment outcome for hypochondriasis is rare. Possible predictors of treatment outcome in cognitive therapy (CT) and exposure therapy (ET) for hypochondriasis were investigated. Method Characteristics and behaviors of 75 patients were considered as possible predictors: sociodemographic variables (sex, age, and cohabitation); psychopathology (pretreatment hypochondriacal symptoms, comorbid mental disorders, and levels of depression, anxiety, and somatic symptoms); and patient in‐session interpersonal behavior. Results Severity of pretreatment hypochondriacal symptoms, comorbid mental disorders, and patient in‐session interpersonal behavior were significant predictors in multiple hierarchical regression analyses. Interactions between the predictors and the treatment (CT or ET) were not found. Conclusions In‐session interpersonal behavior is an important predictor of outcome. Furthermore, there are no specific contraindications to treating hypochondriasis with CT or ET.
    August 17, 2016   doi: 10.1002/jclp.22356   open full text
  • The Impact of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization.
    Autumn Lanoye, Karen E. Stewart, Bruce D. Rybarczyk, Stephen M. Auerbach, Elizabeth Sadock, Arpita Aggarwal, Rachel Waller, Susan Wolver, Kristin Austin.
    Journal of Clinical Psychology. August 09, 2016
    Objective The integration of psychological and behavioral health services into safety net primary care clinics has been viewed as a step toward reducing disparities in mental health treatment and addressing behavioral factors in chronic diseases. Though it is posited that integrated behavioral health (IBH) reduces preventable medical costs, this premise has yet to be tested in a safety net primary care clinic. Method Retrospective pre‐ and posttreatment analysis with quasi‐experimental control group was constructed using propensity score matching. Participants included 1,440 adult patients at a safety net primary care clinic, 720 of whom received IBH services, and 720 of whom received medical treatment only. Results Analysis showed that rates of preventable inpatient utilization decreased significantly among IBH‐treated patients compared to no change among control patients. Conclusion IBH was associated with decreased rates of preventable inpatient visits. IBH may present opportunities to deliver improved holistic patient care while reducing unnecessary inpatient medical utilization.
    August 09, 2016   doi: 10.1002/jclp.22367   open full text
  • Helping the Helpers: Assisting Staff and Volunteer Workers Before, During, and After Disaster Relief Operations.
    Randal P. Quevillon, Brandon L. Gray, Sara E. Erickson, Elvira D. Gonzalez, Gerard A. Jacobs.
    Journal of Clinical Psychology. August 09, 2016
    Self‐care strategies and system supports employed in preparation for, during, and after disaster relief operations (DROs) are crucial to relief worker well‐being and the overall effectiveness of relief efforts. Relief organizations and management must structure DROs in a manner that promotes self‐care and workers must implement proper self‐care strategies. Proper self‐care before, during, and after a DRO can reduce negative reactions to stressful emergency work and promote growth, mastery, and self‐efficacy after the experience. Therefore, the purpose of this article is to discuss the importance of organizational supports and self‐care strategies in disaster relief settings. This article emphasizes the role of both individual and management participation and commitment to relief worker support and positive experience in DROs and provides suggestions for doing so. These suggestions are derived from the empirical and experiential literature and extensions from the theoretical background, and from our experience as managers in DROs.
    August 09, 2016   doi: 10.1002/jclp.22336   open full text
  • Peripartum Depression, Traditional Culture, and Israeli Society.
    Sharon Dekel, Varda Stanger, Emily R Georgakopoulos, Caren M Stuebe, Gabriella A Dishy.
    Journal of Clinical Psychology. August 03, 2016
    Although it is known that culture affects psychopathology, the nature of the relationship between culture and peripartum depression (PPD) is not fully understood. Here we report on 2 cases of Israeli women who are affiliated with traditional cultural groups that emphasize reproduction but developed PPD after childbirth. The first woman is an ultra‐Orthodox Israeli Jew and the second is an Israeli Arab. The 2 cases illustrate the effect of cultural beliefs and rituals on the conceptualization, treatment, and trajectory of PPD. The cases suggest a complex relationship between traditional cultures and PPD, including the possibility that cultural factors may have both adaptive and maladaptive consequences. Future qualitative and quantitative studies are needed to further clarify this relationship.
    August 03, 2016   doi: 10.1002/jclp.22360   open full text
  • Effectiveness of Mindfulness‐Based Stress Reduction Bibliotherapy: A Preliminary Randomized Controlled Trial.
    Holly Hazlett‐Stevens, Yelena Oren.
    Journal of Clinical Psychology. August 03, 2016
    Objective This randomized controlled investigation examined the effectiveness of a self‐help bibliotherapy format of the evidence‐based mindfulness‐based stress reduction (MBSR) intervention. Method College students seeking stress reduction were randomly assigned to a 10‐week MBSR bibliotherapy intervention group (n = 47) or a no‐treatment control group (n = 45). Self‐report measures were collected at baseline and postintervention. Results A total of 25 bibliotherapy and 43 control group participants provided final data following the intervention period. Compared to the control group, bibliotherapy participants reported increased mindfulness following the intervention. Significant decreases on measures of depression, anxiety, stress, perceived stress, and anxiety sensitivity also were reported postintervention as well as increased quality of life in physical health, psychological, and environmental domains. No statistically significant group effects were found for social relationships quality of life domain, worry, and experiential avoidance measures. Conclusion This MBSR workbook may provide an acceptable and effective alternative for motivated individuals seeking to reduce stress, at least for a select group of individuals who are willing and able to sustain participation in the intervention.
    August 03, 2016   doi: 10.1002/jclp.22370   open full text
  • Maternal PTSD and Children's Adjustment: Parenting Stress and Emotional Availability as Proposed Mediators.
    Kristin W. Samuelson, Christina K. Wilson, Elena Padrón, Suellen Lee, Lauren Gavron.
    Journal of Clinical Psychology. August 03, 2016
    Objectives Maternal posttraumatic stress disorder (PTSD) is a risk factor for negative child adjustment, but it is unclear whether this association is direct (e.g., a mother's PTSD symptoms are observed, learned, and internalized by children which results in behavioral and emotional problems) or indirect, through parent–child relationship difficulties or parenting stress. We hypothesized that parenting stress and maternal emotional availability would exhibit indirect effects on relationships between maternal PTSD and children's functioning. Method Participants were 52 trauma‐exposed mothers and their children (aged 7–12 years). Mothers completed measures of PTSD and parenting stress and reported on their children's functioning. Emotional availability was assessed through observer‐rated mother–child interactions. Results Emotional availability was not related to PTSD or child outcomes. Parenting stress had a substantial indirect effect on the relationships between maternal PTSD and child emotion regulation, internalizing, and externalizing behaviors. Conclusions Results highlight the need to target parenting stress in interventions with trauma‐exposed families.
    August 03, 2016   doi: 10.1002/jclp.22369   open full text
  • The Application of Positive Psychotherapy in Mental Health Care: A Systematic Review.
    Sophie Walsh, Megan Cassidy, Stefan Priebe.
    Journal of Clinical Psychology. August 02, 2016
    Objective Positive psychotherapy (PPT) stems from the positive psychology movement and is a multicomponent model promoting therapeutic change by developing engagement, pleasure, and meaning. There is some evidence it is effective for depression. PPT is recommended as a flexible model that can be applied to other patient groups alongside other treatments approaches. However, it remains unclear which of the many components are applied. The study aimed to identify how PPT is applied in mental health care. Method We systematically searched online databases, including Medline, Embase, PsycINFO, British Nursing Index, Cumulative Index of Nursing and Applied Health, and Cochrane registers (CENTRAL), and completed complementary hand and citation searches. Narrative synthesis was used for analysis. Results A total of 12 papers (from 9 studies) widely applied some PPT components (e.g., blessings journal, character strengths) and scarcely applied others (e.g., satisficing plan or family strengths tree). However, papers poorly described the intervention and rationale for applying components. Conclusion Given the lack of rationale for applying PPT, further research is needed to establish which components are acceptable and feasible for use in different patient groups and settings.
    August 02, 2016   doi: 10.1002/jclp.22368   open full text
  • Evidence for the Propositions of the Interpersonal Theory of Suicide Among a Military Sample.
    Caroline Silva, Christopher R. Hagan, Megan L. Rogers, Bruno Chiurliza, Matthew C. Podlogar, Melanie A. Hom, Mirela Tzoneva, Ingrid C. Lim, Thomas E. Joiner.
    Journal of Clinical Psychology. August 01, 2016
    Objective Although the interpersonal theory of suicide may explain the elevated suicide risk among military service members, past explorations have been equivocal. This study aimed to investigate the propositions of the interpersonal theory in a sample of U.S. Army recruiters. Method Participants (N = 3,428) completed self‐report measures assessing the interpersonal theory's constructs (i.e., thwarted belongingness (TB), perceived burdensomeness (PB), acquired capability for suicide), current suicidal ideation, agitation, and insomnia. History of depression was obtained from medical records. Results Hierarchical multiple regression analyses revealed that the interaction between TB and PB was associated with current suicidal ideation, controlling for depression, agitation, and insomnia. This effect was especially notable among those with high capability for suicide. Conclusion Findings provide support for the interpersonal theory in a large, diverse military sample. It may be advantageous to assess and therapeutically address TB and PB among at‐risk service members.
    August 01, 2016   doi: 10.1002/jclp.22347   open full text
  • The Role of Emotion‐Driven Impulse Control Difficulties in the Relation Between Social Anxiety and Aggression.
    Laura J. Dixon, Matthew T. Tull, Aaron A. Lee, Nathan A. Kimbrel, Kim L. Gratz.
    Journal of Clinical Psychology. August 01, 2016
    Objectives To enhance our understanding of the factors that may account for increased aggression in socially anxious individuals, this study examined associations among emotion‐driven impulse control difficulties, social anxiety, and dimensions of aggression (i.e., hostility, anger, physical aggression, verbal aggression). Method Individuals (N = 107; 73.8% male; Mage = 40.8 years) receiving residential substance abuse treatment participated in this cross‐sectional study. Results Social anxiety symptoms were significantly positively correlated with emotion‐driven impulse control difficulties, anger, and hostility, but not verbal or physical aggression. Separate models for each aggression facet were examined to test the direct and indirect paths. Bootstrapped mediation analyses indicated a significant indirect path from social anxiety symptoms to each facet of aggression through emotion‐driven impulse control difficulties (ps < .05). Conclusion Results highlight the potential utility of targeting emotion‐driven impulse control difficulties to decrease aggression among socially anxious individuals.
    August 01, 2016   doi: 10.1002/jclp.22372   open full text
  • “When Grief Breaks Your Heart”: A Case Study of Interpersonal Psychotherapy Delivered in a Primary Care Setting.
    Maria Fatima Gomes, Neerja Chowdhary, Eleni Vousoura, Helen Verdeli.
    Journal of Clinical Psychology. August 01, 2016
    Depression and anxiety, the so‐called common mental disorders (CMDs), are highly prevalent and disabling, yet remain largely untreated. This treatment gap is particularly true in low‐ and middle‐income settings, where there is significant scarcity of resources (including human resources) and treatment accessibility is complicated by stigma surrounding mental illness. To address these challenges, the MANAS trial, one of the largest to date randomized, controlled trials, aimed to test the effectiveness of a stepped care intervention led by lay health counselors in primary care settings in Goa, India. Six‐ and 12‐month follow‐up outcomes suggest that MANAS was a safe, feasible, effective, and cost‐effective intervention for CMDs in that context. This article demonstrates the use of culturally adapted IPT as an intervention to treat CMDs in a 54‐year‐old Indian primary care patient struggling with depression and heart‐related problems after his wife's death. A case formulation is presented based on core IPT principles, followed by detailed delineation of treatment from beginning through termination.
    August 01, 2016   doi: 10.1002/jclp.22362   open full text
  • On Belonging: The American Adolescent of Arab Descent.
    Lama Z. Khouri.
    Journal of Clinical Psychology. July 29, 2016
    Although American families of Arab origin come from 22 countries and from varied backgrounds and cultures, reports suggest that they suffer equally from acculturation stress, stereotyping, discrimination, and the reverberations of the aftermath of September 11 as well as global affairs. However, because children and adolescents from these families, particularly those who are newly arrived immigrants, tend to do well in school, they are rarely targeted by research or policy. This article uses the narratives of 5 middle school age male students from Arab descent who were in a support group that met for 3 years (2004–2007), beginning shortly after President George W. Bush's declaration of the war on the “axis of evil.” I used vignettes from this group to illustrate the stressors this population faces. The final section suggests an option for supporting this population.
    July 29, 2016   doi: 10.1002/jclp.22363   open full text
  • Associations Between Posttraumatic Stress Disorder, Emotion Dysregulation, and Alcohol Dependence Symptoms Among Inner City Females.
    Brittany Goldstein, Bekh Bradley, Kerry J. Ressler, Abigail Powers.
    Journal of Clinical Psychology. July 28, 2016
    Objective The purpose of this study was to examine how emotion dysregulation (ED) might help explain the relationship between posttraumatic stress disorder (PTSD) and alcohol dependence (AD) symptoms in females. Method Participants included 260 women from primary, diabetes, and gynecological clinics of an urban public hospital. This is a primarily African American sample (96.9%), including individuals reporting exposure to at least 1 traumatic event. We examined the associations and predictability patterns between severity of PTSD symptoms, ED, and AD symptoms. Results Using linear regression analyses, PTSD avoidance and numbing symptoms and ED were significant predictors of AD symptoms. When looking at specific dimensions of ED, one's inability to engage in goal‐directed behavior under strong emotional influences showed a full indirect effect on the relationship between PTSD avoidance and numbing symptoms and AD symptoms. Conclusion Our findings suggest that having poor emotion regulation skills may help explain why females with PTSD become dependent on alcohol.
    July 28, 2016   doi: 10.1002/jclp.22332   open full text
  • “You Pulled Me out of a Dark Well”: A Case Study of a Colombian Displaced Woman Empowered Through Interpersonal Counseling (IPC).
    Angela Milena Gomez Ceballos, Ana Claudia Andrade, Talia Markowitz, Helen Verdeli.
    Journal of Clinical Psychology. July 28, 2016
    Interpersonal counseling (IPC), a briefer and simplified adaptation of interpersonal psychotherapy (IPT), was used with internally displaced women (IDW) in Bogotá, Colombia, an implementation study of a mental health care pathway funded by Grand Challenges Canada. Preliminary evidence suggests that IPC led to positive outcomes for IDW and may be a feasible first line treatment for displaced women with elevated symptoms of common mental disorders. The case study demonstrates the use of IPC as an intervention to treat depression, anxiety, and posttraumatic stress symptoms in one participant across 11 sessions, from the case formulation through the termination phase.
    July 28, 2016   doi: 10.1002/jclp.22365   open full text
  • Collaborative Interpersonal Psychotherapy for HIV‐Positive Women in Kenya: A Case Study From the Mental Health, HIV and Domestic Violence (MIND) Study.
    Elizabeth Opiyo, Linnet Ongeri, Grace Rota, Helen Verdeli, Thomas Neylan, Susan Meffert.
    Journal of Clinical Psychology. July 27, 2016
    We examine the efficacy of nonspecialists delivering interpersonal psychotherapy (IPT) to HIV‐positive (HIV+) women. We describe a case in which local personnel without prior mental health training delivered IPT for the treatment of depression and posttraumatic stress disorder in an HIV+ woman who reported experiencing gender‐based violence and was enrolled in HIV care at the Family AIDS, Care, Education and Services program in Kisumu, Kenya.
    July 27, 2016   doi: 10.1002/jclp.22359   open full text
  • Narratives of Violence, Pathology, and Empowerment: Mental Health Needs Assessment of Home‐Based Female Sex Workers in Rural India.
    Srishti Sardana, Marina Marcus, Helen Verdeli.
    Journal of Clinical Psychology. July 27, 2016
    This study explores the narratives of psychological distress and resilience among a group of female sex workers who use residential spaces to attend to clients in rural India. The narratives reflect the lived experiences of these women. They describe the women's reasons for opting into sex work; guilt, shame, and stigma related to their sex worker status; experiences with intimate partner and domestic violence; health‐related problems; communication with their family members about their sex worker status; mental health referral practices among the women; and elements of resilience and strength that they experience within themselves and within their community of fellow sex workers. The article also offers elements of our own experiences of recruiting the women to participate in the focus group, training local outreach workers in conducting focus group discussions, and forging a collaboration with a local community‐based organization to highlight important barriers, challenges, and strategies for planning a group‐based discussion to explore the mental health needs of home‐based sex workers.
    July 27, 2016   doi: 10.1002/jclp.22364   open full text
  • Adults’ Explanations for Intimate Partner Violence During Childhood and Associated Effects.
    Sandra A. Graham‐Bermann, Åsa K. Cater, Laura E. Miller‐Graff, Kathryn H. Howell.
    Journal of Clinical Psychology. July 26, 2016
    Objectives Exposure to intimate partner violence (IPV) is known to challenge children's optimal development. This study sought to associate participants’ beliefs about IPV held during childhood with their adjustment as adults, and to compare their beliefs from childhood to their beliefs in early adulthood. Method A nationally representative sample of 703 Swedish young adults reported on their past and present beliefs about the causes of their parents’ IPV. Standardized measures assessed their mental health (anxiety, depression, and traumatic stress symptoms) and the quality of their relationships as adults. Results The most common explanations for IPV were that the perpetrator suffered from physical or mental illness, had relationship problems, or was distressed. Participants were less likely to blame themselves for IPV or to believe that the perpetrator was cruel when they were adults, compared to their reports of themselves as children. Women were more likely to attribute mental or physical illness as the cause of the perpetrator's IPV. Childhood beliefs that the perpetrator was debilitated (from mental illness or substance abuse) and cruel (took pleasure in violence and/or despised the child) were associated with greater mental health problems and poorer relationship quality in adulthood. Conclusion Evaluation of children's harmful beliefs about IPV could be useful in adapting intervention services aimed at ameliorating negative personal causal attributions.
    July 26, 2016   doi: 10.1002/jclp.22345   open full text
  • Attentional Control Scale for Children: Factor Structure and Concurrent Validity Among Children and Adolescents Referred for Anxiety Disorders.
    Raquel Melendez, Michele Bechor, Yasmin Rey, Jeremy W. Pettit, Wendy K. Silverman.
    Journal of Clinical Psychology. July 26, 2016
    Objective The present study examined the factor structure and concurrent validity of the Attentional Control Scale for Children (ACS‐C; Muris, de Jong, & Engelen, 2004), a youth self‐rating scale of attentional control. Method A multisource assessment approach was used with 186 children and adolescents referred to an anxiety disorders specialty clinic. Results Exploratory factor analysis yielded a 2‐factor structure with internally consistent and moderately correlated subscales of Attentional Focusing and Attentional Shifting. Total ACS‐C and subscale scores demonstrated significant associations with youth and parent ratings of youth anxiety symptoms, youth self ratings of depressive symptoms, and youth diagnosis of attention deficit–hyperactivity disorder. Conclusions These findings support use of the ACS‐C as a self‐rating scale of attentional control among referred youth. Future research is encouraged to examine retest reliability of the ACS‐C and to evaluate whether its internal structure could be enhanced by removing or modifying items that performed poorly.
    July 26, 2016   doi: 10.1002/jclp.22346   open full text
  • Meaning and Posttraumatic Growth Among Survivors of the September 2013 Colorado Floods.
    Pinar Dursun, Michael F. Steger, Christoph Bentele, Stefan E. Schulenberg.
    Journal of Clinical Psychology. July 26, 2016
    In the wake of significant adversity, a range of recovery outcomes are possible, from prolonged distress to minimal effects on functioning and even psychological growth. Finding meaning in one's life is thought to facilitate optimal recovery from such adversity. Research on psychological growth and recovery often focuses on the daily hassles or significant traumas of convenience samples or on people's psychological recovery from medical illness. A small body of research is developing to test theories of growth among survivors of natural disasters. The present study of 57 survivors of the 2013 Colorado floods tested the incremental relations between posttraumatic growth (PTG) and dimensions of meaning in life, vitality, and perceived social support. The most consistent relations observed were among the one dimension of meaning—search for meaning—perceived social support, and PTG. Despite the limitations of this study, we conclude that search for meaning in life may be an important part of recovery from natural disasters, floods being one example.
    July 26, 2016   doi: 10.1002/jclp.22344   open full text
  • Conceptualization and Pilot Testing of a Core Competency‐Based Training Workshop in Suicide Risk Assessment and Management: Notes From the Field.
    Robert J. Cramer, Claire N. Bryson, Morgam K. Eichorst, Lee N. Keyes, Brittany E. Ridge.
    Journal of Clinical Psychology. July 26, 2016
    Objectives As professional psychology training programs and continuing education have moved toward competency based approaches, it has become equally important to develop uniform, evidence‐based approaches for suicide risk assessment and management. The present article presents a workshop curriculum based on established core competencies in suicide risk assessment and management. Method Drawing on theories suicide risk formation, the workshop features an integration of didactic, process, and experiential components. We present pilot data from 2 small group workshops (n = 17): 1 from a clinical psychology doctoral program and 1 from a university counseling center. Results Workshop participation yielded increases in (a) the ability to recognize appropriate clinician responses to suicidal client statements, (b) self‐perceptions of general capacity to interface with suicidal patients and mastery of the 10 core competencies, (c) factual knowledge concerning suicide risk assessment and management, and (d) the self‐rated ability to assess and manage a suicidal patient. Conclusion We discuss statistical and generalizability limitations as well as implications for future modification, implementation, and provision of this training method.
    July 26, 2016   doi: 10.1002/jclp.22329   open full text
  • Contextual Positive Coping as a Factor Contributing to Resilience After Disasters.
    Elaine Z. Shing, Eranda Jayawickreme, Christian E. Waugh.
    Journal of Clinical Psychology. July 13, 2016
    Objective Strategy–situation fit, or contextual coping, posits that the physical and psychological demands associated with stressors are determined in part by the characteristics of each stress situation and may therefore require the use of different coping strategies. In this review, we discuss strategy–situation fit in the context of both natural and manmade disasters as it pertains to positivity and, ultimately, resilience after disasters. Method We reviewed the relevant literature on positivity and coping with disasters using a contextual approach. Results We identified several disaster‐related characteristics (i.e., cause of disaster, temporal characteristics of disasters, and degree of resource loss) that might influence the efficacy of positive coping strategies. We then discussed strategies that could be useful for promoting resilience with regard to these different characteristics. Conclusion This work represents an initial step in conceptualizing disaster resiliency within the framework of contextual positive coping. Recommendations for future avenues of research are discussed.
    July 13, 2016   doi: 10.1002/jclp.22327   open full text
  • Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress.
    Martin J. Dorahy, Mary Corry, Rebecca Black, Laura Matheson, Holly Coles, David Curran, Lenaire Seager, Warwick Middleton, Kevin F. W. Dyer.
    Journal of Clinical Psychology. July 11, 2016
    Objectives Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group. Method Participants were drawn from the DID (n = 20), conflict‐related chronic PTSD (n = 65), and nonclinical (n = 125) populations and completed questionnaires assessing the variables of interest. A model examining the direct impact of shame and dissociation on relationship functioning, and their indirect effect via complex PTSD symptoms, was tested through path analysis. Results The DID sample reported significantly higher dissociation, shame, complex PTSD symptom severity, relationship anxiety, relationship depression, and fear of relationships than the other two samples. Support was found for the proposed model, with shame directly affecting relationship anxiety and fear of relationships, and pathological dissociation directly affecting relationship anxiety and relationship depression. The indirect effect of shame and dissociation via complex PTSD symptom severity was evident on all relationship variables. Conclusion Shame and pathological dissociation are important for not only the effect they have on the development of other complex PTSD symptoms, but also their direct and indirect effects on distress associated with relationships.
    July 11, 2016   doi: 10.1002/jclp.22339   open full text
  • Treatment Outcome of Adolescent Inpatients With Early‐Onset and Adolescent‐Onset Disruptive Behavior.
    Sjoukje Berdina Beike Boer, Albert Eduard Boon, Fop Verheij, Marianne Catharina Henriëtte Donker, Robert Vermeiren.
    Journal of Clinical Psychology. July 08, 2016
    Objective Unlike adolescents with adolescent‐onset (AO) disruptive behavior, adolescents with early‐onset (EO) disruptive behavior may not benefit from treatment. Method Using Symptom Checklist (SCL‐90‐R) ratings at admission and discharge of adolescent inpatients with EO (n = 85) and AO (n = 60) disruptive behavior treatment outcome was determined by (a) a change in mean scores and (b) the Reliable Change Index. For a subgroup, ratings on the Satisfaction Questionnaire Residential Youth Care for Parents (n = 83) were used to verify the treatment outcome. Results Inpatients with EO disruptive behavior had a higher risk of dropout (44.4%) from treatment than the AO group (24.7%). Among the treatment completers, both onset groups reported improvements on the SCL‐90‐R, with 26.9% recovering and 31.7% improving. Inpatients who reported improvement were mostly rated as improved by their parents (r = .33). Conclusion As EO inpatients are more likely to drop out, interventions should aim at motivating youngsters to continue treatment, particularly given the poor outcome in this group. Treatment may benefit both groups because those EO youths who stayed in treatment improved to the same extent as AO inpatients.
    July 08, 2016   doi: 10.1002/jclp.22341   open full text
  • Interpersonal Circumplex Profiles Of Persistent Depression: Goals, Self‐Efficacy, Problems, And Effects Of Group Therapy.
    Kenneth D. Locke, Liliane Sayegh, J. Kim Penberthy, Charlotte Weber, Katherine Haentjens, Gustavo Turecki.
    Journal of Clinical Psychology. July 08, 2016
    Objectives We assessed severely and persistently depressed patients’ interpersonal self‐efficacy, problems, and goals, plus changes in interpersonal functioning and depression during 20 weeks of group therapy. Method Outpatients (32 female, 26 male, mean age = 45 years) completed interpersonal circumplex measures of goals, efficacy, and problems before completing 20 weeks of manualized group therapy, during which we regularly assessed depression and interpersonal style. Results Compared to normative samples, patients lacked interpersonal agency, including less self‐efficacy for expressive/assertive actions; stronger motives to avoid conflict, scorn, and humiliation; and more problems with being too submissive, inhibited, and accommodating. Behavioral Activation and especially Cognitive Behavioral Analysis System of Psychotherapy interventions produced improvements in depression and interpersonal agency, with increases in “agentic and communal” efficacy predicting subsequent decreases in depression. Conclusions While severely and persistently depressed patients were prone to express maladaptive interpersonal dispositions, over the course of group therapy, they showed increasingly agentic and beneficial patterns of cognitions, motives, and behaviors.
    July 08, 2016   doi: 10.1002/jclp.22343   open full text
  • Relations Between Past‐Week Physical Activity and Recent Nonsuicidal Self‐Injury in Treatment‐Seeking Psychiatric Adults.
    Stephanie M. Jarvi, Bridget A. Hearon, Kristen L. Batejan, Stephanie Gironde, Thröstur Björgvinsson.
    Journal of Clinical Psychology. July 08, 2016
    Objective This research study examines the relationship between past‐week physical activity and recent (i.e., within the past 30 days) nonsuicidal self‐injury (NSSI) in a sample of treatment‐seeking adults.  Method Participants included 353 (49.29% female; mean age = 35.16 years) adults attending a partial hospitalization program for acute psychiatric issues. Data were extracted from the program's admission battery of computer‐based self‐report measures completed by each participant on the first treatment day. Results Participants with a recent history of NSSI (i.e., within the past 30 days) engaged in significantly less past‐week physical activity than those without a history of NSSI. Group differences remained significant while controlling for anxiety, but not depression. Conclusion Results suggest that, on average, individuals who have never engaged in NSSI exercise more in the week prior to entering the partial hospital program than those who have a recent history of NSSI. Regular physical activity may be an interesting area of study to explore as a promising adjunctive intervention for NSSI (e.g., vigorous exercise as a way to tolerate distress and manage urges to self‐injure).
    July 08, 2016   doi: 10.1002/jclp.22342   open full text
  • Cognitive Processing Therapy for Spanish‐speaking Latinos: A Formative Study of a Model‐Driven Cultural Adaptation of the Manual to Enhance Implementation in a Usual Care Setting.
    Sarah E. Valentine, Christina P. C. Borba, Louise Dixon, Adin S. Vaewsorn, Julia Gallegos Guajardo, Patricia A. Resick, Shannon Wiltsey Stirman, Luana Marques.
    Journal of Clinical Psychology. July 05, 2016
    Objective As part of a larger implementation trial for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) in a community health center, we used formative evaluation to assess relations between iterative cultural adaption (for Spanish‐speaking clients) and implementation outcomes (appropriateness and acceptability) for CPT. Method Qualitative data for the current study were gathered through multiple sources (providers: N = 6; clients: N = 22), including CPT therapy sessions, provider fieldnotes, weekly consultation team meetings, and researcher fieldnotes. Findings from conventional and directed content analysis of the data informed refinements to the CPT manual. Results Data‐driven refinements included adaptations related to cultural context (i.e., language, regional variation in wording), urban context (e.g., crime/violence), and literacy level. Qualitative findings suggest improved appropriateness and acceptability of CPT for Spanish‐speaking clients. Conclusion Our study reinforces the need for dual application of cultural adaptation and implementation science to address the PTSD treatment needs of Spanish‐speaking clients.
    July 05, 2016   doi: 10.1002/jclp.22337   open full text
  • Web‐Based Positive Psychology Interventions: A Reexamination of Effectiveness.
    Rosalind J. Woodworth, Angela O'Brien‐Malone, Mark R. Diamond, Benjamin Schüz.
    Journal of Clinical Psychology. July 05, 2016
    Objective Seligman, Steen, Park, and Peterson (2005) suggested that positive psychology interventions (PPIs) contain specific, powerful, therapeutic ingredients that effect greater increases in happiness and reductions in depression than a placebo control. This study reexamined the three PPIs that Seligman et al. found to be most effective when delivered over the internet. Method Three PPIs and a placebo control, identical with the interventions used by Seligman et al., were examined in a web‐based, randomized assignment design. Results Mixed‐design analysis of variance and multilevel modeling showed that all interventions, including the placebo, led to significant increases in happiness and reductions in depression. The effects of PPIs were indistinguishable from those of the placebo control. Conclusion Using web‐based delivery, both PPIs and theoretically neutral placebos can increase happiness and reduce depression in self‐selected populations. Possible explanations include that non‐specific factors common to most therapeutic treatments are responsible for the observed changes, or that cultural or other context‐related variables operate to account for the divergent findings.
    July 05, 2016   doi: 10.1002/jclp.22328   open full text
  • An Investigation of the Relationship Between the Alliance Negotiation Scale and Psychotherapy Process and Outcome.
    Jennifer M. Doran, Jeremy D. Safran, J. Christopher Muran.
    Journal of Clinical Psychology. July 05, 2016
    Objective This study examines the validity of the Alliance Negotiation Scale (ANS) in a psychotherapy research program. Analyses were designed to evaluate the relationship between the ANS and psychotherapy process and outcome variables. Method Data were collected in a metropolitan psychotherapy research program. Participants completed 30 sessions of therapy, postsession assessments, and a battery of measures at intake and termination. Results Relationships were found between the ANS and session outcome, working alliance, and the presence of ruptures and their resolution. Relationships emerged between the ANS and treatment outcome on measures of psychiatric distress and interpersonal problems. Conclusions The ANS demonstrated relationships with several psychotherapy process and outcome variables. The ANS was the most differentiated from the working alliance on measures of interpersonal functioning and in discriminating personality disorder pathology. These results extend previous findings on the ANS’ psychometric integrity, and offer new data on the relationship between negotiation and treatment outcome.
    July 05, 2016   doi: 10.1002/jclp.22340   open full text
  • Testing a Revised Interpersonal Theory of Depression Using a Laboratory Measure of Excessive Reassurance Seeking.
    Jeremy G. Stewart, Kate L. Harkness.
    Journal of Clinical Psychology. July 05, 2016
    Objective This study tested whether core beliefs with themes of abandonment and rejection moderated the link between trait and behavioral excessive reassurance seeking (ERS) and interpersonal rejection. Method Participants were 118 women with high (n = 43; mean [M]age = 18.58, standard deviation [SD]age = 1.24) and low (n = 75; Mage = 18.58, SDage = 1.24) levels of depression symptoms and their male romantic partners. Couples reported their depression, ERS, abandonment/rejection cognitions, and relationship quality. We also coded women's reassurance‐seeking behavior during an audiotaped discussion task. Results Among women with high levels of depression symptoms and low levels of abandonment/rejection core beliefs, behavioral ERS was associated with lower partner‐reported relationship quality. Self‐reported ERS was significantly associated with partner relationship quality, but the effect was not moderated by depression or core beliefs. Conclusions ERS is a potent predictor of stress and subsequent depression. Our findings underscore the need to better understand factors (e.g., cognitions, partner characteristics) that may determine whether ERS behaviors beget interpersonal stress and rejection.
    July 05, 2016   doi: 10.1002/jclp.22338   open full text
  • An Actor–Partner Interdependence Model of Acquired Brain Injury Patient Impairments and Caregiver Psychosocial Functioning: A Dyadic‐Report, Multinational Study.
    Paul B. Perrin, Anne Norup, Alfonso Caracuel, Andrew Bateman, Morten Tjørnlund, Juan Carlos Arango‐Lasprilla.
    Journal of Clinical Psychology. June 30, 2016
    Objective The purpose of this study was to use actor–partner interdependence modeling (APIM) to examine the simultaneous effects of both acquired brain injury (ABI) patient and caregiver ratings of patient impairments on both patient and caregiver ratings of caregiver psychosocial dysfunction. Method A sample of 968 individuals with ABI and their caregivers (n = 1,936) from 4 countries completed the European Brain Injury Questionnaire, a measure of ABI impairments and caregiver psychosocial functioning in the context of providing care for the person with ABI. Results An APIM with all adequate or good fit indices found that patient ratings of their own impairments in the domains of social disadaptation and depression were uniquely and positively associated with patient ratings of caregiver psychosocial dysfunction, yet none of the patient ratings of their own impairments were uniquely associated with caregiver ratings of caregiver psychosocial dysfunction. Caregiver ratings of patient impairments across all 3 domains (cognition, social disadaptation, and depression) were uniquely and positively associated with caregiver ratings of caregiver psychosocial dysfunction. Yet only caregiver ratings of patient social disadaptation were uniquely and positively associated with patient ratings of caregiver psychosocial dysfunction. Conclusions These findings suggest that caregivers’ views of ABI patients’ impairments are likely much more associated with caregiver psychosocial functioning than are patients’ views of their own impairments, pointing to caregivers’ interpretations of their patients’ impairments as a primary target for cognitive behavioral interventions.
    June 30, 2016   doi: 10.1002/jclp.22324   open full text
  • Evaluating a Multimedia Tool for Suicide Risk Assessment and Management: The Linehan Suicide Safety Net.
    Melanie S. Harned, Anita Lungu, Chelsey R. Wilks, Marsha M. Linehan.
    Journal of Clinical Psychology. June 15, 2016
    Objective The present study examined the usability and effectiveness of the Linehan Suicide Safety Net (LSSN), a web‐based, multimedia tool designed to support clinicians working with individuals who are suicidal. The core feature of LSSN is the Linehan Risk Assessment and Management Protocol (LRAMP), an empirically derived protocol that provides a structured checklist for assessing, managing, and documenting suicide risk. Method Mental health professionals (N = 44) completed assessments at baseline and monthly during a 3‐month evaluation period. Results The LSSN was rated as acceptable and highly usable. Use of the LSSN was associated with a significant increase in confidence in conducting suicide risk assessment and management and a decrease in concerns related to treating suicidal clients. Conclusion The LSSN appears to be a promising tool for clinicians working with suicidal clients.
    June 15, 2016   doi: 10.1002/jclp.22331   open full text
  • The Safety Behavior Assessment Form: Development and Validation.
    Jason T. Goodson, Gerald J. Haeffel, David A. Raush, Rachel Hershenberg.
    Journal of Clinical Psychology. May 26, 2016
    Objective To develop and validate an easy to administer measure of safety behaviors called the Safety Behavior Assessment Form (SBAF). Method We provide reliability and validity evidence from four studies. The first study used a cross‐sectional design with a sample consisting of both clinical (U.S. military Veterans; n = 42) and nonclinical participants (undergraduates; n = 198). Study 2 used a cross‐sectional design with a sample of U.S. military Veterans (n = 215). Study 3 used a pre‐post treatment design with a sample of U.S. military Veterans (n = 42). Study 4 used a 2‐time‐point longitudinal design with a sample of undergraduates (n = 77). Results The SBAF demonstrated strong levels of internal consistency and test‐retest reliability in all four studies. The SBAF also demonstrated predictive and discriminant validity. In Study 3, the SBAF predicted anxious, but not depressive, treatment outcomes in a sample of Veterans. In Study 4, the SBAF predicted prospective changes in anxiety over a 2‐week interval in a sample of undergraduates even after controlling for a competing measure of safety behaviors. Conclusion Results of these four studies indicate that the SBAF is a reliable and valid measure of safety behaviors that can be used in both clinical and nonclinical settings.
    May 26, 2016   doi: 10.1002/jclp.22325   open full text
  • Immigration Stress and Alcohol Use Severity Among Recently Immigrated Hispanic Adults: Examining Moderating Effects of Gender, Immigration Status, and Social Support.
    Miguel Ángel Cano, Mariana Sánchez, Mary Jo Trepka, Frank R. Dillon, Diana M. Sheehan, Patria Rojas, Mariano J. Kanamori, Hui Huang, Rehab Auf, Mario La Rosa.
    Journal of Clinical Psychology. May 26, 2016
    Objective Identifying and understanding determinants of alcohol use behavior among Hispanic immigrants is an increasingly significant public health concern. Although prior research has examined associations of cultural stressors with alcohol use among Hispanics, few studies have tested these associations among recent adult immigrants. As such, this study aimed to examine (a) the association of immigration stress on alcohol use severity among recently immigrated Hispanic adults (≤ 1 year in the United States) and (b) the moderating effects of gender, immigration status, and social support. Method A hierarchical multiple regression and moderation analyses were conducted on a sample of 527 participants in South Florida. Results Results indicated that, after controlling for demographic variables, preimmigration drinking behavior, and dimensions of social support, the association of higher immigration stress with higher alcohol use severity was statistically significant. Moderation analyses indicated that immigration stress had a statistically significant association with alcohol use severity among men, but not women. Also, dimensions of social support consistently reduced the deleterious effect of immigration stress on alcohol use severity. Conclusion This study adds to the scarce literature on cultural stressors and alcohol use among recent Hispanic immigrants. Findings suggest that it may be important to design gender‐specific interventions and that increasing levels of social support may offset the effects of immigration stress on alcohol use.
    May 26, 2016   doi: 10.1002/jclp.22330   open full text
  • Romantic Relationships and Relationship Satisfaction Among Adults With Asperger Syndrome and High‐Functioning Autism.
    Sandra Strunz, Constanze Schermuck, Sarah Ballerstein, Christoph J. Ahlers, Isabel Dziobek, Stefan Roepke.
    Journal of Clinical Psychology. May 16, 2016
    Objective Individuals with autism spectrum disorder (ASD) often experience difficulties in maintaining romantic relationships. In this study high‐functioning adults with ASD were examined concerning their romantic relationship interest and experience. Method Participants, 31 recruited via an outpatient clinic and 198 via an online survey, were asked to answer a number of self‐report questionnaires. The total sample comprised 229 high‐functioning adults with ASD (40% males, average age: 35 years). Results Of the total sample, 73% indicated romantic relationship experience and only 7% had no desire to be in a romantic relationship. ASD individuals whose partner was also on the autism spectrum were significantly more satisfied with their relationship than those with neurotypical partners. Severity of autism, schizoid symptoms, empathy skills, and need for social support were not correlated with relationship status. Conclusion Our findings indicate that the vast majority of high‐functioning adults with ASD are interested in romantic relationships.
    May 16, 2016   doi: 10.1002/jclp.22319   open full text
  • Assessing Callous‐Unemotional Traits in Adolescents: Determining Cutoff Scores for the Inventory of Callous and Unemotional Traits.
    Meagan Docherty, Paul Boxer, L. Rowell Huesmann, Maureen O'Brien, Brad Bushman.
    Journal of Clinical Psychology. May 16, 2016
    Objective This study aims to establish a cut score for the Inventory of Callous‐Unemotional Traits, a well‐validated measure of callous‐unemotional (CU) traits in youth for which there is currently no cutoff score. Method We analyzed data on 634 adolescents from high schools (n = 343) and juvenile detention centers (n = 291). Participants, their parents and guardians, and their teachers and staff members reported on participants’ CU traits and aggressive/violent behavior. Results All three reports of CU traits as well as intersource composites were associated with aggression, violence, and detained status. Parent report was a better indicator compared to self‐reports and teacher reports. Appropriate cut scores based on each report and composite were determined. Conclusion We recommend that information from all available informants should be used whenever possible, but when only one informant report is feasible, parent reports are preferable.
    May 16, 2016   doi: 10.1002/jclp.22313   open full text
  • The Intersession Process in Psychotherapy for Anorexia Nervosa: Characteristics and Relation to Outcome.
    Armin Hartmann, Almut Zeeck, Wolfgang Herzog, Beate Wild, Martina Zwaan, Stephan Herpertz, Markus Burgmer, Joern Wietersheim, Sefik Tagay, Andreas Dinkel, Bernd Löwe, Gaby Resmark, David Orlinsky, Stephan Zipfel.
    Journal of Clinical Psychology. May 16, 2016
    Objective The “inter session process” (ISP) is defined as therapy‐related conscious thoughts, memories, and emotions that patients and therapists experience between psychotherapy sessions. It indicates how the participants process and use treatment. The main aim of this study is to describe the ISP characteristics of patients in outpatient treatment for anorexia nervosa (AN). An additional aim is to explore the relation between patients' ISP and treatment outcome. Method Patients taking part in a randomized controlled trial on outpatient psychotherapy for AN (ANTOP) filled in the Intersession Experience Questionnaire before each of the 40 psychotherapy sessions. Trajectories of different aspects of the ISP were analyzed with growth curve models based on orthogonal polynomials and tested for differences between 3 outcome categories (recovery, partially recovered, full syndrome AN). Results Data from 108 cases were available for analysis. ISP facets showed diverse, mostly nonlinear, trajectories over the course of treatment. Less favorable outcomes were associated with higher levels of patients’ experiencing negative emotions when recalling therapeutic dialogue, thinking about therapy during dreaming/drowsy states, and applying therapeutic learning (in the second half of treatment). Conclusions Findings confirm an overall relation between ISP and treatment outcome. In outpatient treatment in AN, patients with a less successful course seem to be more preoccupied with therapy and therapist between sessions. For the ISP facet “applying therapeutic learning,” findings point to an optimal range dependent on treatment phase. Growth curve modeling is required to describe the nonlinear trajectories of ISP facets.
    May 16, 2016   doi: 10.1002/jclp.22293   open full text
  • Disaster Mental Health and Community‐Based Psychological First Aid: Concepts and Education/Training.
    Gerard A. Jacobs, Brandon L. Gray, Sara E. Erickson, Elvira D. Gonzalez, Randal P. Quevillon.
    Journal of Clinical Psychology. May 13, 2016
    Any community can experience a disaster, and many traumatic events occur without warning. Psychologists can be an important resource assisting in psychological support for individuals and communities, in preparation for and in response to traumatic events. Disaster mental health and the community‐based model of psychological first aid are described. The National Preparedness and Response Science Board has recommended that all mental health professionals be trained in disaster mental health, and that first responders, civic officials, emergency managers, and the general public be trained in community‐based psychological first aid. Education and training resources in these two fields are described to assist psychologists and others in preparing themselves to assist their communities in difficult times and to help their communities learn to support one another.
    May 13, 2016   doi: 10.1002/jclp.22316   open full text
  • Changes in Mindfulness and Posttraumatic Stress Disorder Symptoms Among Veterans Enrolled in Mindfulness‐Based Stress Reduction.
    Kyle R. Stephenson, Tracy L. Simpson, Michelle E. Martinez, David J. Kearney.
    Journal of Clinical Psychology. May 06, 2016
    Objectives The current study assessed associations between changes in 5 facets of mindfulness (Acting With Awareness, Observing, Describing, Non‐Reactivity, and Nonjudgment) and changes in 4 posttraumatic stress disorder (PTSD) symptom clusters (Re‐Experiencing, Avoidance, Emotional Numbing, and Hyperarousal symptoms) among veterans participating in mindfulness‐based stress reduction (MBSR). Method Secondary analyses were performed with a combined data set consisting of 2 published and 2 unpublished trials of MBSR conducted at a large Veterans Affairs hospital. The combined sample included 113 veterans enrolled in MBSR who screened positive for PTSD and completed measures of mindfulness and PTSD symptoms before and after the 8‐week intervention. Results Increases in mindfulness were significantly associated with reduced PTSD symptoms. Increases in Acting With Awareness and Non‐Reactivity were the facets of mindfulness most strongly and consistently associated with reduced PTSD symptoms. Increases in mindfulness were most strongly related to decreases in Hyperarousal and Emotional Numbing. Conclusions These results extend previous research, provide preliminary support for changes in mindfulness as a viable mechanism of treatment, and have a number of potential practical and theoretical implications.
    May 06, 2016   doi: 10.1002/jclp.22323   open full text
  • Emotional Dysregulation in Adults With Attention‐Deficit/Hyperactivity Disorder–Validity, Predictability, Severity, and Comorbidity.
    Salvatore Corbisiero, Beatrice Mörstedt, Hannes Bitto, Rolf‐Dieter Stieglitz.
    Journal of Clinical Psychology. May 06, 2016
    Objectives Attention‐deficit/hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity. However, this triad might not be able to explain the complete spectrum of ADHD symptoms, as emotional dysregulation (ED) frequently seems to accompany the disorder. The aim of this study was to further understand the role of ED in adult ADHD. Method The sample comprised 393 adults with ADHD without or with comorbidity, and 121 adults without ADHD or any other mental disorder. Additionally, the sample focused on ED. The contribution of core symptoms and the effect of comorbidity on ED were tested and the predictive value of ED for the ADHD diagnosis itself analyzed. Finally, all subjects were categorized into groups–No ADHD, ADHD, and ADHD + ED–to analyze the differences in the severity of ADHD symptomatology in the three groups. Results ED levels were found to be elevated in patients with ADHD. The core symptoms affected ED, and the ADHD diagnosis was predicted by ED. The addition of ED to a regression model with the core symptoms was shown to improve the predictability of the ADHD diagnosis. The presence of ED proved to be an indicator of the severity of adult ADHD independent of a present comorbidity. Conclusions ED is a significant symptom in adult patients with ADHD and appears to be associated with ADHD itself. Whilst the presence of other mental disorders intensifies symptoms of ED, ED seems not to manifest solely as a consequence of comorbidity.
    May 06, 2016   doi: 10.1002/jclp.22317   open full text
  • A Systematic Review of Efficacy of the Attention Training Technique in Clinical and Nonclinical Samples.
    Mark M. Knowles, Philip Foden, Wael El‐Deredy, Adrian Wells.
    Journal of Clinical Psychology. April 29, 2016
    Objective The Attention Training Technique (ATT; Wells, 1990) is a brief metacognitive treatment strategy aimed at remediating self‐focused processing and increasing attention flexibility in psychological disorder. Method We systematically reviewed and examined the efficacy of ATT in clinical and nonclinical samples. Scientific databases were searched from 1990 to 2014 and 10 studies (total N = 295) met inclusion criteria. Single‐case data were meta‐analyzed using the improvement rate difference, and standardized between and within‐group effect sizes (ESs) were examined across 4 analogue randomized controlled trials (RCTs). Results Single‐case outcomes indicated that ATT yields large ES estimates (pooled ES range: 0.74–1.00) for anxiety and depressive disorders. Standardized ESs across the RCTs indicated that ATT yields greater treatment gains than reference groups across majority outcomes (adjusted Cohen's d range: 0.40–1.23). Conclusions These preliminary results suggest ATT may be effective in treating anxiety and depressive disorders and help remediate some symptoms of schizophrenia. Although a limited number of studies with small sample sizes warrants caution of interpretation, ATT appears promising and future studies will benefit from adequately powered RCTs.
    April 29, 2016   doi: 10.1002/jclp.22312   open full text
  • Prevalence and Demographic Correlates of Alexithymia: A Comparison Between Australian Psychiatric and Community Samples.
    Lauren McGillivray, Rodrigo Becerra, Craig Harms.
    Journal of Clinical Psychology. April 29, 2016
    Objectives A cross‐sectional empirical design was used to compare differences in alexithymia between Australian psychiatric and community samples and examine the influence of sample type on the relation between alexithymia and psychological distress. Method Psychiatric outpatients (N = 151) and a convenience sample of the general community (N = 216) completed questionnaires measuring alexithymia and psychological distress. Results Alexithymia was several times more prevalent in the psychiatric sample than the community sample. While the psychiatric sample reported greater psychological distress, no difference was found in the strength of the association between alexithymia and psychological distress between the study samples. Conclusion These findings emphasize the pervasive problem alexithymia presents within the Australian psychiatric population and the importance of increasing recognition of alexithymia for the future research about and treatment of psychiatric patients.
    April 29, 2016   doi: 10.1002/jclp.22314   open full text
  • Predictors of Treatment Attrition Among Adult Outpatients With Clinically Significant Suicidal Ideation.
    Melanie A. Hom, Thomas E. Joiner.
    Journal of Clinical Psychology. April 26, 2016
    Objective To identify demographic, diagnostic, and personality factors that predict treatment dropout in a sample of outpatients with clinically significant suicidal ideation. Method A total of 287 adult outpatients at elevated risk for suicide completed self‐report measures of demographics, suicidal and depression symptoms, and personality characteristics at treatment intake. Clinician‐assessed psychiatric diagnoses and ratings of overall functioning also were collected. Results Lower overall functioning (odds ratio [OR] = .947; 95% confidence interval [CI] [.909, .987]) and the presence of a substance use disorder (OR = 4.543; 95% CI [1.058, 19.499]) were the most robust predictors of attrition. Dropouts also were more likely to have a depressive disorder, more comorbid diagnoses, and more severe depression and suicidal symptoms. Conclusions Findings suggest that clinician‐assessed poorer overall functioning and a substance use disorder diagnosis are risk factors for attrition among suicidal individuals, above and beyond other symptom measures. Further research is warranted to investigate attrition in additional outpatient samples.
    April 26, 2016   doi: 10.1002/jclp.22318   open full text
  • Sequential Treatment of Comorbid Insomnia and Generalized Anxiety Disorder.
    Geneviève Belleville, Hans Ivers, Lynda Bélanger, France C. Blais, Charles M. Morin.
    Journal of Clinical Psychology. April 25, 2016
    Objective To explore the efficacy of cognitive‐behavior therapy (CBT) for patients with comorbid generalized anxiety disorder (GAD) and insomnia using 2 sequential treatments. Method Using a single‐case methodology, 10 women (mean age = 45) with chronic insomnia and GAD were randomly assigned to CBT for GAD followed by CBT for insomnia, or to CBT for insomnia followed by CBT for GAD. Sleep and anxiety were measured via diagnostic interviews, daily diaries, and self‐report questionnaires. Results Time series analyses, group effect sizes, and indications of clinically significant change revealed improvements on anxiety, worry, and sleep after CBT for GAD. Following CBT for insomnia, positive changes were observed on sleep and, to a lesser extent, anxiety and worry. Conclusions In the presence of comorbid GAD and insomnia, initiating treatment for GAD first produced superior clinical benefits in anxiety and sleep. The addition of insomnia‐specific treatment led to additional improvements in worry and sleep quality.
    April 25, 2016   doi: 10.1002/jclp.22300   open full text
  • Therapeutic Alliance during Prolonged Exposure Versus Client‐Centered Therapy for Adolescent Posttraumatic Stress Disorder.
    Sandra Capaldi, Anu Asnaani, Laurie J. Zandberg, Joseph K. Carpenter, Edna B. Foa.
    Journal of Clinical Psychology. April 22, 2016
    Objectives To examine the relationship between improvements in adolescent ratings of therapeutic alliance and reductions in posttraumatic stress disorder (PTSD) severity over time among adolescent girls during prolonged exposure therapy for adolescents (PE‐A) versus client‐centered therapy (CCT), as well as to examine differences in changes in alliance between treatment groups. Method A total of 61 adolescent girls (aged 13–18 years) with sexual assault‐related PTSD received PE‐A or CCT in a randomized controlled trial. Participants rated alliance at session 3, midtreatment, and posttreatment. Results The rate of improvement in adolescent‐rated alliance was greater in PE‐A than CCT over the course of treatment. In addition, improvement in adolescent‐rated alliance significantly contributed to improvements in PTSD (regardless of treatment condition), but not vice versa. Conclusions Contrary to beliefs that trauma‐focused treatments fail to establish strong therapeutic alliance in sexually abused adolescents, improvement in adolescent ratings of alliance were greater in PE‐A compared to CCT, and improvements in adolescent‐rated alliance were significantly associated with better treatment outcome across both types of treatments.
    April 22, 2016   doi: 10.1002/jclp.22303   open full text
  • Nightmare Disorder, Psychopathology Levels, and Coping in a Diverse Psychiatric Sample.
    Annette Schagen, Jaap Lancee, Marijke Swart, Victor Spoormaker, Jan Bout.
    Journal of Clinical Psychology. April 21, 2016
    Objective Nightmares are associated with psychopathology and impaired coping in the general population. However, little is known about this association in a psychiatric population. In this study, we investigate whether patients with diverse psychiatric disorders have increased symptomatology and different coping styles if they suffer from comorbid nightmare disorder. Method Participants were 498 patients with diverse moderate to severe psychiatric disorders. As part of a standard assessment procedure, they filled out questionnaires regarding nightmares, psychopathology, personality pathology, and coping. Results A multivariate analysis of covariance and post hoc tests showed that patients with nightmare disorder scored higher on psychopathology (ηp2 = .03; p = .001) and personality pathology (ηp2 = .01–.03; p < .05). No significant differences were found with regards to coping strategies. Conclusion Nightmare disorder is associated with higher levels of psychopathology and personality pathology in a sample of patients with diverse psychiatric disorders.
    April 21, 2016   doi: 10.1002/jclp.22315   open full text
  • Relationship Functioning in Vietnam Veteran Couples: The Roles of PTSD and Anger.
    Erika M. Roberge, Nathaniel J. Allen, Judith W. Taylor, Craig J. Bryan.
    Journal of Clinical Psychology. April 20, 2016
    Objective Posttraumatic stress disorder (PTSD) and anger have been implicated separately in relationship dysfunction for veterans; however, no studies have simultaneously examined the roles of each of these constructs. Method This study examined the roles of PTSD and anger in the relationships of Vietnam veterans and their partners (n = 33 couples) with actor–partner interdependence modeling (APIM). Couples in which the veteran was diagnosed with PTSD (PTSD‐positive; n = 20) were compared to couples in which the veteran did not have PTSD (PTSD‐negative; n = 13) on measures of frequency of anger and relationship functioning. Results PTSD‐positive and PTSD‐negative couples reported similar levels of relationship functioning, yet PTSD‐positive veterans reported experiencing anger significantly more often than PTSD‐negative veterans. Across groups, anger was predictive of relationship functioning, but PTSD severity was not. Conclusions Trait anger may have a more deleterious effect on relationship functioning than PTSD symptoms. Theoretical and clinical implications are discussed.
    April 20, 2016   doi: 10.1002/jclp.22301   open full text
  • No Way Out: Entrapment as a Moderator of Suicide Ideation Among Military Personnel.
    Leah Shelef, Yossi Levi‐Belz, Eyal Fruchter, Yoav Santo, Eyal Dahan.
    Journal of Clinical Psychology. April 19, 2016
    Objective Suicide is a leading and growing cause of death in the military during peacetime. This study sought to examine the psychological mechanisms relating to entrapment, stress, and psychological protective factors facilitating suicide ideation among military personnel. Method The study population comprised 168 soldiers (aged 18–21) divided into 3 groups: suicide attempters (n = 58), those receiving treatment by a mental health professional, reporting no suicidal behavior (n = 58), and controls (n = 50). Results In general, the suicidal group scored higher than the 2 other groups in stress levels and entrapment but lower than the other 2 groups in perceived problem‐solving abilities and perceived social support. Moreover, the interaction of stress and entrapment predict suicide ideation beyond stress, protective factors, and entrapment alone. Conclusion Entrapment is an important predictor of suicide ideation and can serve as a moderator, in that its presence may exacerbate the harsh situation of subjective stress within the military context and intensify it into a suicide risk.
    April 19, 2016   doi: 10.1002/jclp.22304   open full text
  • Smoking Status and Substance Use Treatment Outcomes Among Spanish Speakers Enrolled in Substance Abuse Treatment.
    Marcel A. Dios, Miguel Ángel Cano, Sarah Childress, Ellen Vaughan, Yohanna Cerna, Raymond Niaura.
    Journal of Clinical Psychology. April 19, 2016
    Objective Smoking is highly prevalent among individuals with drug and alcohol disorders. Concurrent tobacco dependence treatment during substance use disorder (SUD) treatment is supported, yet the association between SUD treatment outcomes and smoking status has been understudied in minorities, including Latinos. Method Participants were 322 Spanish‐speaking Latinos enrolled in a SUD treatment study in 5 U.S. cities. Logistic regression examined associations between baseline smoking status and treatment outcomes for nontobacco substance use at follow‐up. Covariates included age, gender, level of education, marital status, treatment group, and mandated treatment status. Results Results indicated smokers had a reduced likelihood of abstinence for all nontobacco substances (p = .001) and their primary drug of use (p = .007). Conclusions Findings contribute to the growing literature indicating a possible beneficial effect of smoking cessation services on SUD treatment, specifically among Latinos. Further research is needed to identify ideal smoking cessation treatments for Latinos.
    April 19, 2016   doi: 10.1002/jclp.22302   open full text
  • Consistency of Reporting for Stressful Life Events Among Nondeployed Soldiers.
    Anica Pless Kaiser, Susan P. Proctor, Jennifer J. Vasterling.
    Journal of Clinical Psychology. April 08, 2016
    Objectives Measurement of stress exposure is central to understanding military mental health outcomes. Although temporal stability of combat event reporting has been examined, less is known about the stability of reporting for noncombat events in military samples. Objectives are to examine consistency in reporting stressful life events in nondeployed U.S. Army soldiers and its association with posttraumatic stress disorder (PTSD) symptomatology. Method Examined reporting consistency over approximately 8 months among 466 soldiers. Regression models examined factors associated with decreased, increased, and stable reporting. Results Stability of the number of events endorsed over time was high. However, item‐level agreement was slight to moderate (kappas: .13–.54), with inconsistencies due primarily to decreased reporting. After adjusting for covariates and initial PTSD, second assessment PTSD was associated with increased and stable reporting. Conclusions Inconsistent reporting extends beyond combat events to other stressful life events in military personnel and is associated with PTSD.
    April 08, 2016   doi: 10.1002/jclp.22311   open full text
  • Predictors of Posttraumatic Growth and Posttraumatic Stress Symptom Severity in Undergraduates Reporting Potentially Traumatic Events.
    Gina P. Owens.
    Journal of Clinical Psychology. April 08, 2016
    Objective Individuals often struggle to understand traumatic events. For some not yet able to successfully process the trauma, posttraumatic stress symptoms (PTS) may result, while others may report posttraumatic growth (PTG). The present study examined personality characteristics, attachment, and meaning made as predictors of PTG and PTS symptom severity. Method Undergraduates reporting potentially traumatic events (N = 229) completed measures through an online survey. Over half of participants (64%) were female, with a mean age of 19 years. Results Higher extraversion, agreeableness, and conscientiousness and lower meaning made and attachment avoidance significantly predicted higher PTG. Lower neuroticism and attachment anxiety and higher meaning made significantly predicted lower PTS severity. The Meaning Made x Attachment Anxiety interaction significantly predicted PTS severity. Conclusion Different facets of personality and attachment style affect PTG and PTS symptom severity. Meaning made seems especially relevant to PTS severity. These constructs may be important for clinicians working with trauma survivors to help lower distress and promote growth.
    April 08, 2016   doi: 10.1002/jclp.22309   open full text
  • Psychological Predictors of Anxiety and Depression in Parkinson's Disease: A Systematic Review.
    Jack K. Garlovsky, Paul G. Overton, Jane Simpson.
    Journal of Clinical Psychology. April 08, 2016
    Objectives Parkinson's disease (PD) is a neurodegenerative disorder, affecting the motor system with psychological difficulties also frequently reported. While explanations for psychological difficulties are historically situated within a biomedical framework, more recently the relevance of psychological determinants has become a research focus. This review therefore examines this relationship with the two most commonly reported psychological difficulties (anxiety and depression) in people with PD. Method Databases were systematically searched up to December 17, 2013, identifying 24 studies meeting inclusion criteria. Results Significant predictors of heightened anxiety and depression included increased emotion‐focused coping; less problem‐focused coping; lower perceived control; more dominant beliefs about PD as part of a person's identity and influence on life; less social support and more avoidant personality types. Conclusions Relationships between some specific psychological predictors and depression and anxiety seem well supported. The complexity of relationships between these psychological determinants should be taken into consideration when delivering psychological interventions.
    April 08, 2016   doi: 10.1002/jclp.22308   open full text
  • A Competency Framework for the Practice of Psychology: Procedures and Implications.
    John Hunsley, Howard Spivak, Jack Schaffer, Darcy Cox, Carla Caro, Emil Rodolfa, Sandra Greenberg.
    Journal of Clinical Psychology. April 06, 2016
    Objective Several competency models for training and practice in professional psychology have been proposed in the United States and Canada. Typically, the procedures used in developing and finalizing these models have involved both expert working groups and opportunities for input from interested parties. What has been missing, however, are empirical data to determine the degree to which the model reflects the views of members of the profession as a whole. Method Using survey data from 466 licensed or registered psychologists (approximately half of whom completed one of two versions of the survey), we examined the degree to which psychologists, both those engaged primarily in practice and those involved in doctoral training, agreed with the competency framework developed by the Association of State and Provincial Psychology Boards’ Practice Analysis Task Force (Rodolfa et al., 2013). Results When distinct time points in training and licensure or registration were considered (i.e., entry‐level supervised practice in practicum settings, advanced‐level supervised practice during internship, entry level independent practice, and advanced practice), there was limited agreement by survey respondents with the competency framework's proposal about when specific competencies should be attained. In contrast, greater agreement was evident by respondents with the competency framework when the reference point was focused on entry to independent practice (i.e., the competencies necessary for licensure or registration). Conclusion We discuss the implications of these findings for the development of competency models, as well as for the implementation of competency requirements in both licensure or registration and training contexts.
    April 06, 2016   doi: 10.1002/jclp.22296   open full text
  • Are Borderline Personality Symptoms Associated With Compulsive Sexual Behaviors Among Women in Treatment for Substance Use Disorders? An Exploratory Study.
    JoAnna Elmquist, Ryan C. Shorey, Scott Anderson, Gregory L. Stuart.
    Journal of Clinical Psychology. April 05, 2016
    Objective Extant literature has documented a significant relationship between borderline symptoms and substance use disorders. As supported in past work, there is a significant theoretical relationship between borderline symptoms and compulsive sexual behaviors because both disorders share common underlying behaviors and traits. There is no known research that has examined the empirical relationship between borderline symptoms and compulsive sexual behaviors in a population with substance use disorders. To fill this important gap in the literature, this relationship was examined in the current study. Method Medical records from 120 women admitted to a private, residential treatment program for substance use disorders were reviewed for the current study. Results Hierarchical multiple regression analysis demonstrated that borderline symptoms were significantly associated with compulsive sexual behaviors after controlling for alcohol use and problems, drug use and problems, age, and positive impression management. Conclusion Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between symptoms and compulsive sexual behaviors.
    April 05, 2016   doi: 10.1002/jclp.22310   open full text
  • Distinguishing Mediational Models and Analyses in Clinical Psychology: Atemporal Associations Do Not Imply Causation.
    E. Samuel Winer, Daniel Cervone, Jessica Bryant, Cliff McKinney, Richard T. Liu, Michael R. Nadorff.
    Journal of Clinical Psychology. March 31, 2016
    Purpose A popular way to attempt to discern causality in clinical psychology is through mediation analysis. However, mediation analysis is sometimes applied to research questions in clinical psychology when inferring causality is impossible. This practice may soon increase with new, readily available, and easy‐to‐use statistical advances. Thus, we here provide a heuristic to remind clinical psychological scientists of the assumptions of mediation analyses. Approach We describe recent statistical advances and unpack assumptions of causality in mediation, underscoring the importance of time in understanding mediational hypotheses and analyses in clinical psychology. Example analyses demonstrate that statistical mediation can occur despite theoretical mediation being improbable. Conclusion We propose a delineation of mediational effects derived from cross‐sectional designs into the terms temporal and atemporal associations to emphasize time in conceptualizing process models in clinical psychology. The general implications for mediational hypotheses and the temporal frameworks from within which they may be drawn are discussed.
    March 31, 2016   doi: 10.1002/jclp.22298   open full text
  • Positive Psychology and Disaster Mental Health: Strategies for Working with Children and Adolescents.
    Eric M. Vernberg, Erin P. Hambrick, Bridget Cho, Michelle L. Hendrickson.
    Journal of Clinical Psychology. March 28, 2016
    Positive psychology concepts and principles can be incorporated into preparedness, crisis response, and recovery phases of disaster mental health efforts to address the needs of children, adolescents, and families. This article articulates general developmental considerations for applying positive psychology in disaster mental health contexts and discusses how 5 essential elements of immediate and midterm mass trauma intervention identified by Hobfoll et al. (2007) may be infused in applications of positive psychology for children and adolescents. Specific strategies for working with children, adolescents, and their families in home, community, and school contexts are drawn in part from disaster mental health resources developed jointly by the National Child Traumatic Stress Network and National Center for Posttraumatic Stress Disorder, including the Psychological First Aid Field Operations Guide (Brymer et al., 2006), the Skills for Psychological Recovery Field Operations Guide (Berkowitz et al., 2010), and the Psychological First Aid for Schools Field Operations Manual (Brymer et al., 2012). Two case examples illustrate the use of positive psychology principles.
    March 28, 2016   doi: 10.1002/jclp.22289   open full text
  • Psychological Treatments for Provoked Vestibulodynia: Integration of Mindfulness‐Based and Cognitive Behavioral Therapies.
    Cara R. Dunkley, Lori A. Brotto.
    Journal of Clinical Psychology. March 28, 2016
    Provoked vestibulodynia (PVD) is a chronic and distressing genital pain condition involving sharp pain to the vulvar vestibule with lifetime prevalence as high as 12%. PVD is the most prevalent cause of pain during sexual intercourse (dyspareunia) in premenopausal women, and gives rise to considerable sexual and relational concerns. As intercourse for women with PVD is either painful or impossible, PVD has pronounced negative effects on women's romantic relationship adjustment and sexual intimacy, as well as their emotional well‐being and sense of sexual self‐efficacy. Given the low efficacy and high side‐effect profile of medications for the treatment of PVD, attention has shifted toward psychological interventions over the past decade. Psychological treatments for PVD have the advantage of targeting both the experience of pain and its many psychosexual consequences, such as reduced desire and arousal. Cognitive behavioral therapy (CBT) currently represents one of the most popular first‐line psychological interventions for PVD. Mindfulness has been increasingly used alongside, or instead of CBT for a variety of health‐related conditions, particularly with respect to chronic pain disorders and more recently in women with PVD. This review provides a detailed overview of CBT and mindfulness‐based approaches in treating PVD.
    March 28, 2016   doi: 10.1002/jclp.22286   open full text
  • A Factor Analytic Evaluation of the Difficulties in Emotion Regulation Scale.
    Daniel J. Lee, Tracy K. Witte, Joseph R. Bardeen, Margaret T. Davis, Frank W. Weathers.
    Journal of Clinical Psychology. March 28, 2016
    Objectives The present study aimed to elucidate the factor structure of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004)–a widely used measure of emotion dysregulation. Method Participants were 3 undergraduate samples (N = 840, 78.33% female, mean age = 20.30). Results We began by using confirmatory factor analysis (CFA) to examine 3 existing models, finding that none consistently demonstrated adequate fit across samples. Subsequently, we conducted an exploratory factor analysis, identifying a novel 5‐factor model that consistently resulted in adequate fit across samples. We also ran several CFA models after removing the Awareness subscale items–which have performed inconsistently in prior research–finding that a reduced‐measure variant of the model retained by Gratz and Roemer (2004) resulted in adequate fit across samples. No higher‐order models consistently resulted in adequate fit across samples. Conclusions Our findings are consistent with previous work in suggesting use of a DERS total score may not be appropriate. Additionally, further work is needed to examine the novel 5‐factor model and the effect of reverse‐scored items on the DERS factor structure.
    March 28, 2016   doi: 10.1002/jclp.22297   open full text
  • Characterizing Positive and Negative Emotional Experiences in Young Adults With Borderline Personality Disorder Symptoms.
    Carol Chu, Sarah E. Victor, E. David Klonsky.
    Journal of Clinical Psychology. March 28, 2016
    Objectives Some researchers suggest that borderline personality disorder (BPD) is characterized by elevated negative emotion; others argue that BPD involves both reduced positive and increased negative emotion. This study characterizes the emotional experiences of individuals with BPD symptoms in a combined university and community sample. Method Participants (N = 150) completed a clinical interview assessing BPD symptoms and self‐report measures of positive and negative emotion. A subset (n = 106) completed a measure of emotion daily for 2 weeks. Pearson's correlations and multilevel modeling were used to examine the cross‐sectional and longitudinal relationships between BPD symptoms and emotions. Results BPD symptoms were robustly related to increased negative emotion; this relationship remained after accounting for positive emotion. BPD symptoms were weakly related to decreased positive emotion; this relationship was no longer significant after accounting for negative emotion. BPD symptoms predicted higher levels of negative and not positive emotion over 14 days. These patterns held for subscales assessing intensity, frequency, and duration of negative and positive emotions. Conclusion Findings suggest that individuals with BPD features are chiefly distinguished by elevated negative emotional experience.
    March 28, 2016   doi: 10.1002/jclp.22299   open full text
  • Mindful Attention to Variability Intervention and Successful Pregnancy Outcomes.
    Sigal Zilcha‐Mano, Ellen Langer.
    Journal of Clinical Psychology. March 23, 2016
    Objective Based on a definition of mindfulness as actively noticing novelty (Langer, 1989; Langer, Blank, & Chanowitz, 1978), the present study sought to examine whether mindfulness training (attention to sensation variability) resulted in better childbirth outcomes for both mother and infant. Method At Weeks 25–30 of pregnancy, mindful instructions to attend to the variability of their positive and negative physical sensations were given to 1 group of participants and compared with 2 control groups (N = 105). The Langer Mindfulness Scale was used to assess the relationship between trait mindfulness and health outcomes. Results Findings showed that trait mindfulness predicted the well‐being of expecting mothers and better neonatal outcomes. Mindfulness training resulted in better health for the expecting mother. Conclusion Findings suggest that mindfulness without meditation can be easily taught and may enhance the pregnancy experience for mother and fetus.
    March 23, 2016   doi: 10.1002/jclp.22294   open full text
  • Perceptions of Institutional Betrayal Predict Suicidal Self‐Directed Violence Among Veterans Exposed to Military Sexual Trauma.
    Lindsey L. Monteith, Nazanin H. Bahraini, Bridget B. Matarazzo, Kelly A. Soberay, Carly Parnitzke Smith.
    Journal of Clinical Psychology. March 23, 2016
    Objectives We examined perceptions of institutional betrayal among Veterans exposed to military sexual trauma (MST) and whether perceptions of institutional betrayal are associated with symptoms of posttraumatic stress disorder (PTSD), depression, and suicidal ideation and attempt after MST. Method A total of 49 Veterans with MST completed self‐report measures and interviews in a Veterans Health Administration setting. Results Many participants reported perceptions that a military institution created an environment in which MST seemed common, likely to occur, and did not proactively prevent such experiences. Many participants expressed difficulty reporting MST and indicated that the institutional response to reporting was inadequate. Over two‐thirds perceived that the institution had created an environment in which they no longer felt valued or in which continued membership was difficult. Perceptions of institutional betrayal were associated with PTSD symptoms, depressive symptoms, and increased odds of attempting suicide after MST. In contrast, perceptions of institutional betrayal were not associated with post‐MST suicidal ideation. Among the subsample of Veterans exposed to military sexual assault, the association between institutional betrayal and PTSD symptoms approached significance. Conclusions Perceptions regarding institutional betrayal appear to be highly relevant to MST and its sequelae. These findings underscore the importance of Veterans’ perceptions of the military institution's efforts to prevent and respond to MST to individual recovery from sexual trauma. Additional research regarding the association between institutional betrayal and health‐related outcomes is needed.
    March 23, 2016   doi: 10.1002/jclp.22292   open full text
  • Depressive Symptoms and Suicidal Ideation in College Students: The Mediating and Moderating Roles of Hopelessness, Alcohol Problems, and Social Support.
    Dorian A. Lamis, Elizabeth D. Ballard, Alexis M. May, Robert D. Dvorak.
    Journal of Clinical Psychology. March 23, 2016
    Objective Mixed evidence for the associations among depression, hopelessness, alcohol problems, and suicidal ideation in college students may be due to the influence of social support. Method A moderated–mediation analysis was conducted to examine relationships among suicide risk factors in 2,034 college students. Results Social support moderated the relation between depressive symptoms and hopelessness in predicting suicidal thoughts; specifically, the association between depressive symptoms and hopelessness was diminished among those students with high levels of social support. This resulted in attenuated indirect associations between depressive symptoms and suicidal ideation via hopelessness. Alcohol problems were associated with likelihood of experiencing suicidal ideation, but not severity. Conclusion Social support may be a key variable for suicide prevention among college students.
    March 23, 2016   doi: 10.1002/jclp.22295   open full text
  • Response Shifts in Depression Intervention for Early Adolescents.
    Pei‐Chen Wu.
    Journal of Clinical Psychology. March 18, 2016
    Objective Patient‐reported outcome measures are increasingly required as metrics for determining the efficacy of depression interventions. However, the scores obtained from self‐reports over the course of treatment may be biased because respondents restructured the factors of the depression symptoms (reconceptualization), changed their values of the symptoms in reflecting depression (reprioritization), or adjusted their standards of assessing the levels of symptoms (recalibration). The aim of present study is to assess response shifts on the depression measure. Method This study uses the procedures for assessing longitudinal measurement invariance to evaluate response shift effects on the Beck Depression Inventory II (BDI‐II) with 320 early adolescents suffering from depression (43.8% boys and 56.2% girls) over the course of their treatment in the school settings. Results The findings reveal clear signs of response shifts (recalibration) in the BDI‐II for depressed students. Compared with the factor scores before treatment, the factor scores after treatment were underestimated, especially on the negative attitude and performance difficulty factors. Conclusions Estimates of treatment efficacy based on observed test scores appear to be confounded by response shifts.
    March 18, 2016   doi: 10.1002/jclp.22291   open full text
  • Building Community Capacity and Fostering Disaster Resilience.
    Virginia Gil‐Rivas, Ryan P. Kilmer.
    Journal of Clinical Psychology. March 18, 2016
    Objective To describe, within an ecologically grounded framework, key principles, and recommendations for community‐level intervention to build community capacity and promote disaster resilience. Method Using an ecological framework, this article describes community resilience and related constructs and key principles for community‐level disaster preparedness and response. Results Current research suggests the importance of focusing on bolstering resources that promote wellness and facilitate individual and community resilience in the face of disaster. Conclusion We advocate for using an ecological framework grounded in such values as collaboration, social justice, empowerment, and an appreciation of diversity to guide disaster work with communities. We highlight the need to: (a) focus on building community‐specific capacity for disaster preparedness, response, and recovery; (b) emphasize increasing the capacity and supportive potential of community members’ natural settings to promote wellness; (c) address power and resource inequities; and (d) enhance capacity to ensure contextually and culturally appropriate structures, methods, and interventions.
    March 18, 2016   doi: 10.1002/jclp.22281   open full text
  • A New Look at the Factor Structure of the MHC‐SF in Iran and the United States Using Exploratory Structural Equation Modeling.
    Mohsen Joshanloo.
    Journal of Clinical Psychology. March 18, 2016
    Objective This study examined the factor structure and measurement invariance of the Mental Health Continuum‐Short Form (MHC‐SF) in young adults from Iran and the USA and across gender. Method The sample consisted of 387 Iranian and 395 American university students. Confirmatory factor analysis (CFA) and the new method of exploratory structural equation modeling (ESEM) were used to analyze the data. Results The three‐dimensional model of well‐being as measured by the MHC‐SF was consistent with the data. ESEM resulted in better fit indices as well as considerably lower factor correlations than did CFA. Partial measurement invariance across nations and full measurement invariance across gender were established. Conclusion The results confirm the three‐dimensional structure of mental well‐being, and indicate that the items of the MHC‐SF function largely similarly across the two nations. These results also showcase the unique value of ESEM in understanding the factor structure of mental well‐being.
    March 18, 2016   doi: 10.1002/jclp.22287   open full text
  • “The Worst Experience of My Life”: The Internship Crisis and Its Impact on Students.
    Mike C. Parent, Tyler C. Bradstreet, Makenzie Wood, Eddy Ameen, Jennifer L. Callahan.
    Journal of Clinical Psychology. March 18, 2016
    Objective The objective of the present study was to understand how internship applicants perceive themselves as being affected by the ongoing imbalance between the number of internship spots available and the number of applicants to internship. Method The present study undertook a qualitative, and supplemental quantitative, analysis of 1,076 internship applicant responses to an item included in the 2011 postmatch survey asking participants how the internship crisis has affected them. Results Results indicated that the internship application process in general was viewed overwhelmingly negatively. Respondents described personal stress and system issues in their responses. Respondents described reciprocal stresses; applications spur on stresses, which are compounded by fears of not matching. Such fears cast negative light on training. Participants also described resiliencies that buffered against stresses and perceptions of discrimination or bias that add to stress. Conclusions The implications of these findings for supporting students, working to resolve the internship crisis, and adapting policy are discussed.
    March 18, 2016   doi: 10.1002/jclp.22290   open full text
  • Individual Face‐to‐Face Cognitive Behavioural Therapy in Multiple Sclerosis: A Qualitative Study.
    K. Gottberg, C. Chruzander, G. Backenroth, S. Johansson, G. Ahlström, C. Ytterberg.
    Journal of Clinical Psychology. March 16, 2016
    Objective To investigate how people with multiple sclerosis (MS) experience their participation in individual, face‐to‐face cognitive behavioural therapy (CBT) aimed at alleviating depressive symptoms. Method Semistructured interviews with 12 participants were conducted after CBT and analyzed using qualitative content analysis. Results Two main themes emerged: CBT as a demanding process and confronting everyday life after CBT with self‐knowledge and well‐being. The participants had gained strategies for handling feelings of depression and anxiety. The therapist was considered important for guiding them through the demanding therapy. Conclusion It is important to inform the participants of what CBT entails so that they are mentally prepared for the demanding process and can make the necessary adjustments in their daily life. Knowledge of MS among the therapists as well as collaboration with the multidisciplinary MS care may facilitate participation in CBT.
    March 16, 2016   doi: 10.1002/jclp.22288   open full text
  • Symptoms of Psychopathology Within Groups of Eating‐Disordered, Restrained Eating, and Unrestrained Eating Individuals.
    Garrett A. Pollert, Alicia A. Kauffman, Jennifer C. Veilleux.
    Journal of Clinical Psychology. March 15, 2016
    Objective While eating‐disordered individuals have shown high levels of comorbid psychopathology, there has not been an assessment of these symptoms across groups exhibiting different forms of problematic eating behavior. Method Using 1,122 participants recruited via Amazon Mechanical Turk, this study examined self‐reported differences between controls, restrained eaters, and individuals meeting criteria for binge eating disorder and bulimia nervosa on several measures of psychopathology unrelated to eating. Results On nearly all outcome measures, eating‐disordered participants had greater symptoms of psychopathology compared to restrained eaters, who had greater levels compared to controls. Among the eating‐disordered participants, bulimia nervosa participants had more symptoms of psychopathology than binge eating‐disordered participants. Conclusion Treatment of the populations included in this study may be informed by an understanding of the different amounts of symptoms of comorbid psychopathology that confer additional distress and impairment above and beyond disordered eating behavior.
    March 15, 2016   doi: 10.1002/jclp.22283   open full text
  • Getting Back to Work: Cognitive Behavioral Predictors of Depressive Symptoms and Job Search Success.
    Benjamin J. Pfeifer, Daniel R. Strunk.
    Journal of Clinical Psychology. March 15, 2016
    Objective Little is known about how cognitive behavioral approaches to depression might explain functional impairments associated with the disorder, such as extended periods of unemployment. To address this issue, we examined 5 cognitive behavioral predictors of depressive symptom change and job search outcome. Method Using a sample of 75 unemployed adults, we examined cognitive style, brooding, dysfunctional attitudes, avoidance, and cognitive behavioral (CB) skills as predictors of change in depressive symptoms, job search self‐efficacy, and receipt of a job offer over a 3‐month period. Results CB skills predicted lower depressive symptoms and increased odds of having received a job offer at the follow‐up. Brooding predicted change in job search self‐efficacy, but not in the expected direction. Conclusion CB skills appear to predict job search outcomes as well as depressive symptoms. We encourage future work examining how CB skills may affect depressive symptoms, job search behaviors, and other areas of functioning.
    March 15, 2016   doi: 10.1002/jclp.22279   open full text
  • Bad Roots to Grow: Deficient Implicit Self‐Evaluations in Chronic Depression With an Early Onset.
    Annette Randenborgh, Markus Pawelzik, Markus Quirin, Julius Kuhl.
    Journal of Clinical Psychology. March 15, 2016
    Objective Implicit self‐esteem, which is based on associative learning processes, is considered to be constituted earlier in life than explicit, verbalized self‐esteem. While depressed individuals report negative explicit self‐esteem, research has predominantly demonstrated equivalent levels of implicit self‐esteem of depressed and healthy individuals. We further illuminate this finding by theorizing and empirically demonstrating that chronically depressed individuals show particularly low levels of implicit self‐esteem when depression had an early onset. Method We applied measures of implicit (name–letter test) and explicit (Rosenberg Self‐Esteem Scale) self‐esteem in chronically depressed patients with an early onset (N = 17), a late onset (N = 13), and an episodic depression (N = 29). Results As expected, patients with an early onset showed lower implicit self‐esteem than the 2 other groups. Conclusion Implicit self‐esteem may function as a marker of how deeply negative self‐views are internalized. Furthermore, the distinction between early and late onset of chronic depression seems to be valuable for classification and potentially treatment of unipolar depression.
    March 15, 2016   doi: 10.1002/jclp.22275   open full text
  • Meaning in Life Buffers the Association Between Risk Factors for Suicide and Hopelessness in Participants With Mental Disorders.
    José H. Marco, Sandra Pérez, Joaquín García‐Alandete.
    Journal of Clinical Psychology. March 14, 2016
    Objective Hopelessness is a proximal risk factor of suicide. Meaning in life has been found to be a protective factor against suicidal ideation; however, the majority of studies that have explored the role of meaning in life in the context of suicidality have been conducted in nonclinical populations. The aim of this study was to investigate whether meaning in life can moderate and buffer the association between suicide risk factors and hopelessness in a clinical sample with a heightened risk of suicide. Method A total of 224 participants diagnosed with mental disorders completed self‐report measures of suicide risk factors, hopelessness, and meaning in life. Results The main result from this study was that meaning in life moderated the association between suicide risk factors and hopelessness. Conclusion Meaning in life is an important variable in the prevention and treatment of people at risk of suicide.
    March 14, 2016   doi: 10.1002/jclp.22285   open full text
  • Use of Social Desirability Scales in Clinical Psychology: A Systematic Review.
    Enrico Perinelli, Paola Gremigni.
    Journal of Clinical Psychology. March 11, 2016
    Objective There is still an open debate about the utility of social desirability indicators. This report systematically reviewed the use of social desirability scales in studies addressing social desirability in clinical psychology. Method A systematic review (January 2010–March 2015) was conducted, including 35 studies meeting the inclusion criteria of being published in peer‐reviewed journals and describing quantitative findings about an association of social desirability with clinical psychology variables using a cross‐sectional or longitudinal design. Results Social desirability was associated with self‐reports of various clinical‐psychological dimensions. Most of the included studies treated social desirability as a 1‐dimensional variable and only 10 of 35 disentangled the impression management and self‐deception components. Although theoretical literature does not consider social desirability a mere response bias, only 4 of the reviewed articles controlled for the possible suppressor effect of personality variables on social desirability, while the majority focused upon the stylistic (response bias) rather than the substantive (personality) nature of this construct. Conclusion The present review highlighted some limitations in the use of social desirability scales in recent clinical psychology research and tried to offer a few suggestions for handling this issue.
    March 11, 2016   doi: 10.1002/jclp.22284   open full text
  • Offline Versus Online Suicide‐Related Help Seeking: Changing Domains, Changing Paradigms.
    Amy‐Lee Seward, Keith M. Harris.
    Journal of Clinical Psychology. February 29, 2016
    Objective Suicidal individuals are among the most reluctant help‐seekers, which limits opportunities for treating and preventing unnecessary suffering and self‐inflicted deaths. This study aimed to assist outreach, prevention, and treatment efforts by elucidating relationships between suicidality and both online and offline help seeking. Method An anonymous online survey provided data on 713 participants, aged 18–71 years. Measures included an expanded General Help‐Seeking Questionnaire and the Suicidal Affect‐Behavior‐Cognition Scale. Results General linear modeling results showed that, as predicted, face‐to‐face help‐seeking willingness decreased as risk level increased. However, for emerging adults help‐seeking likelihood increased with informal online sources as risk increased, while other online help‐seeking attitudes differed little by risk level. Linear regression modeling determined that, for suicidal individuals, willingness to seek help from online mental health professionals and online professional support sites was strongly related (ps < .001). Help seeking from social networking sites and anonymous online forums was also interrelated, but more complex, demonstrating the importance of age and social support factors (ps < .001). Conclusion These findings show that the Internet has altered the suicide‐related help‐seeking paradigm. Online help seeking for suicidality was not more popular than face‐to‐face help seeking, even for emerging adults. However, treatment and prevention professionals have good reasons to increase their online efforts, because that is where some of the highest risk individuals are going for help with their most severe personal problems.
    February 29, 2016   doi: 10.1002/jclp.22282   open full text
  • Mental Health Stress, Family Resources and Psychological Distress: A Longitudinal Mediation Analysis in African American Grandmothers Raising Grandchildren.
    Deborah M. Whitley, Dorian A. Lamis, Susan J. Kelley.
    Journal of Clinical Psychology. February 25, 2016
    Objectives This study examines the effectiveness of a multidisciplinary intervention for African American grandmothers raising grandchildren on the relationship between dichotomized levels of mental health stress (low vs. high) and elevated levels of psychological distress, mediated by perceptions of family resources. Method A nonrandom sample of African American grandmothers (N = 679) was assessed to test the predictive relations among study constructs in the context of a prospective mediational model. Results Perception of family resources contributes to lower psychological distress among custodial grandmothers exhibiting low and high levels of mental health stress. There was no significant difference in the strength of the mediated effects between the 2 mental health stress groups. Conclusion The findings suggest appropriate resource‐focused interventions can enhance grandmothers’ subjective assessments of family resources and reduce psychological distress. However, additional research is needed to ascertain the consistency and generalizability of findings.
    February 25, 2016   doi: 10.1002/jclp.22272   open full text
  • Measures Assessing the Quality of Case Conceptualization: A Systematic Review.
    Sandra Bucci, Lorna French, Katherine Berry.
    Journal of Clinical Psychology. February 25, 2016
    Context The quality of case conceptualization differs across clinicians. It is unclear which case conceptualization quality assessment measure researchers, clinicians, and trainers might use for their specific purpose. Objective We evaluated measures that purport to assess the quality of case conceptualizations. Method We searched EMBASE, PubMed, Medline, and PsycINFO databases with the terms case formulation* OR case conceptuali*ation*. Further specific terms were then used to narrow the search. Results Of all the articles reviewed, 8 measures of case conceptualization met inclusion criteria. There is no single measure that has been validated across a range of different settings. However, the Case Conceptualisation Coding Rating Scale, Case Formulation Content Coding Method, and Case Formulation Quality Checklist have been most robustly tested. Conclusion Further research is required to test the psychometric properties of measures so that robust quality measures can be used across different settings/client groups.
    February 25, 2016   doi: 10.1002/jclp.22280   open full text
  • Grouping Youth With Similar Symptoms: A Person‐Centered Approach to Transdiagnostic Subgroups.
    F. Tony Bonadio, Morgan Dynes, Jennifer Lackey, Carolyn Tompsett, Kelly Amrhein.
    Journal of Clinical Psychology. February 25, 2016
    Objectives The present study extracted symptom profiles based on parent and youth report on a broad symptom checklist. Profiles based on parent‐reported symptoms were compared to those based on adolescent self‐report to clarify discrepancies. Method The current study used archival data from 1,269 youth and parent dyads whose youth received services at a community mental health center. The mean age of the sample was 14.31 years (standard deviation = 1.98), and the youth sample was half male (50.1%) and primarily Caucasian (86.8%). Latent profile analysis was used to extract models based on parent and self‐reported emotional and behavioral problems. Results Results indicated that a 5‐class solution was the best fitting model for youth‐reported symptoms and an adequate fit for parent‐reported symptoms. For 46.5% of the sample, class membership matched for both parent and youth. Conclusion Latent profile analysis provides an alternative method for exploring transdiagnostic subgroups within clinic‐referred samples.
    February 25, 2016   doi: 10.1002/jclp.22274   open full text
  • Meaning Making in the Context of Disasters.
    Crystal L. Park.
    Journal of Clinical Psychology. February 22, 2016
    Objective Understanding the factors underlying adaptive psychological responses and recovery after disasters has important implications for intervention and prevention efforts. To date, little attention has been paid to successful coping processes in recovering from natural and technological disasters. This article takes a meaning making perspective to explicate how survivors successfully adapt after disasters. Method Relevant literature is reviewed to illustrate the process of adaptation and resilience after disasters. Results Studies to date suggest both survivors’ global meaning, particularly their religiousness and sense of meaning, and their appraisals and meaning making after the disaster are important influences on their postdisaster resilience. Meanings made in the form of changes in global beliefs and perceived growth have been reported and shown to have inconsistent relations with adjustment. Conclusions Although much more research is needed, current literature suggests that meaning making processes are central to recovery and resilience after a range of disasters.
    February 22, 2016   doi: 10.1002/jclp.22270   open full text
  • Beliefs in an Unjust World: Mediating Ethnicity‐Related Stressors and Psychological Functioning.
    Christopher T. H. Liang, Carin M. Molenaar.
    Journal of Clinical Psychology. February 16, 2016
    Objective Racism is negatively associated with health. Explorations of cognitive reactions, such as beliefs in an unjust world (BUW), are needed to understand the associations between both perceived discrimination and own‐group conformity pressures (OGCPS) and reduced psychological well‐being. Method With a sample of 215 ethnic minority individuals, this study used structural equation modeling to explore BUW's mediating role between the two aforementioned forms of ethnicity‐related stressors (ERS), anger rumination, and negative affect. Results ERS were directly positively associated with BUW, anger rumination, and negative affect. BUW were directly and positively associated with both anger rumination and negative affect. Finally, BUW significantly mediated the direct relationships between both ethnicity‐related stressors and anger rumination and negative affect. Conclusion Although addressing racism and OGCPS at a systemic level (e.g., policy, prejudice prevention) is needed to reduce ERS, these findings suggest that BUW is one point of possible clinical intervention for individuals who have experienced these stressors.
    February 16, 2016   doi: 10.1002/jclp.22271   open full text
  • Assessment of Meaning in Adolescents Receiving Clinical Services in Mississippi Following the Deepwater Horizon Oil Spill: An Application of the Purpose in Life Test‐Short Form (PIL‐SF).
    Stefan E. Schulenberg, C. Veronica Smith, Christopher F. Drescher, Erin M. Buchanan.
    Journal of Clinical Psychology. November 17, 2015
    Objectives This study's purpose was to assess perceived meaning in adolescents. Specifically, our goals were to examine the psychometric properties of the Purpose in Life test‐Short Form (PIL‐SF) and its ability to predict psychological outcomes in an adolescent sample. Method Aspects of well‐being (self‐efficacy, life satisfaction, and resilience) and psychological distress (posttraumatic stress, depression, anxiety, and general stress) were assessed in a sample of adolescents (N = 91; 58.2% female; mean age = 14.89) receiving clinical services following the Deepwater Horizon Oil Spill. Results Meaning was positively associated with life satisfaction, self‐efficacy, and resilience, and negatively associated with posttraumatic stress and depression. Meaning was not significantly related to anxiety or general stress. Females reported significantly more meaning than males, while no significant differences were noted by race/ethnicity. Conclusions The PIL‐SF is a useful measure with adolescents. Moreover, meaning is an important concept to consider with respect to disasters.
    November 17, 2015   doi: 10.1002/jclp.22240   open full text
  • Meaning, Resilience, and Traumatic Stress After the Deepwater Horizon Oil Spill: A Study of Mississippi Coastal Residents Seeking Mental Health Services.
    Bethany J. Aiena, Erin M. Buchanan, C. Veronica Smith, Stefan E. Schulenberg.
    Journal of Clinical Psychology. October 20, 2015
    The present study examines the relationship between resilience, perceived meaning in life, and traumatic stress symptoms among coastal residents of Mississippi directly affected by the Deepwater Horizon oil spill (also known as the Gulf oil spill). The study was conducted as part of a larger project that assessed the spill's effect on the mental health of individuals seeking therapeutic services. Multiple regression analyses were conducted to determine if resilience and perceived meaning are significant predictors of scores from a measure of posttraumatic stress. Descriptive data, reliability coefficients, and correlations were also calculated. Higher levels of resilience and meaning together were predictive of fewer posttraumatic stress symptoms after controlling for the effect of the spill. Resilience and meaning appeared to be similar predictors of lower posttraumatic stress scores, and meaning appears to be an important facet of what makes a person resilient.
    October 20, 2015   doi: 10.1002/jclp.22232   open full text
  • Mindfulness as a Protective Factor for the Burden of Caregivers of Amyotrophic Lateral Sclerosis Patients.
    Francesco Pagnini, Deborah Phillips, Colin M. Bosma, Andrew Reece, Ellen Langer.
    Journal of Clinical Psychology. October 20, 2015
    Objectives Caregivers of people with severe chronic conditions, such as amyotrophic lateral sclerosis (ALS), are at risk of developing depression and anxiety and reduced quality of life. Few studies have explored protective factors in this population and none investigated the role of mindfulness. The study aimed to examine the relationship between mindfulness and health‐related outcomes in a population of ALS caregivers. Methods We conducted an online survey with ALS caregivers, and again at 4‐month follow‐up, to assess mindfulness, burden, quality of life, anxiety, and depression. The associations between mindfulness and the other outcomes were evaluated both cross‐sectionally and longitudinally. Results Mindfulness correlated negatively with burden, depression, and anxiety and positively with quality of life, maintaining stability through time. Conclusion Our results showed that mindfulness is positively related to quality of life and negatively related to level of burden. We suggest that this construct can represent a preventative factor toward the negative effects of caregiving.
    October 20, 2015   doi: 10.1002/jclp.22235   open full text
  • A Preliminary Test of the Interpersonal Psychological Theory of Suicidal Behavior in Young People With a First Episode of Psychosis.
    Rebecca Heelis, Hermine Graham, Chris Jackson.
    Journal of Clinical Psychology. October 13, 2015
    Objectives The interpersonal‐psychological theory (IPT) of suicidal behavior suggests that an individual who does not feel they belong and believes they are a burden combined with the capability to attempt suicide is more likely to attempt suicide. The study aimed to investigate this hypothesis in the context of psychosis. Method Young people with a first episode of psychosis (N = 45) who considered suicide, attempted suicide, and had no history of suicide or attempt were compared on self‐report measures of suicidal desire, capability for suicide, and substance use. Results No significant differences were found between groups in terms of suicidal desire or capability. All participants perceived they were a burden, did not feel they belonged, and had the capability for suicide. Poisoning (n = 22) was the most frequently reported method of a suicide attempt. Of those who had attempted suicide, 50% (n = 7) reported that it had been related to a psychotic episode. Of the participants, 30 reported previous suicidal ideation mainly to completely end or stop the distress they were experiencing. Levels of depression were significantly different between groups; moderate levels of depression were reported in the suicidal ideation and attempt groups. Conclusion The concepts of IPT appear to resonate with the experience of psychosis, regardless of suicidality. Specific features of psychosis and their influence on suicidality are worth further exploration.
    October 13, 2015   doi: 10.1002/jclp.22233   open full text
  • Acculturative Stress, Self‐Esteem, and Eating Pathology in Latina and Asian American Female College Students.
    Kimberly Claudat, Emily K. White, Cortney S. Warren.
    Journal of Clinical Psychology. October 13, 2015
    Objective The overarching purpose of this study was to explore the relationships among acculturative stress, self‐esteem, and eating pathology in Asian American and Latina female college students. Method Participants (N = 638, mean age = 19.88) completed self‐report measures of the variables of interest online. Results Bivariate correlations indicated that for women of both ethnic groups, acculturative stress was negatively correlated with self‐esteem and positively correlated with eating pathology. Multigroup structural equation modeling indicated that for Asian American and Latina women, self‐esteem partially mediated the relationship between acculturative stress and eating pathology. However, self‐esteem did not serve as a significant moderator of this relationship for either ethnic group. Conclusion Overall, data suggest that acculturative stress is associated with increased eating pathology and self‐esteem may mediate this relationship. These relationships suggest that assessment of eating pathology and self‐esteem may be indicated for women presenting clinically with acculturative stress concerns.
    October 13, 2015   doi: 10.1002/jclp.22234   open full text
  • Burnout and Depression: Two Entities or One?
    Irvin Sam Schonfeld, Renzo Bianchi.
    Journal of Clinical Psychology. October 09, 2015
    Objectives The purpose of this study was to examine the overlap in burnout and depression. Method The sample comprised 1,386 schoolteachers (mean [M]age = 43; Myears taught = 15; 77% women) from 18 different U.S. states. We assessed burnout, using the Shirom‐Melamed Burnout Measure, and depression, using the depression module of the Patient Health Questionnaire. Results Treated dimensionally, burnout and depressive symptoms were strongly correlated (.77; disattenuated correlation, .84). Burnout and depressive symptoms were similarly correlated with each of 3 stress‐related factors, stressful life events, job adversity, and workplace support. In categorical analyses, 86% of the teachers identified as burned out met criteria for a provisional diagnosis of depression. Exploratory analyses revealed a link between burnout and anxiety. Conclusions This study provides evidence that past research has underestimated burnout–depression overlap. The state of burnout is likely to be a form of depression. Given the magnitude of burnout–depression overlap, treatments for depression may help workers identified as “burned out.”
    October 09, 2015   doi: 10.1002/jclp.22229   open full text
  • Incorporating Resilience Factors Into the Interpersonal Theory of Suicide: The Role of Hope and Self‐Forgiveness in an Older Adult Sample.
    Jennifer S. Cheavens, Kelly C. Cukrowicz, Ryan Hansen, Sean M. Mitchell.
    Journal of Clinical Psychology. October 08, 2015
    Objectives The interpersonal theory of suicide posits that perceived burdensomeness and thwarted belongingness are risk factors for suicide ideation. To more comprehensively characterize this model, it is important to identify resilience factors. Forgiveness of oneself may attenuate the relation between perceived burdensomeness and suicide ideation. Similarly, hope might weaken the association between thwarted belongingness and suicide ideation. Method We examined these relations cross‐sectionally in a sample (N = 91) of older adults after including symptoms of depression and demographic variables in the models. Results Self‐forgiveness moderated the relation between perceived burdensomeness and suicide ideation. Hope did not moderate the relation between thwarted belongingness and suicide ideation. Conclusions These findings suggest that including resilience factors (i.e., self‐forgiveness) in models of suicide ideation may result in better identification of those most at risk for suicide and may allow for more precise intervention targets.
    October 08, 2015   doi: 10.1002/jclp.22230   open full text
  • Differential Links Between Leisure Activities and Depressive Symptoms in Unemployed Individuals.
    William K. Goodman, Ashley M. Geiger, Jutta M. Wolf.
    Journal of Clinical Psychology. October 07, 2015
    Objective Unemployment has consistently been linked to an elevated risk for depression. Exercise, specifically leisure‐based physical activities, has received increasing attention as alternative treatment options. However, because leisure activities are pursued during discretionary time, it is unclear if the mental health benefits of physical and leisure activities apply during times of unemployment as well. Method Depressive symptoms and participation in recreational activities were assessed in 142 employed and 158 unemployed participants (age = 34 ± 11 years; male = 150). Results Independent of employment status, all recreational activities were inversely associated with depressive symptoms. However, social (employed: ηp2 = .21; unemployed: ηp2 = .11) and self‐focused (employed: ηp2 = .19; unemployed: ηp2 = .10) recreational activities were more strongly related to depressive symptoms than exercise (employed: ηp2 = .12; unemployed: ηp2 > .05). Conclusion These findings highlight the strong mental health associations of recreational activities and suggest that, particularly for unemployed individuals, promoting recreational activities, rather than exercise, may leverage the stronger negative relationship with risk of depression.
    October 07, 2015   doi: 10.1002/jclp.22231   open full text
  • Can Low‐Cost Strategies Improve Attendance Rates in Brief Psychological Therapy? Double‐Blind Randomized Controlled Trial.
    Jaime Delgadillo, Omar Moreea, Elizabeth Murphy, Shehzad Ali, Joshua K. Swift.
    Journal of Clinical Psychology. October 01, 2015
    Objectives To assess if telephone text message appointment reminders and orientation leaflets can increase the proportion of patients who attend brief interventions after being assessed as suitable for guided self‐help following cognitive behavioral therapy principles. Method Attendance was operationally defined as having accessed at least 1 therapy appointment. A secondary outcome was the proportion of attenders who completed or dropped out of therapy. After initial assessment, 254 patients with depression and anxiety disorders were randomly assigned to 1 of 3 groups: (a) usual waitlist control, (b) leaflet, (c) leaflet plus text message. Differences in the proportions of patients who started and completed therapy across groups were assessed using chi‐square and logistic regression analyses. Results Overall, 63% of patients in this sample attended therapy. Between‐group differences were not significant for attendance, x2(2) = 3.94, p = .14, or completion rates, x2(2) = 2.98, p = .23. These results were not confounded by demographic or clinical characteristics. Conclusions Low‐cost strategies appear to make no significant difference to therapy attendance and completion rates.
    October 01, 2015   doi: 10.1002/jclp.22228   open full text
  • Psychosocial Functioning and Life Satisfaction in Adults With Autism Spectrum Disorder Without Intellectual Impairment.
    Lilly Schmidt, Jennifer Kirchner, Sandra Strunz, Julia Broźus, Kathrin Ritter, Stefan Roepke, Isabel Dziobek.
    Journal of Clinical Psychology. September 25, 2015
    Objectives This study aimed at (a) comparing psychosocial functioning and life satisfaction in adults with autism spectrum disorder (ASD) and nonclinical participants and (b) identifying areas of functioning that are most predictive for life satisfaction in individuals with ASD. Method A total of 43 adults with ASD without intellectual impairment (age: mean = 31, standard deviation = 10 years; 63% females) and healthy nonclinical individuals (N = 44) were surveyed. Results Individuals with ASD reported significant functional impairments and less life satisfaction compared with nonclinical individuals in many areas of life. Although impairments were prominent in domains involving interaction with other people such as understanding and communication, getting along with others, and participation in society, daily living skills (e.g., getting around, self‐care, and household) were not different from nonclinical participants. Participating in society was identified as the only factor predicting life satisfaction in individuals with ASD. Conclusion There is a need for interventions facilitating functioning on a broad level and support toward societal inclusion for individuals with ASD.
    September 25, 2015   doi: 10.1002/jclp.22225   open full text
  • Psychotherapists Growing Older: A Study of Senior Practitioners.
    David E. Orlinsky, Michael Helge Rønnestad.
    Journal of Clinical Psychology. September 24, 2015
    A sample of 1,102 psychotherapists aged 60 years and older was selected from the multinational database of the Society for Psychotherapy Research Collaborative Research Network. These older therapists were first described in terms of gender, generation, years in practice, civil status, professional background, and theoretical orientation. To compare them on practice‐related characteristics with cohorts of younger therapists, the following age‐based taxonomy was developed: young adult (21 < 30); prime adult (30 < 45); mature adult (45 < 60); senior adult (60 to 90). Senior adults were further differentiated into young old (60 to 66), mid old (67 to 74), and long old (75 to 90). Comparisons between therapist age groups were made regarding practice setting, quality of therapeutic involvement, current use of supervision and personal therapy, currently experienced professional growth, personal life quality, and perceived aspects of self in close personal relationships. Given a series of positive results favoring senior adults as a group, and even long old compared to young old, it is suggested that these hardy “surviving” therapists typically have succeeded in mastering the developmental tasks of previous phases of professional development.
    September 24, 2015   doi: 10.1002/jclp.22223   open full text
  • A Female Therapist's Perspective on Growing Older.
    Iris Fodor.
    Journal of Clinical Psychology. September 22, 2015
    As an older woman therapist, I find that my life experience grounds me in my work with people of all ages and backgrounds as they deal with life crises, aging issues, and loss. People with whom I work in therapy appreciate the fact that I am older and have had varied life experiences. Gender issues are still central to my work with clients whether I am working with a man or a woman. I am an integrative therapist, with a background in cognitive‐behavioral therapy and gestalt therapy. Therapists need to help clients to identify less with their aging bodies and our culture's view of attractiveness, shifting instead to a paradigm that values life experience and the cultivation of wisdom. We need to find ways of embracing what we have learned about life instead of extolling youthful values. As I get older, I more fully appreciate a constructivism framework and life‐cycle perspective, focusing on making sense of clients’ life narratives. Storytelling and memoirs have both provided a framework for working with clients on coping with the many changes and challenges of life that bring them to therapy and added another layer to my integrative therapeutic work.
    September 22, 2015   doi: 10.1002/jclp.22221   open full text
  • Predictors of Prolonged Grief, Resilience, and Recovery Among Bereaved Spouses.
    Anthony D. Mancini, Beyza Sinan, George A. Bonanno.
    Journal of Clinical Psychology. September 22, 2015
    Objective Most reactions to loss can be characterized by three prototypical trajectories of resilience, gradual recovery, and chronic distress (Bonanno, ). However, research on the factors that uniquely predict these trajectories of response has been limited. We examined theoretically relevant predictors of each of the trajectory patterns. Method We assessed 115 bereaved spouses at 1.5 to 3 years postloss and 74 married controls. To identify grief trajectory, we provided bereaved participants with a graphical depiction of the trajectories and asked them to select the one that best described their experience. Results Group comparisons revealed substantial differences between resilient and prolonged grievers, and almost no differences between resilient and married controls. Multivariate analyses indicated that prolonged grief, when compared to resilience, was uniquely associated with maladaptive dependency traits, difficulty accessing positive memories of the deceased, and higher recalled marital adjustment. Conclusion The present results extend our understanding of factors associated with distinct trajectories of adjustment after loss.
    September 22, 2015   doi: 10.1002/jclp.22224   open full text
  • Stepping Into Retirement: A Postcard From the Threshold.
    Michael F. Hoyt.
    Journal of Clinical Psychology. September 21, 2015
    As I begin a postclinical career transition, I pause and describe various early retirement personal, familial, and professional reverberations, as well as some aging‐related “long‐view” observations about conducting therapy.
    September 21, 2015   doi: 10.1002/jclp.22222   open full text
  • Properties of the Dialectical Behavior Therapy Ways of Coping Checklist in a Diagnostically Diverse Partial Hospital Sample.
    Aliza T. Stein, Bridget A. Hearon, Courtney Beard, Kean J. Hsu, Thröstur Björgvinsson.
    Journal of Clinical Psychology. September 21, 2015
    Objective Dialectical behavior therapy (DBT) was developed for treatment of borderline personality disorder (BPD), and adapted forms of DBT are currently used to treat bipolar disorder, eating disorders, anxiety, and depression. This study was designed to validate the Dialectical Behavior Therapy Ways of Coping Checklist (DBT‐WCCL) DBT Skills subscale (DSS) for use in a diagnostically heterogeneous sample. Method We used naturalistic data from 228 patients receiving treatment at a partial hospital program to assess psychometric properties of the DBT‐WCCL DSS. We assessed interitem correlations, internal consistency, factor structure, construct validity and sensitivity to change. Results Internal consistency, construct validity, and sensitivity to change were good. The measure displayed good convergent and discriminant validity. Factor analysis results were consistent with previous research indicating a 1‐factor solution for this subscale. Conclusions Psychometric properties were similar to the original BPD sample, indicating that this measure can be used as an assessment tool for DBT skill use in a diverse psychiatric population.
    September 21, 2015   doi: 10.1002/jclp.22226   open full text
  • Self‐Compassion and Self‐Criticism in Recovery in Psychosis: An Interpretative Phenomenological Analysis Study.
    Felicity Waite, Matthew T. D. Knight, Deborah Lee.
    Journal of Clinical Psychology. September 21, 2015
    Objective To increase understanding of the internal processes of recovery in psychosis, with particular consideration given to self‐compassion and self‐criticism. Method Qualitative data were collected by semistructured interviews, from 10 participants with psychosis, and analyzed using interpretative phenomenological analysis. Results Five superordinate themes emerged: (a) “my mind can't take the load”: the “curse” of psychosis; (b) the “trap” of self‐criticism; (c) “coming to terms” with psychosis in my life to “move on”; (d) “on my own two feet”; and (e) “an opportunity” for growth. The themes included a reciprocal relationship between psychosis and self‐criticism, processes of acceptance, empowerment, and posttraumatic growth. Conclusions The internal process of self‐to‐self relating contributed to 2 maintenance cycles: self‐criticism maintained distressing experiences of psychosis and compassionate self‐acceptance resulted in empowered action and promoted recovery and growth. The dual process of acceptance and change in relationship to self was central to recovery.
    September 21, 2015   doi: 10.1002/jclp.22211   open full text
  • The Arts, Crafts, and Sciences of Psychotherapy.
    Lorna Smith Benjamin.
    Journal of Clinical Psychology. September 17, 2015
    Contemporary training and practice of psychotherapy and the research that supports it is the subject of this review. I discuss it in the light of what I value most from my own professional training, which was, in my opinion, highly privileged by comparison with what is offered today. A minimal hoped‐for outcome is that younger readers will find valuable tidbits here and there that will be useful in their own versions of psychotherapy. A maximal hope is that a few individuals who choose to maintain clinical skills as well as emphasize psychotherapy research might be encouraged to follow their instincts toward excellence. They would allow their curiosity to bloom and their work to be creative and more adherent to the rules of natural science than time allows in these days of dashboards that count funding associated with numbers of publications, grants, teaching, and service hours. Admittedly, that path less well traveled would be risky, because what truly is new takes time to develop and implement and the outcomes when research truly can disconfirm hypotheses (as distinct from fail to confirm them) are, well, uncertain.
    September 17, 2015   doi: 10.1002/jclp.22217   open full text
  • Introduction: Reflections of Senior Therapists.
    Jesse D. Geller, Barry A. Farber.
    Journal of Clinical Psychology. September 17, 2015
    This introduction to this issue of JCLP: In Session (“Reflections of Senior Therapists”) focuses on the multifaceted ways in which adult development influences what it means to be a psychotherapist and to do the work of psychotherapy. This issue brings together first person narratives written by a group of eminent psychotherapists as well as an empirical report, based on a major international survey, on the challenges, demands, and rewards experienced by senior therapists. Taken together, these essays provide a compelling case that not only can practicing psychotherapy during the later years of one's life continue to be fulfilling and meaningful, but also the lessons learned along the journey can make one an even wiser and more effective therapist than previously. Learning to do psychotherapy, like adult development itself, is not a process that at some point comes to an end, but one that is resumed again and again in every decade. These essays provide a rich array of information, insight, and guidance regarding the personal and professional experience of practicing therapy during every era of adulthood, including one's senior years.
    September 17, 2015   doi: 10.1002/jclp.22215   open full text
  • How I Have Changed Over Time as a Psychotherapist.
    Stanley B. Messer.
    Journal of Clinical Psychology. September 11, 2015
    Reflecting on my career as a psychotherapist has led me to consider 3 major areas that have affected the way I practice, namely, assimilative integration, the visions of reality, and brief psychodynamic therapy. Although starting out as a traditional psychoanalytic therapist, I became more integrative as I was exposed to other approaches and to patients with a variety of needs. As a result I developed a mode of integration, which I call assimilative. After applying the literary genres of tragedy, comedy, romance, and irony to psychoanalytic, behavioral, and humanistic psychotherapies, I found that they also could be used to describe any patient's multiple facets and psychological challenges. I demonstrate here how such visions helped in the treatment of a case of bipolar disorder. Upon recognizing the need for briefer forms of treatment, I developed an interest in conducting, conceptualizing, and researching brief psychodynamic therapy. I conclude the article by answering questions posed by the editors regarding how I have changed over time in conducting psychotherapy.
    September 11, 2015   doi: 10.1002/jclp.22220   open full text
  • Reflections on Becoming an Older and More Experienced Psychotherapist.
    Judy L. Kantrowitz.
    Journal of Clinical Psychology. September 11, 2015
    In this article, I describe how greater self‐awareness and increased affect tolerance changed my clinical work with patients. I provide a clinical example to illustrate how my personal growth occurred. Blind spots, created through both conflict and ignorance, are discussed. My acceptance of my limitations in general, as well as those that come with age, and the awareness of the limitations of time itself all increase as I age. Grief and mourning become more central in my work. My comfort and confidence increase, but awareness of my age makes me more selective about whom I will treat. I treasure the work more than ever and experience the benefits of mutual peer supervision increasing over time. I hope to convey what a privilege it has been to be a psychotherapist.
    September 11, 2015   doi: 10.1002/jclp.22219   open full text
  • From There and Back Again.
    Arthur C. Bohart.
    Journal of Clinical Psychology. September 11, 2015
    This article describes my journey from being a radical, person‐centered therapist in the 1960s to the present. In the 1960s, my colleagues and I saw therapy as a person‐to‐person encounter. Over the years I lost that notion and became corrupted by the idea that therapy is a process of intervening to make things happen in clients. In the 1990s, I found my way back to the idea of therapy as a meeting of persons because of a research review that showed that it was clients’ investment and creativity that were primarily responsible for making therapy work and because of my experiences with clients. In the meantime, the field had aged and political developments within it, such as the empirically supported treatments movement, also influenced how I came to view myself. I conclude by giving my current view of therapy as a process in which I am not intervening but engaging in a person‐to‐person meeting, within which I am free to offer techniques and ideas from many different approaches if appropriate.
    September 11, 2015   doi: 10.1002/jclp.22216   open full text
  • A Professional Journey Through Life.
    Marvin R. Goldfried.
    Journal of Clinical Psychology. September 10, 2015
    In response to the request to write about those changes that have occurred in my professional outlook and practice that have come with age, I have recounted some of the experiences I have had that seem to have contributed to these changes. There are a couple of important themes that have run through my professional experiences as a therapist, supervisor, teacher, and researcher. One of the themes has to do with my psychotherapy orientation. The other involves the tension that I have experienced between research and practice. I begin by discussing each of these, and then go on to highlight some of the more general lessons learned over the years, including coming to be more myself as a therapist, developing a broader perspective on life, being more clinically integrative, and learning to be accepting of what therapy can and cannot do.
    September 10, 2015   doi: 10.1002/jclp.22218   open full text
  • Ethnic Identity and Major Depression in Asian American Subgroups Nationwide: Differential Findings in Relation to Subcultural Contexts.
    Amy L. Ai, Ethel G. Nicdao, Hoa B. Appel, Daniel Hyung Jik Lee.
    Journal of Clinical Psychology. September 03, 2015
    Objectives Asian Americans (AA) are the fastest growing minority population in the United States. Leading AA scholars have highlighted the unmet service needs and the necessity to investigate subgroup variations in the mental health of AAs. This study addressed a research gap of whether racial and ethnic identity (REI) in three AA subgroups (Chinese, Filipino, and Vietnamese) consistently protects against major depressive disorder (MDD), counteracting the deleterious role of discrimination. Method Using the National Latino and Asian American Study (NLAAS), we explored the varying and incremental predictive values of REI, above and beyond the effects of known demographic and acculturation predictors, alongside other potentially protective factors. Results In three sets of two‐step logistic regressions, REI had an inverse relationship with MDD in the Filipino subgroup only but a positive association in the Chinese subgroup. The damaging role of negative REI moderated the effect of discrimination. The longest stay in the United States and discrimination predicted a higher likelihood of a MDD diagnosis in the Filipino subgroup. Social support contributed to the lower odds of MDD in Chinese and Vietnamese subgroups, had lower odds of having MDD, and religious attendance may act as a protective factor in the Vietnamese subgroup. Conclusion Our findings do not reinforce uniform protection of REI but lend partial support for two underlying rationales. Based on cultural psychologists’ framework, inconsistent findings are interpreted within the sociocultural contexts of the 3 subgroups.
    September 03, 2015   doi: 10.1002/jclp.22214   open full text
  • Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update.
    Carol Chu, Kelly M. Klein, Jennifer M. Buchman‐Schmitt, Melanie A. Hom, Christopher R. Hagan, Thomas E. Joiner.
    Journal of Clinical Psychology. August 19, 2015
    Objective Empirically informed suicide risk assessment frameworks are useful in guiding the evaluation and treatment of individuals presenting with suicidal symptoms. Joiner et al. (1999) formulated one such framework, which has provided a concise heuristic for the assessment of suicide risk. The purpose of this review is to ensure compatibility of this suicide risk assessment framework with the growing literature on suicide‐related behaviors. Methods This review integrates recent literature on suicide risk factors and clinical applications into the existing model. Further, we present a review of risk factors not previously included in the Joiner et al. (1999) framework, such as the interpersonal theory of suicide variables of perceived burdensomeness, thwarted belongingness, and capability for suicide (Joiner, 2005; Van Orden et al., 2010) and acute symptoms of suicidality (i.e., agitation, irritability, weight loss, sleep disturbances, severe affective states, and social withdrawal). Results These additional indicators of suicide risk further facilitate the classification of patients into standardized categories of suicide risk severity and the critical clinical decision making needed for the management of such risk. Conclusions To increase the accessibility of empirically informed risk assessment protocols for suicide prevention and treatment, an updated suicide risk assessment form and decision tree are provided.
    August 19, 2015   doi: 10.1002/jclp.22210   open full text
  • A Comparison of Humiliation Measurement in a Depressive Versus Non‐clinical Sample: A Possible Clinical Utility.
    A. Collazzoni, C. Capanna, M. Bustini, C. Marucci, S. Prescenzo, M. Ragusa, A. Tosone, V. Di Ubaldo, P. Stratta, A. Rossi.
    Journal of Clinical Psychology. August 14, 2015
    Objective We aimed to deepen the clinical utility of humiliation assessment in the study of depression. Method We performed a correlational analysis of the relationship between humiliation, depression, resilience, and negative primary familial environment in 80 clinically depressed subjects (41 men and 39 women; mean age = 40.71, standard deviation SD = 9.94) and a strictly matched sample of 80 non‐clinical subjects (41 men and 39 women; mean age = 40.64, SD = 10.24). We also implemented a hierarchical multiple regression analysis for each sample, to test the prediction of these variables on depression. Results Humiliation showed positive correlations with depressive factors, while negative correlations emerged with resilience in both samples. The hierarchical multiple regression analysis showed humiliation to be the most predictive factor of depression in the clinical sample only. Conclusion This study improves the understanding of the relationship of humiliation and depression in both clinical and non‐clinical populations.
    August 14, 2015   doi: 10.1002/jclp.22212   open full text
  • Interpersonal Functioning Among Treatment‐Seeking Trans Individuals.
    Amanda Davey, Walter Pierre Bouman, Caroline Meyer, Jon Arcelus.
    Journal of Clinical Psychology. August 06, 2015
    Objectives Trans people have been found to have high levels of depression. In view of the association between interpersonal problems and depression and the importance of interpersonal skills to navigate the transition of trans people, this study aims to investigate the levels of interpersonal problems among treatment‐seeking trans men and women and the role of depression in this association. Method A total of 104 patients from a UK gender identity clinic and 104 age‐ and gender‐matched control participants completed self‐report measures of interpersonal problems and general psychopathology, including depression. Results Trans people reported significantly higher scores on global interpersonal problems and on the Inventory of Interpersonal Problems‐32 (IIP‐32) Hard to be Sociable, Hard to be Supportive, and Hard to be Involved subscales and lower scores on the Too Open subscale. Depression accounted for significant differences on IIP‐32 global and the Too Open subscale but not on Hard to be Sociable, Hard to be Supportive, and Hard to be Involved subscales. Conclusions Trans individuals present with interpersonal problems, which could potentially increase their vulnerability to mental health problems. Therefore, addressing interpersonal problems may help to prevent the development of depressive symptomatology and facilitate transition.
    August 06, 2015   doi: 10.1002/jclp.22209   open full text
  • Validation of the Automatic Thoughts Questionnaire (ATQ) Among Mainland Chinese Students in Hong Kong.
    Jia‐Yan Pan, Shengquan Ye, Petrus Ng.
    Journal of Clinical Psychology. May 29, 2015
    Objective The present study validated the combined version of the 8‐item Automatic Thought Questionnaire (ATQ) and 10 positive items from the ATQ‐revised among Chinese university students. Method A total of 412 Mainland Chinese university students were recruited in Hong Kong by an online survey. Results A 14‐item Chinese ATQ was derived via item analysis. Satisfactory internal consistency reliability and good split‐half reliability were obtained. Exploratory and confirmatory factor analysis revealed a 3‐correlated‐factor solution for the Chinese ATQ: negative thought, positive thought (emotional), and positive thought (cognitive). The negative ATQ subscale score was positively correlated with negative affect, and negatively correlated with positive affect and life satisfaction. The two positive ATQ subscale scores were negatively correlated with negative affect, and positively correlated with positive affect and life satisfaction. Conclusion The 14‐item ATQ is a valid and reliable instrument for measuring automatic thoughts in the Chinese context of Hong Kong.
    May 29, 2015   doi: 10.1002/jclp.22193   open full text
  • Examining Mechanisms of Change in a Yoga Intervention for Women: The Influence of Mindfulness, Psychological Flexibility, and Emotion Regulation on PTSD Symptoms.
    Alexandra M. Dick, Barbara L. Niles, Amy E. Street, Dawn M. DiMartino, Karen S. Mitchell.
    Journal of Clinical Psychology. May 28, 2014
    Objective This study explored possible mechanisms through which symptoms of posttraumatic stress disorder (PTSD) were reduced in a randomized controlled trial comparing the effect of a yoga intervention with an assessment control. Method We examined whether changes in psychological flexibility, mindfulness, and emotion regulation strategies (expressive suppression and reappraisal) were associated with posttreatment PTSD symptoms for 38 women with Diagnostic and Statistical Manual of Mental Disorders Fourth Edition full or subthreshold PTSD. Results Hierarchical linear regression models revealed that expressive suppression significantly decreased for the yoga group relative to the assessment control. Psychological flexibility increased significantly for the control but not yoga group. However, increases in psychological flexibility were associated with decreases in PTSD symptoms for the yoga but not control group. Conclusion Preliminary findings suggest that yoga may reduce expressive suppression and may improve PTSD symptoms by increasing psychological flexibility. More research is needed to replicate and extend these findings.
    May 28, 2014   doi: 10.1002/jclp.22104   open full text
  • Mindfulness Intervention for Child Abuse Survivors: A 2.5‐Year Follow‐Up.
    Michael D. Earley, Margaret A. Chesney, Joyce Frye, Preston A. Greene, Brian Berman, Elizabeth Kimbrough.
    Journal of Clinical Psychology. May 20, 2014
    Objective The present study reports on the long‐term effects of a mindfulness‐based stress reduction (MBSR) program for adult survivors of childhood sexual abuse. Method Of the study participants, 73% returned to the clinic for a single‐session follow‐up assessment of depression, posttraumatic stress disorder (PTSD), anxiety, and mindfulness at 2.5 years. Results Repeated measures mixed regression analyses revealed significant long‐term improvements in depression, PTSD, anxiety symptoms, and mindfulness scores. The magnitude of intervention effects at 128 weeks ranged from d = .5 to d = 1.1. Conclusion MBSR may be an effective long‐term treatment for adults who have experienced childhood sexual abuse. Further investigation of MBSR with this population is warranted given the durability of treatment effects described here.
    May 20, 2014   doi: 10.1002/jclp.22102   open full text
  • Factor Structure and Psychometric Properties of English and Spanish Versions of the Edinburgh Postnatal Depression Scale Among Hispanic Women in a Primary Care Setting.
    Chelsey M. Hartley, Nicole Barroso, Yasmin Rey, Jeremy W. Pettit, Daniel M. Bagner.
    Journal of Clinical Psychology. May 07, 2014
    Background Although a number of studies have examined the factor structure of the Edinburgh Postnatal Depression Scale (EPDS) in predominately White or African American samples, no published research has reported on the factor structure among Hispanic women who reside in the United States. Objective The current study examined the factor structure of the EPDS among Hispanic mothers in the United States. Method Among 220 Hispanic women, drawn from a pediatric primary care setting, with an infant aged 0 to 10 months, 6 structural models guided by the empirical literature were evaluated using confirmatory factor analysis. Results Results supported a 2‐factor model of depression and anxiety as the best fitting model. Multigroup models supported the factorial invariance across women who completed the EDPS in English and Spanish. Conclusion These findings provide initial support for the 2‐factor structure of the EPDS among Hispanic women in the United States.
    May 07, 2014   doi: 10.1002/jclp.22101   open full text
  • Internet Gaming Disorder Treatment: A Review of Definitions of Diagnosis and Treatment Outcome.
    Daniel L. King, Paul H. Delfabbro.
    Journal of Clinical Psychology. April 19, 2014
    Objective Internet gaming disorder (IGD) is a new disorder currently positioned in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Few clinical studies report that psychological and pharmacological interventions can significantly reduce the severity of IGD symptomatology. The aim of this review was to assess current knowledge of the short‐ and long‐term benefits of IGD interventions. This review presents a systematic evaluation of definitions of diagnosis and treatment outcomes employed in IGD treatment studies, including an assessment of goodness of fit with the DSM‐5 classification. Method A computer database search of Academic Search Premier, PubMed, PsychINFO, ScienceDirect, Web of Science, and Google Scholar was conducted to identify all available research evidence on Internet gaming disorder treatment (N = 8 studies). Diagnostic and treatment outcome parameters were systematically evaluated. Results Several weaknesses of IGD treatment literature were identified. Only 2 treatment studies have employed an equivalent method of diagnosis for IGD. Studies have not assessed formative change in diagnostic status at posttreatment or follow‐up. Duration of follow‐up has been inadequate to assess relapse and remission. Posttreatment assessment has been predominantly limited to IGD symptomatology, comorbidity, and frequency of gaming behavior. Conclusion Currently, there is insufficient evidence to warrant suggestion that trialled IGD interventions confer a long‐term therapeutic benefit. Several improvements to study design and reporting are proposed to guide future studies of IGD.
    April 19, 2014   doi: 10.1002/jclp.22097   open full text
  • Predicting Who Benefits Most From Cognitive‐Behavioral Therapy for Anxiety and Depression.
    Jesse Renaud, Jennifer J. Russell, Gail Myhr.
    Journal of Clinical Psychology. April 19, 2014
    Objectives We examined core features of patient suitability for cognitive‐behavioral therapy (CBT) and their ability to predict CBT outcomes. Method A sample of 256 outpatients diagnosed with depression and anxiety disorders were assessed using the Suitability for Short‐Term Cognitive Therapy (SSCT) scale. Therapists rated patients’ symptom severity using the Clinical Global Impression scale before and after therapy. Results A factor analysis of the SSCT scale yielded 2 factors: (a) Capacity for Participation in CBT Process and (b) Attitudes Relevant to the CBT Process. A multiple regression analysis revealed that only Capacity for Participation in CBT Process uniquely predicted improvement at termination. Conclusions These findings highlight the importance of assessing the suitability of CBT for individual patients. Specifically, patients with greater capacity to identify and articulate thoughts and feelings and to share them in a nondefensive, focused way benefit most from CBT.
    April 19, 2014   doi: 10.1002/jclp.22099   open full text
  • Elucidating Posttraumatic Stress Symptom Profiles and Their Correlates Among Women Experiencing Bidirectional Intimate Partner Violence.
    Julianne C. Hellmuth, Véronique Jaquier, Suzanne C. Swan, Tami P. Sullivan.
    Journal of Clinical Psychology. April 19, 2014
    Objective This study employed latent class analysis to identify profiles of women experiencing intimate partner violence (IPV) based on the severity of posttraumatic stress disorder (PTSD) symptoms. Method Self‐report data from a sample of 369 women experiencing bidirectional IPV was used. Results A 3‐class solution comprising low, moderate, and high PTSD severity profiles best fit the data. Profiles were differentially related to whether IPV victimization was considered traumatic (PTSD criterion A); whether functioning was impaired as a result of PTSD symptoms (PTSD criterion F); whether the woman met full diagnostic criteria for PTSD; depression symptom severity; and severity of psychological, physical, and sexual IPV victimization and use of IPV. An extremely high percentage of women in the high (96%) and moderate (88%) severity classes experienced functional impairment, although many did not meet full diagnostic criteria for PTSD. Conclusions Findings support the need for interventions individually tailored to one's treatment needs based on the nature of one's traumatic stressor and the impact of PTSD on daily functioning.
    April 19, 2014   doi: 10.1002/jclp.22100   open full text
  • Predictors of Anger Treatment Outcomes.
    Margaret‐Anne Mackintosh, Leslie A. Morland, Karen Kloezeman, Carolyn J. Greene, Craig S. Rosen, Jon D. Elhai, B. Christopher Frueh.
    Journal of Clinical Psychology. April 17, 2014
    Objective This study investigated predictors of therapeutic outcomes for veterans who received treatment for dysregulated anger. Method Data are from a randomized controlled trial investigating the effectiveness of video teleconferencing compared to in‐person delivery of anger management therapy (AMT) among 125 military veterans. Multilevel modeling was used to assess 2 types of predictors (demographic characteristics and mental health factors) of changes in anger symptoms after treatment. Results Results showed that while veterans benefited similarly from treatment across modalities, veterans who received two or more additional mental health services and who had longer commutes to care showed the greatest improvement on a composite measure of self‐reported anger symptoms. Conclusion Results highlight that veterans with a range of psychosocial and mental health characteristics benefited from AMT, while those receiving the most additional concurrent mental health services had better outcomes.
    April 17, 2014   doi: 10.1002/jclp.22095   open full text
  • Misophonia: Incidence, Phenomenology, and Clinical Correlates in an Undergraduate Student Sample.
    Monica S. Wu, Adam B. Lewin, Tanya K. Murphy, Eric A. Storch.
    Journal of Clinical Psychology. April 17, 2014
    Objective Individuals with misophonia display extreme sensitivities to selective sounds, often resulting in negative emotions and subsequent maladaptive behaviors, such as avoidance and anger outbursts. While there has been increasing interest in misophonia, few data have been published to date. Method This study investigated the incidence, phenomenology, correlates, and impairment associated with misophonia symptoms in 483 undergraduate students through self‐report measures. Results Misophonia was a relatively common phenomenon, with nearly 20% of the sample reporting clinically significant misophonia symptoms. Furthermore, misophonia symptoms demonstrated strong associations with measures of impairment and general sensory sensitivities, and moderate associations with obsessive‐compulsive, anxiety, and depressive symptoms. Anxiety mediated the relationship between misophonia and anger outbursts. Conclusion This investigation contributes to a better understanding of misophonia and indicates potential factors that may co‐occur and influence the clinical presentation of a person with misophonia symptoms.
    April 17, 2014   doi: 10.1002/jclp.22098   open full text
  • The Survey of Treatment Entry Pressures (STEP): Identifying Client's Reasons for Entering Substance Abuse Treatment.
    Karen Leggett Dugosh, David S. Festinger, Kevin G. Lynch, Douglas B. Marlowe.
    Journal of Clinical Psychology. April 09, 2014
    Objective Systematically identifying reasons that clients enter substance abuse treatment may allow clinicians to immediately focus on issues of greatest relevance to the individual and enhance treatment engagement. We developed the Survey of Treatment Entry Pressures (STEP) to identify the specific factors that precipitated an individual's treatment entry. The instrument contains 121 items from 6 psychosocial domains (i.e., family, financial, social, medical, psychiatric, legal). The current study examined the STEP's psychometric properties. Method A total of 761 participants from various treatment settings and modalities completed the STEP prior to treatment admission and 4–7 days later. Analyses were performed to examine the instrument's psychometric properties including item response rates, test–retest reliability, internal consistency, and factor structure. Results The items displayed adequate test–retest reliability and internal consistency within each psychosocial domain. Generally, results from exploratory and confirmatory factor analyses support a 2‐factor structure reflecting type of reinforcement schedule. Conclusion The study provides preliminary support for the psychometric properties of the STEP. The STEP may provide a reliable way for clinicians to characterize and capitalize on a client's treatment motivation early on which may serve to improve treatment retention and therapeutic outcomes.
    April 09, 2014   doi: 10.1002/jclp.22093   open full text
  • Substantial Symptom Changes in Naturalistic Recovery from Aversive Events.
    Sadie E. Larsen, Howard Berenbaum.
    Journal of Clinical Psychology. April 09, 2014
    Objective Researchers have recommended examining trajectories of recovery from aversive events, including sudden gains and spikes. We examined rates, attributions for, and outcomes associated with substantial symptom improvements and brief exacerbations after aversive events. Method Sixty‐three women completed questionnaire measures of mood, depression, and posttraumatic stress disorder symptoms. They used a Life History Calendar (LHC) to draw the trajectory of symptom levels from the event to the present, and were interviewed regarding the course of their symptoms. Based on the LHC and interview, we coded whether each participant experienced substantial improvements and/or brief exacerbations and reasons for them. Results Participants frequently experienced substantial improvements and brief exacerbations, most of which they attributed to external events. Substantial improvements—but not substantial brief exacerbations—were associated with significantly lower symptom levels. Conclusion Substantial improvements are similar to sudden gains in therapy samples. Substantial improvements in avoidance and mood have positive, bidirectional effects on each other.
    April 09, 2014   doi: 10.1002/jclp.22092   open full text
  • Experiential Dynamic Therapy: A Preliminary Investigation Into the Effectiveness and Process of the Extended Initial Session.
    K. Aafjes‐van Doorn, J. Macdonald, M. Stein, A. M. Cooper, S. Tucker.
    Journal of Clinical Psychology. April 09, 2014
    Objective This study explored whether patients in specialist psychology services made early gains on theoretically relevant therapeutic processes and outcomes after a trial therapy session (one 2‐ to 3‐hour initial Experiential Dynamic Therapy session). Method This practice‐based, nonrandomized trial used a pre–post design. Thirty‐one patients (23 women, average age of 37) completed standardized measures of symptoms of general distress, interpersonal functioning, self‐compassion, and remoralization before and after the trial therapy session. Video recordings of the sessions’ therapy process were rated on the Achievement of Therapeutic Objectives Scale. Results After the trial therapy session, patients reported a significant increase in remoralization and self‐compassion and a significant decrease in symptoms of general distress but not interpersonal problems. Process ratings were not significantly associated with improvement on these outcome measures. Conclusions This initial positive effect could be due to the session or an effect of time or placebo. Future research using active control conditions is warranted.
    April 09, 2014   doi: 10.1002/jclp.22094   open full text
  • Treatment Fears in Anxiety Disorders: Development and Validation of the Treatment Ambivalence Questionnaire.
    Karen Rowa, Shannon Gifford, Randi McCabe, Irena Milosevic, Martin M. Antony, Christine Purdon.
    Journal of Clinical Psychology. April 09, 2014
    Objectives There are a number of effective psychological interventions for anxiety disorders. Anecdotal and empirical evidence indicates that clients are often highly apprehensive about commencing therapy. However, to date, there have been no empirical studies of the content of individuals’ fears about beginning a psychological treatment for anxiety problems. Here we describe the development and initial validation of the Treatment Ambivalence Questionnaire (TAQ), a 30‐item self‐report measure of concerns about commencing psychological treatment for anxiety. Methods Participants were a large group of individuals with a principal diagnosis of an anxiety disorder who were referred to a specialty anxiety disorders clinic. Participants completed the TAQ as well as several general self‐report instruments before commencing treatment. Results The TAQ exhibited good internal consistency and, based on exploratory factor analyses, the items yielded three subscales: (a) fears of the personal consequences of engaging in treatment (e.g., personality change), (b) fears of negative or adverse reactions to treatment (e.g., not getting better), and (c) concerns about the inconvenience of engaging in treatment (e.g., treatment will be time‐consuming). Confirmatory factor analysis supported this factor structure. Scores on the TAQ did not simply represent general symptom severity or distress. Preliminary data on the relation of TAQ scores to treatment outcome suggested either no relationship or a small relationship. Conclusion The TAQ may be a useful means of normalizing treatment fears, identifying and addressing specific fears, and identifying people who may benefit from treatment readiness interventions.
    April 09, 2014   doi: 10.1002/jclp.22096   open full text
  • Development of a Q‐Sort Version of the Defense Mechanism Rating Scales (DMRS‐Q) for Clinical Use.
    Mariagrazia Di Giuseppe, J. Christopher Perry, Jonathan Petraglia, Jennifer Janzen, Vittorio Lingiardi.
    Journal of Clinical Psychology. April 04, 2014
    This report focuses on the need to provide clinicians with a reliable and valid measure for detecting patient defense mechanisms “inside psychotherapy.” To avoid the limitations of existing methods, we designed a Q‐sort based on the theoretical definitions and criteria of the Defense Mechanisms Rating Scales (DMRS‐Q), but one that does not require transcripts of clinical interviews or sessions and may be applied without specific training on defenses. The DMRS‐Q is sensitive to changes in psychotherapy and its scores correlate significantly with various aspects of mental functioning, making it potentially available for the psychotherapy process and outcome research as well. We report the results of using the DMRS‐Q on a systematic single case study with the aim of detecting changes in defense mechanisms during a long‐term psychodynamic psychotherapy. The DMRS‐Q reveals change both in quantitative scores and in the literary Defensive Profile Narrative.
    April 04, 2014   doi: 10.1002/jclp.22089   open full text
  • Clinical Assessment of Psychological Adaptive Mechanisms in Medical Settings.
    Thomas P. Beresford.
    Journal of Clinical Psychology. April 01, 2014
    The psychological adaptive mechanism (PAM) model for systematic clinical assessment can be applied in any human setting in which individuals adapt to the conditions of their lives. This report focuses on applying the PAM assessment technique to the stress and anxiety of physical illness. To do so, we must consider maturity of PAMs simultaneously in relation to the cognitive functioning of the brain as assessed either in the office or at bedside. After considering case examples to illustrate this application, the discussion proceeds to include larger patient groups to which clinical PAM assessment might be applied, with special reference to cognitive function. The report concludes with suggestions for further improvement of the PAM clinical recognition method as well as its current practical applicability as an acquired clinical skill designed for use in everyday practice.
    April 01, 2014   doi: 10.1002/jclp.22090   open full text
  • Identifying Psychotic Defenses in a Clinical Interview.
    Sylvie Berney, Yves Roten, Véronique Beretta, Ueli Kramer, Jean‐Nicolas Despland.
    Journal of Clinical Psychology. April 01, 2014
    The Defense Mechanisms Rating Scales (DMRS), one of the most widely used and validated instruments in the study of defense mechanisms, does not include psychotic defenses. The Psychotic‐DMRS (P‐DMRS) has been developed to include 6 psychotic defense mechanisms: psychotic denial, autistic withdrawal, distortion, delusional projection, fragmentation, and concretization. We discuss psychotic defenses, including the difference between psychotic defenses and psychotic symptoms. Six clinical illustrations demonstrate how the 6 P‐DMRS defenses can be identified in patients’ narratives selected from the transcripts of dynamic interviews. Implications with respect to patient evaluation and treatment are discussed.
    April 01, 2014   doi: 10.1002/jclp.22087   open full text
  • Meeting Suffering With Kindness: Effects of a Brief Self‐Compassion Intervention for Female College Students.
    Elke Smeets, Kristin Neff, Hugo Alberts, Madelon Peters.
    Journal of Clinical Psychology. April 01, 2014
    Objective The present study investigated the effectiveness of a newly developed 3‐week self‐compassion group intervention for enhancing resilience and well‐being among female college students. Method Fifty‐two students were randomly assigned to either an intervention designed to teach skills of self‐compassion (n = 27) or an active control group intervention in which general time management skills were taught (n = 25). Both interventions comprised 3 group meetings held over 3 weeks. To measure resilience and well‐being gains, participants filled out a number of questionnaires before and after the intervention. Results Results showed that the self‐compassion intervention led to significantly greater increases in self‐compassion, mindfulness, optimism, and self‐efficacy, as well as significantly greater decreases in rumination in comparison to the active control intervention. Whereas both interventions increased life satisfaction and connectedness, no differences were found for worry and mood. Conclusion These findings suggest that a brief self‐compassion intervention has potential for improving student resilience and well‐being.
    April 01, 2014   doi: 10.1002/jclp.22076   open full text
  • Adaptive Defense Mechanisms: Function and Transcendence.
    Jesse A. Metzger.
    Journal of Clinical Psychology. March 27, 2014
    This article reviews the high‐adaptive (mature) defense mechanisms, along with case material illustrating each. These defenses are described in terms of not only the specific means by which they serve to ward off anxiety and manage conflict, but also how they often transcend their role as defenses by contributing to the creation of new “products” of value, such as new meanings, perspectives, modes of relating, and works of art or science. This report also discusses the implications of the use of adaptive defenses, especially humor, in the context of psychotherapy.
    March 27, 2014   doi: 10.1002/jclp.22091   open full text
  • The Effects of the Therapist's Disengaged Feelings on the In‐Session Process in Psychodynamic Psychotherapy.
    Randi Ulberg, Svein Amlo, Anne Grete Hersoug, Hanne‐Sofie Johnsen Dahl, Per Høglend.
    Journal of Clinical Psychology. March 27, 2014
    The primary aim of this article was to explore the effects of the therapist's disengaged feelings (i.e., bored, tired of, sleepy, indifferent, aloof) in psychodynamic therapy. The Transference Work Scale was used in combination with the Defense Mechanism Rating Scales and Structural Analyses of Social Behavior to explore the in‐session process in 2 therapies with female patients with interpersonal problems. Analyses showed differences in in‐session processes (i.e., defense mechanisms; transference work; degree of affiliation and interdependence in the dialogue) and treatment outcome between therapies characterized by a low versus a higher degree of disengaged feelings. Compared to the case with the engaged therapist, the disengaged therapist showed poorer interaction and less response to transference and defense interpretation. When aware of their disengaged feelings, therapists are advised to encourage their patients to discuss the patient–therapist interaction.
    March 27, 2014   doi: 10.1002/jclp.22088   open full text
  • Clinical Approaches to Somatization.
    Fredric N. Busch.
    Journal of Clinical Psychology. March 27, 2014
    Somatization is the experience and expression of psychological distress through bodily symptoms. Somatization can be conceptualized as an emotional state that has not been represented symbolically or as a defense against intolerable emotions and fantasies. Bodily concerns can also function as a means of seeking responsiveness from others. Alexithymia refers to a difficulty identifying and symbolizing emotional states that has been found to be associated with somatization. When functioning as a defense, a focus on the body can be used to avoid frightening or intolerable feelings and fantasies, or to ward off aggressive fantasies by viewing oneself as physically damaged. Systematic studies have demonstrated the presence of the defense of somatization in mood disorders, particularly anxiety and panic disorders. In treating anxiety disorders, the therapist helps the patient to determine the nature of emotions and fantasies that the patient is defending against, particularly fears and conflicts surrounding anger and separation.
    March 27, 2014   doi: 10.1002/jclp.22086   open full text
  • Anomalies and Specific Functions in the Clinical Identification of Defense Mechanisms.
    J. Christopher Perry.
    Journal of Clinical Psychology. March 27, 2014
    Standard teaching about defense mechanisms generally focuses on definitions, which do not readily aid the clinician in identifying defenses whenever individuals use them. This report demonstrates a process by which the clinician can identify when a defense is used, which ones are likely being used, and with what aim. Clinicians first notice that a defense may be operating whenever the other individual presents with anomalies in the expression of affect, behavior, speech, or its content. Some of these anomalies are described. Next, to identify the specific defense or general level of defensive functioning used, the clinician must identify the specific function of the defense in context using a process of guided clinical inference. This report examines 2 verbatim examples from recorded interviews of one case to demonstrate this process. The examples present a microcosm of clinical concerns that have a surprising relationship to the individual's course and prognosis.
    March 27, 2014   doi: 10.1002/jclp.22085   open full text
  • Ethnic Variations in Suicidal Ideation and Behaviors: A Prominent Subtype Marked by Nonpsychiatric Factors Among Asian Americans.
    Joyce Chu, Koyun Chi, Ken Chen, Amy Leino.
    Journal of Clinical Psychology. March 24, 2014
    Objective Main objectives were to utilize multivariate rather than traditional regression approaches to capture the heterogeneity of subtypes of suicidal ideation and behaviors within ethnic minority groups. Mental illness is associated with suicidal ideation and behaviors in a vast majority of the general population, making psychopathology a common identifier of suicide risk. Yet recent studies suggest a need to better characterize suicidal ideation and behaviors among ethnic minorities and Asian Americans who do not exhibit the most commonly assessed risk factors. Method The present study examined adults 18 years of age or older from the National Latino and Asian American Study and utilized latent class analysis to classify 191 Asian Americans with a history of serious suicidal ideation or attempts from a community sample into subtypes. Results Two main subtypes resulted, including 48% in a “psychiatric” and 52% in a “nonpsychiatric” subtype of suicidal ideation and behaviors. The nonpsychiatric subtype was predominantly characterized by sociocultural factors (discrimination, family conflict, and low acculturation), medical problems, and limited functioning. The nonpsychiatric was less likely than the psychiatric subtype to seek help for mental health but was no different in access to a medical doctor, highlighting possible points of outreach. Conclusions Findings advance the culture and suicide literature by highlighting how current research and practice that characterize suicidal ideation and behaviors as a mental health phenomenon may not comprehensively identify suicidality among an ethnic minority group.
    March 24, 2014   doi: 10.1002/jclp.22082   open full text
  • Validating the Rapid Responder Construct Within a Practice Research Network.
    Samuel S. Nordberg, Louis G. Castonguay, Aaron J. Fisher, James F. Boswell, David Kraus.
    Journal of Clinical Psychology. March 20, 2014
    Objective The present study was a replication and extension of prior work (Stulz, Lutz, Leach, Lucock, & Barkham, ) that identified multiple groups of clients in treatment with high‐symptom severity and markedly different recovery trajectories (rapid/early response vs. little or no response). Method Using data collected through repeated administrations of the Depression subscale of the Treatment Outcome Package (n = 147), growth mixture modeling was employed to determine whether clients fell into discrete groups of response trajectories during 15 sessions of psychotherapy. Additionally, logistic regressions were conducted to assess possible predictors of group membership. Results Three separate groups of treatment responders were identified: 2 high‐symptom groups–rapid responders and nonresponders–and 1 low‐symptom group of nonresponders. Elevated social conflict and suicidality predicted increased likelihood of membership in the high‐symptom nonresponder group. Increased feelings of interpersonal hostility and better sexual functioning predicted increased likelihood of membership in the rapid responder group. Conclusion Replication of earlier results provides further evidence for the usefulness of modeling change during psychotherapy using multiple trajectories. Predictors of group membership indicate the influence of functional impairment on recovery, and support the importance of multidimensional measurement of client problems.
    March 20, 2014   doi: 10.1002/jclp.22077   open full text
  • Clinical Efficacy of Attentional Bias Modification Procedures: An Updated Meta‐Analysis.
    Cristina Mogoaşe, Daniel David, Ernst H. W. Koster.
    Journal of Clinical Psychology. March 20, 2014
    Context Attentional bias modification (ABM) treatment is a promising intervention tool for a variety of clinical conditions. Objectives This study provides an updated review of the clinical effect of ABM by employing standard meta‐analytic procedures to (a) estimate the average effect size of ABM in reducing both attention bias (AB) and symptoms, (b) estimate the average effect size for different conditions (e.g., anxiety, depression, and substance abuse), (c) test possible variables that may moderate the effect sizes, and (d) investigate the relationship between preexistent AB and the reduction in AB and symptoms. Method We included 43 controlled trials with a total of 2,268 participants providing 47 group comparisons (i.e., training vs. control condition). Inclusion criteria were as follows: AB was specifically targeted to reduce symptomatology and emotional vulnerability; participants were randomized to the experimental conditions; a control condition (defined as sham training) existed; symptoms were assessed at least postintervention; sufficient data were provided to allow effect size estimation. Results We obtained a small overall effect size on symptoms postintervention, g = 0.160, 95% confidence interval (CI) = [0.055, 0.265], driven by anxiety studies, g = 0.260, 95% CI = [0.132, 0.388], and studies conducted in healthy participants, g = 0.211, 95% CI = [0.046, 0.375]; no significant effect sizes were found postintervention for other symptom categories. Conclusion The therapeutic benefit of ABM is rather small for anxiety, while the amount of data for other symptom categories is limited. We argue that more efficient, psychometrically sound procedures are needed for assessing and modifying AB.
    March 20, 2014   doi: 10.1002/jclp.22081   open full text
  • Psychotherapeutic Outcomes Measures: A Critical Review for Practitioners.
    Anthony M. Tarescavage, Yossef S. Ben‐Porath.
    Journal of Clinical Psychology. March 20, 2014
    Objective Use of psychotherapeutic outcome measures improves patient outcomes and demonstrates patient improvement. However, practitioners infrequently use these measures because of concerns regarding their practicality and utility. We critically evaluate global self‐report measures of adult psychotherapeutic outcome on key practical and utilitarian criteria. Method The following measures were evaluated according to practical criteria (e.g., administration time and cost) and utilitarian criteria (e.g., psychometrics and sensitivity to change): Behavior and Symptom Identification Scale‐24; Clinical Outcomes in Routine Evaluation Outcome Measure; Depression Anxiety Stress Scales; Health Survey Short Form‐36; Outcome Questionnaire‐45; Patient Reported Outcome Measurement Information System; Symptom Checklist‐90‐Revised; and Brief Symptom Inventory. Results All of the reviewed outcome measures had a number of practical strengths, including short administration time. However, we also identified utilitarian concerns for each measure that are likely to affect their use and interpretation. Conclusion Each of the reviewed outcome measures mostly address practitioners’ concerns regarding practicality and utility. This critical review can aid practitioners in selecting an outcome measure based on their preferences.
    March 20, 2014   doi: 10.1002/jclp.22080   open full text
  • Nonsuicidal Self‐Injury Among a Sample of United States Military Personnel and Veterans Enrolled in College Classes.
    Craig Bryan, Annabelle Bryan.
    Journal of Clinical Psychology. March 11, 2014
    Objective To investigate the rate of nonsuicidal self‐injury (NSSI), to describe sociodemographic and clinical correlates of NSSI, and to examine the association of NSSI with suicidal thoughts and behaviors in a sample of U.S. military personnel and veterans. Method An anonymous online survey was completed by 335 U.S. military personnel and veterans (70.0% male; age mean = 36.67, standard error = 10.59; 82.3% Caucasian, 4.9% African American, 2.8% Asian, 3.7% Native American, 1.2% Pacific Islander, and 7.6% other) enrolled in college classes. Descriptive statistics were calculated, and logistic regression was used to test the associations among NSSI, suicide ideation, suicide planning, and suicide attempts. Results Fourteen percent of the sample reported lifetime NSSI and 3% reported NSSI during the last 12 months. The most common method was cutting (78.7%), with 66% reporting use of 2 or more methods for NSSI. Average age of NSSI onset was 17.55 years. Increased likelihood of NSSI was associated with older age, shorter length of time in service, greater trauma exposure, female gender, Native American racial identity, and combat support deployments. Personnel in the Navy and with a history of combat deployment were significantly less likely to report NSSI. NSSI was significantly associated with suicide ideation, suicide planning, and suicide attempts even when adjusting for covariates. Conclusion The rate of NSSI is comparable to estimates in nonmilitary U.S. samples. NSSI is a significant risk factor for suicidal thoughts and behaviors in this group.
    March 11, 2014   doi: 10.1002/jclp.22075   open full text
  • Proximity, Relationship Closeness, and Cognitive Vulnerability: Predicting Enduring Depressive Reactions to a College Campus Tragedy.
    Benjamin J. Pfeifer, Gerald J. Haeffel.
    Journal of Clinical Psychology. March 11, 2014
    Objective To test the hypothesis that enduring depressive reactions to tragedy are due to a unique combination of three factors—close physical proximity to the event, close relationship with the victim(s), and high levels of cognitive vulnerability. Method Participants were 70 undergraduates (66% female; mean age = 18) from a midsized private university. Cognitive vulnerability and depressive symptoms were assessed 2 years before a college campus tragedy; physical proximity, relationship with the victim, and depressive symptoms were assessed 2 months after the tragedy. Results Individuals with a combination of high levels of cognitive vulnerability and close physical proximity to the event were at greater risk for enduring depression, but only if they did not have a very close relationship with the victim. Conclusion This article puts forth a testable theory that helps to explain why some individuals are at risk for enduring depressive reactions to tragedy. Implications for research and practice are discussed.
    March 11, 2014   doi: 10.1002/jclp.22078   open full text
  • Efficacy of a Workbook to Promote Forgiveness: A Randomized Controlled Trial With University Students.
    Quandrea Harper, Everett L. Worthington, Brandon J. Griffin, Caroline R. Lavelock, Joshua N. Hook, Scott R. Vrana, Chelsea L. Greer.
    Journal of Clinical Psychology. March 11, 2014
    Objective The present study investigated the efficacy of a 6‐hour self‐directed workbook adapted from the REACH Forgiveness intervention. Method Undergraduates (N = 41) were randomly assigned to either an immediate treatment or waitlist control condition. Participants were assessed across 3 time periods using a variety of forgiveness outcome measures. Results The 6‐hour workbook intervention increased forgiveness, as indicated by positive changes in participants’ forgiveness ratings that differed by condition. In addition, benchmarking analysis showed that the self‐directed workbook intervention is at least as efficacious as the delivery of the REACH Forgiveness model via group therapy. Conclusion A self‐directed workbook intervention adapted from the REACH Forgiveness intervention provides an adjunct to traditional psychotherapy that could assist the mental health community to manage the burden of unforgiveness among victims of interpersonal harm.
    March 11, 2014   doi: 10.1002/jclp.22079   open full text
  • Acute Symptoms of Posttraumatic Stress and Dissociative Experiences Among Female Israeli Civilians Exposed to War: The Roles of Intrapersonal and Interpersonal Sources of Resilience.
    Avi Besser, Michael Weinberg, Virgil Zeigler‐Hill, Yuval Neria.
    Journal of Clinical Psychology. March 11, 2014
    Background The positive personality characteristics of optimism, hope, self‐esteem, and perceived availability of social support are believed to play an important role in psychological adjustment to stressful life events. For example, these characteristics have been shown to be associated with fewer mood disturbances in response to a variety of stressors. However, relatively little is known about the extent to which these characteristics serve as sources of resilience among civilians during real‐time exposure to war. Objective This “natural laboratory” study examined the role that individual differences both in intrapersonal (i.e., positive personality features of hope, optimism, and self‐esteem) and in interpersonal (i.e., perceived social support from family, friends, and significant others) sources of resilience may play in the development of acute anxiety symptoms of posttraumatic stress disorder (PTSD) and dissociative experiences during exposure to war. Method A nonclinical community sample of 140 female adults was assessed during real‐time exposure to missile and rocket fire during an eruption of violence in the Middle East in November 2012. Results The results demonstrate that both intrapersonal and interpersonal sources of resilience were negatively associated with acute PTSD and dissociative symptoms. Conclusion The findings of this study provide evidence that both intrapersonal and interpersonal sources of resilience may significantly mitigate the risk for acute anxiety symptoms among civilian communities exposed to traumatic events.
    March 11, 2014   doi: 10.1002/jclp.22083   open full text
  • Do Manualized Treatments for Depression Reduce Insomnia Symptoms?
    Adriana Yon, Forrest Scogin, Elizabeth A. DiNapoli, Jesse McPherron, Patricia A. Arean, Daniel Bowman, Christine S. Jamison, Jennifer A. Karpe, David Latour, Charles F. Reynolds, Noelle Rohen, Jamie E. L. Pardini, Larry W. Thompson.
    Journal of Clinical Psychology. March 04, 2014
    Objective Researchers evaluated the effect of manualized treatments for depression on comorbid symptoms of insomnia. Method Hierarchical linear modeling was used to analyze archival data collected from 14 studies (N = 910) examining the efficacy of psychological treatments for depression in adults. Results Participants receiving a psychological treatment for depression experienced significantly more relief from symptoms of insomnia with overall, early‐, middle‐, and late‐night sleep than those not receiving such treatment. Conclusion Symptoms of insomnia in those with an average (or lower) level of depression can be reduced through psychological treatment for depression. However, more severe depressive symptoms do not receive great relief from sleep disturbance and may require an additional treatment component targeting symptoms of insomnia.
    March 04, 2014   doi: 10.1002/jclp.22062   open full text
  • An Investigation of the Biosocial Model of Borderline Personality Disorder.
    Duncan Gill, Wayne Warburton.
    Journal of Clinical Psychology. March 01, 2014
    Objectives We sought to test the Biosocial Theory of borderline personality disorder (BPD) that posits that borderline traits are due to emotional dysregulation, caused by the interaction between childhood emotional vulnerability and invaliding parenting. Method A total of 250 adults (76% female, median age = 32.06 years) from a nonclinical population completed self‐report measures assessing current levels of borderline traits and emotional dysregulation. They also completed retrospective measures of childhood emotional vulnerability and parental invalidation. Results Invalidating parenting and emotional vulnerability independently predicted emotion dysregulation, but an interaction effect was not found. Having experienced validating parenting was found to be a protective factor for developing borderline traits but was not significantly related to emotional dysregulation. Conclusion Data in this sample did not support the underlying genesis of BPD proposed by the Biosocial Theory and a model that more parsimoniously explains the development of BPD is proposed.
    March 01, 2014   doi: 10.1002/jclp.22074   open full text
  • Efficacy of REACH Forgiveness Across Cultures.
    Yin Lin, Everett L. Worthington, Brandon J. Griffin, Chelsea L. Greer, Annabella Opare‐Henaku, Caroline R. Lavelock, Joshua N. Hook, Man Yee Ho, Holly Muller.
    Journal of Clinical Psychology. February 03, 2014
    Objective This study investigates the efficacy of the 6‐hour REACH Forgiveness intervention among culturally diverse undergraduates. Method Female undergraduates (N = 102) and foreign extraction (46.2%) and domestic (43.8%) students in the United States were randomly assigned to immediate treatment or waitlist conditions. Treatment efficacy and the effect of culture on treatment response were assessed using measures of emotional and decisional forgiveness across 3 time periods. Results Students in the treatment condition reported greater improvement in emotional forgiveness, but not decisional forgiveness, relative to those in the waitlist condition. Gains were maintained at a 1‐week follow‐up. Although culture did not moderate the effect of treatment, a main effect of culture on emotional forgiveness and marginally significant interaction effect of culture on decisional forgiveness were found. Conclusion The REACH Forgiveness intervention was efficacious for college students from different cultural backgrounds when conducted in the United States. However, some evidence may warrant development of culturally adapted forgiveness interventions.
    February 03, 2014   doi: 10.1002/jclp.22073   open full text
  • Emotional Reactivity in Bipolar Depressed Patients.
    P. Stratta, D. Tempesta, R. L. Bonanni, S. Cataldo, A. Rossi.
    Journal of Clinical Psychology. January 30, 2014
    Objective Emotional reactivity in bipolar affective disorders has received increased attention as a relevant issue with regard to the ability to respond to emotional external stimuli for individual real world adaptation. We investigated emotional reactivity using the International Affective Picture System (IAPS) paradigm in bipolar patients during the depressive phase compared to healthy controls. Method Twenty‐three bipolar patients with a major depressive episode without manic symptoms and 27 healthy control subjects were recruited. They were asked to judge their emotional reactivity while viewing 90 pictures selected from the IAPS. Their ratings were categorized according to the emotional valence and arousal in response to pleasant, neutral, and unpleasant stimuli. Results The patients showed lower valence ratings for neutral pictures compared to healthy subjects. No significant between‐group differences were found for the pleasant and unpleasant pictures. Higher activation for patients to all emotional stimuli was seen. Conclusion Patients during the depressive phase gave more negative valence to neutral images. This can suggest that they are more pessimistic in the way they perceive the environment as more reactive to emotional cues.
    January 30, 2014   doi: 10.1002/jclp.22072   open full text
  • Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy in the Treatment of Substance Use Disorder With Incarcerated Women.
    Patricia Villagrá Lanza, Paula Fernández García, Filomena Rodríguez Lamelas, Ana González‐Menéndez.
    Journal of Clinical Psychology. January 21, 2014
    ObjectivesThis randomized controlled study compared acceptance and commitment therapy (ACT), cognitive‐behavioral therapy (CBT), and a control group. MethodThe participants were 50 incarcerated women diagnosed with current substance use disorder. Two psychologists carried out pre‐ and posttreatment assessment and a 6‐month follow‐up assessment using the following instruments: Anxiety Sensitivity Index, Addiction Severity Index‐6, Mini International Neuropsychiatric Interview, and Acceptance and Action Questionnaire. ResultsThe study shows that the women who received treatment benefited differentially from the interventions. At posttreatment, CBT was more effective than ACT in reducing anxiety sensitivity; however, at follow‐up, ACT was more effective than CBT in reducing drug use (43.8 vs. 26.7%, respectively) and improving mental health (26.4% vs. 19.4%, respectively). Conclusion ACT may be an alternative to CBT for treatment of drug abuse and associated mental disorders. In fact, at long‐term, ACT may be more appropriate than CBT for incarcerated women who present serious problems.
    January 21, 2014   doi: 10.1002/jclp.22060   open full text
  • Cultivating Secondary Traumatic Growth Among Healthcare Workers: The Role of Social Support and Self‐Efficacy.
    Kotaro Shoji, Judith Bock, Roman Cieslak, Katarzyna Zukowska, Aleksandra Luszczynska, Charles C. Benight.
    Journal of Clinical Psychology. January 13, 2014
    Objective This 2‐study longitudinal investigation examined the indirect effects of secondary traumatic stress (STS) on secondary traumatic growth via two mediators: perceived social support and secondary trauma self‐efficacy. In particular, we tested if the 2 hypothetical mediators operate sequentially, that is, with secondary trauma self‐efficacy facilitating social support (i.e., cultivation hypothesis) and/or social support enhancing self‐efficacy (i.e., enabling hypothesis). Method Participants in Study 1 (N = 293 at Time 1, N = 115 at Time 2) were behavioral healthcare providers working with U.S. military personnel suffering from trauma. Study 2 was conducted among Polish healthcare workers (N = 298 at Time 1, N = 189 at Time 2) providing services for civilian survivors of traumatic events. Results In both studies, multiple mediational analyses showed evidence for the cultivation hypothesis. The relationship between STS at Time 1 and secondary traumatic growth at Time 2 was mediated sequentially by secondary trauma self‐efficacy at Time 1 and social support at Time 2. The enabling hypothesis was not supported. Conclusion Education and development programs for healthcare workers may benefit from boosting self‐efficacy with the intent to facilitate perceived social support.
    January 13, 2014   doi: 10.1002/jclp.22070   open full text
  • Perceived Burdensomeness and Suicide‐Related Behaviors in Clinical Samples: Current Evidence and Future Directions.
    Ryan M. Hill, Jeremy W. Pettit.
    Journal of Clinical Psychology. January 13, 2014
    Context The interpersonal‐psychological theory of suicide identifies perceived burdensomeness as a primary component of suicidal desire and a possible point of intervention for suicide prevention. A growing literature has explored the relationship between perceived burdensomeness and suicide‐related behaviors. Objective The aim of this review is to integrate the evidence, identify critical gaps in the evidence‐base, and explore implications for translation to prevention and intervention science. Methods Papers published that reported on the association between perceived burdensomeness and suicide‐related behaviors were included. Results The literature indicates (a) significant cross‐sectional associations between perceived burdensomeness and suicidal ideation and suicide attempts and (b) that perceived burdensomeness acts as either a moderator or a mediator of the association between risk and protective factors and suicide‐related behaviors. Conclusion Research is needed to examine the longitudinal association between perceived burdensomeness and suicide‐related behaviors, develop additional measurement approaches, generalize findings to other samples, and begin translating findings to prevention and intervention science.
    January 13, 2014   doi: 10.1002/jclp.22071   open full text
  • Psychological Mindedness as a Protective Factor Against Revictimization in Intimate Relationships.
    Osnat Zamir, Yoav Lavee.
    Journal of Clinical Psychology. January 07, 2014
    Objectives We tested the moderating effect of psychological mindedness (PM) on the relationship between past experience of child abuse and both intimate partner violence (IPV) and intimate relationship quality. Method Female Israeli graduate students (N = 425; mean age 35.9 years), either married or in cohabitation, completed an electronic questionnaire. The data were analyzed by SEM multiple group analysis of women with high vs. low PM. Results Child abuse was associated with IPV among women with a low level of PM but not among women with a high level of PM. Contrary to expectation, childhood abuse was associated with lower marital quality among women with a high level of PM but not for women with a low level of PM. Conclusion Results support the notion that psychologically minded people are “wiser but sadder” (Farber, , p. 216). The findings are discussed in relation to revictimization theories, with clinical implications noted.
    January 07, 2014   doi: 10.1002/jclp.22061   open full text
  • Shared Understanding as a Gateway for Treatment Engagement: A Preliminary Study Examining the Effectiveness of the Culturally Enhanced Video Feedback Engagement Intervention.
    Miwa Yasui, David B. Henry.
    Journal of Clinical Psychology. December 31, 2013
    Objective For ethnic minority families, the bridging of clinician–client differences is essential to their engagement in treatment. The Culturally Enhanced Video Feedback Engagement (CEVE) intervention aims to enhance client engagement through fostering clinician–client shared cultural understanding. The present study tested the effectiveness of the CEVE on client‐rated clinician cultural competence and therapeutic alliance. Method Nineteen ethnic minority families with children aged 3–6 years were randomized to the CEVE (n = 9) or treatment as usual (n = 10) at an outpatient clinic. Results Results from linear mixed effects regression models indicated a significant effect of the CEVE on intercept, suggesting that clinician cultural competence and therapeutic alliance were significantly higher in the CEVE condition. No effect was found for clinician growth in skills. Conclusions The results indicate that the CEVE enhances client treatment engagement via clinician cultural competence and clinician–client alliance, suggesting its promise as a clinical engagement tool, particularly for treatments serving ethnic minority families.
    December 31, 2013   doi: 10.1002/jclp.22058   open full text
  • Forgiveness, Coping, and Terrorism: Do Tendency to Forgive and Coping Strategies Associate With the Level of Posttraumatic Symptoms of Injured Victims of Terror Attacks?
    Michael Weinberg, Sharon Gil, Ora Gilbar.
    Journal of Clinical Psychology. December 18, 2013
    Objective The study examined the tendency to forgive (self, others, and situations) and coping strategies (problem‐focused, emotion‐focused, and avoidance) among terror attack victims as associated with posttraumatic stress disorder (PTSD) symptom severity. MethodThe sample included 108 terror victims who had been injured in terror attacks (mean age 46.23, standard deviation = 11.61; 58.3% male). Participants agreed to undergo assessments of their PTSD symptoms, coping strategies, and tendency to forgive. ResultsA nested structural equation model design showed that tendency to forgive is positively associated with problem‐focused coping and negatively associated with avoidance coping. Additionally, tendency to forgive and problem‐focused coping are associated with decreased PTSD symptom severity, whereas emotion‐focused coping is associated with elevated PTSD symptom severity. ConclusionsTendency to forgive and coping strategies are significantly associated with each other and with severity of PTSD symptoms among individuals injured in terror attacks. Theoretical and clinical implications of the findings are discussed.
    December 18, 2013   doi: 10.1002/jclp.22056   open full text
  • Triggers of Fear: Perceptual Cues Versus Conceptual Information in Spider Phobia.
    Henrik M. Peperkorn, Georg W. Alpers, Andreas Mühlberger.
    Journal of Clinical Psychology. December 18, 2013
    Objective Fear reactions in spider‐phobic patients can be activated by specific perceptual cues or by conceptual fear‐related information. Matching perceptual fear cues and fear‐related information were expected to result in maximal fear responses, perceptual fear cues alone in less fear, and information alone in the weakest responses. Method We used virtual reality to manipulate the available cues and information. Forty‐eight phobic patients and 48 healthy participants were repeatedly exposed to either a perceptual cue, information, or a combination of both. Results In conditions with a fear‐relevant perceptual cue, phobic patients reported increased fear compared to the condition with information only. Across exposures trials, these reactions diminished. Skin conductance in phobic patients was significantly higher in the combined than in the cue or the information condition. Conclusions Perceptual cues are essential for phobic fear reactions in spider phobia. In combination with fear‐relevant information, perceptual cues activate an intense and persistent fear reaction.
    December 18, 2013   doi: 10.1002/jclp.22057   open full text
  • Specific and Nonspecific Psychological Interventions for PTSD Symptoms: A Meta‐Analysis With Problem Complexity as a Moderator.
    Heike Gerger, Thomas Munder, Jürgen Barth.
    Journal of Clinical Psychology. December 18, 2013
    Context The necessity of specific intervention components for the successful treatment of patients with posttraumatic stress disorder is the subject of controversy. Objective To investigate the complexity of clinical problems as a moderator of relative effects between specific and nonspecific psychological interventions. Methods We included 18 randomized controlled trials, directly comparing specific and nonspecific psychological interventions. We conducted moderator analyses, including the complexity of clinical problems as predictor. Results Our results have confirmed the moderate superiority of specific over nonspecific psychological interventions; however, the superiority was small in studies with complex clinical problems and large in studies with noncomplex clinical problems. Conclusions For patients with complex clinical problems, our results suggest that particular nonspecific psychological interventions may be offered as an alternative to specific psychological interventions. In contrast, for patients with noncomplex clinical problems, specific psychological interventions are the best treatment option.
    December 18, 2013   doi: 10.1002/jclp.22059   open full text
  • Anhedonia and Pain Avoidance in the Suicidal Mind: Behavioral Evidence for Motivational Manifestations of Suicidal Ideation in Patients With Major Depressive Disorder.
    Weizhen Xie, Huanhuan Li, Xinwei Luo, Rong Fu, Xiangyu Ying, Ning Wang, Qifeng Yin, Yingmin Zou, Yanyan Cui, Xiang Wang, Chuan Shi.
    Journal of Clinical Psychology. December 04, 2013
    Objectives Psychological pain may be helpful in conceptualizing suicidal behavior, in that high motivation to avoid pain combined with painful feelings may contribute to an increased risk of suicide. However, no experimental study has tested this hypothesis. The aim of the present study is to provide empirical evidence for the relationship between anhedonia, pain avoidance motivation, and suicidal ideation. Method The sample comprised 40 depressed outpatients and 20 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory, Psychache Scale, Three‐Dimensional Psychological Pain Scale, the monetary incentive delay (MID), and affective incentive delay (AID) tasks. Based on BSS scores, clinical participants were divided into high suicidal ideation (HSI) and low suicidal ideation (LSI) groups. Results In the AID task, the HSI group had longer response times (RTs) under the reward condition than those under the punishment condition (p = .002). The LSI and control groups had shorter RTs under the reward condition compared with those under the neural condition (p <.001 and p = .008, respectively). The LSI group also had shorter RTs under the reward condition than under the punishment condition (p = .003). Pain arousal (r = −.33, p <.01) and BSS scores were significantly negatively correlated with differences in RTs between neutral and reward conditions. Pain avoidance (r = .35, p <.01) and BSS scores were positively correlated with differences in RTs between neutral and punishment conditions. Conclusions The AID task was more sensitive than the MID task for the detection of participants’ motivation in approaching hedonic experiences and avoiding pain. A suicidal mindset is manifested as decreased motivation to experience hedonia and increased motivation to avoid pain, which could be strong predictors of suicidal behavior.
    December 04, 2013   doi: 10.1002/jclp.22055   open full text
  • Clients’ Pretreatment Role Expectations, the Therapeutic Alliance, and Clinical Outcomes in Outpatient Therapy.
    Candace L. Patterson, Timothy Anderson, Christina Wei.
    Journal of Clinical Psychology. October 29, 2013
    Objectives The present study examined the associations between pretreatment role expectations, working alliance, and therapy outcome. A mediational model was hypothesized wherein the therapeutic alliance mediates the relationship between clients’ pretreatment role expectations and psychotherapy outcome. Method Sixty‐eight clients completed the Expectations About Counseling‐Brief Form at pretreatment, the Working Alliance Inventory‐Short Form Revised after Session 3, and the Outcome Questionairre‐45 at both pretreatment and the final session. Results All 3 expectations factors (Personal Commitment, Facilitative Conditions, Counselor Expertise) were related to the alliance. However, only expectations for Counselor Expertise were related to outcome, although this relationship did not appear to be mediated by the alliance. Conclusions Suggested research directions, clinical implications, and study limitations are discussed.
    October 29, 2013   doi: 10.1002/jclp.22054   open full text
  • Meaning in Life: Relationship to Clinical Diagnosis and Psychotherapy Outcome.
    Jana Volkert, Holger Schulz, Anna Levke Brütt, Sylke Andreas.
    Journal of Clinical Psychology. October 25, 2013
    ObjectivesTo examine the relationship of meaning in life (MiL) to clinical diagnosis and psychotherapy outcome and investigate specific meaning areas. Method This study investigated 214 inpatients with mental disorders and 856 healthy controls using self‐report measures of MiL and psychopathological symptoms. Results Patients showed lower MiL compared to controls. Diagnosis‐specific differences in MiL were found for depression. MiL increased in the course of treatment and remained stable at follow‐up. The most relevant meaning areas were social relationships for patients and controls. Conclusion This study provides evidence for lower MiL in inpatients with a spectrum of mental disorders, and in particular in patients with depression, compared to controls. Furthermore, perceived meaning improves over the duration of psychotherapy. Employing aspects of the meaning framework in therapy may be useful to help patients overcome psychological problems and make life worth living.
    October 25, 2013   doi: 10.1002/jclp.22053   open full text
  • Mental Health Professionals’ Natural Taxonomies of Mental Disorders: Implications for the Clinical Utility of the ICD‐11 and the DSM‐5.
    Geoffrey M. Reed, Michael C. Roberts, Jared Keeley, Catherine Hooppell, Chihiro Matsumoto, Pratap Sharan, Rebeca Robles, Hudson Carvalho, Chunyan Wu, Oye Gureje, Itzear Leal‐Leturia, Elizabeth H. Flanagan, João Mendonça Correia, Toshimasa Maruta, José Luís Ayuso‐Mateos, Jair Jesus Mari, Zeping Xiao, Spencer C. Evans, Shekhar Saxena, María Elena Medina‐Mora.
    Journal of Clinical Psychology. October 07, 2013
    Objective To examine the conceptualizations held by psychiatrists and psychologists around the world of the relationships among mental disorders in order to inform decisions about the structure of the classification of mental and behavioral disorders in World Health Organization's International Classification of Diseases and Related Health Problems 11th Revision (ICD‐11). Method 517 mental health professionals in 8 countries sorted 60 cards containing the names of mental disorders into groups of similar disorders, and then formed a hierarchical structure by aggregating and disaggregating these groupings. Distance matrices were created from the sorting data and used in cluster and correlation analyses. Results Clinicians’ taxonomies were rational, interpretable, and extremely stable across countries, diagnostic system used, and profession. Clinicians’ consensus classification structure was different from ICD‐10 and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM‐IV), but in many respects consistent with ICD‐11 proposals. Conclusions The clinical utility of the ICD‐11 may be improved by making its structure more compatible with the common conceptual organization of mental disorders observed across diverse global clinicians.
    October 07, 2013   doi: 10.1002/jclp.22031   open full text
  • A Multifaith Spiritually Based Intervention Versus Supportive Therapy for Generalized Anxiety Disorder: A Pilot Randomized Controlled Trial.
    Diana Koszycki, Cynthia Bilodeau, Kelley Raab‐Mayo, Jacques Bradwejn.
    Journal of Clinical Psychology. October 07, 2013
    Objectives We have previously reported that a multifaith spiritually based intervention (SBI) may have efficacy in the treatment of generalized anxiety disorder (GAD). This randomized pilot trial tested whether the SBI had greater efficacy than a nonspecific control condition in GAD. Method Twenty‐three participants with GAD of at least moderate severity were randomized to 12 individual sessions of the SBI (n = 11) or supportive psychotherapy (SP)—our control condition (n = 12). Results Intent‐to‐treat analysis revealed the SBI fared better than SP in decreasing blind clinician ratings of anxiety and illness severity and self‐report worry and intolerance of uncertainty, with large between‐group effect sizes. The SBI also produced greater changes in spiritual well‐being. Results remained the same when supplementary analyses were performed on the completer sample. Treatment gains were maintained at 3‐months follow‐up. Conclusions This small pilot trial demonstrates that a nondenominational SBI has greater efficacy than a rigorous control in improving symptoms of GAD and enhancing spiritual well‐being. These results are encouraging and further research on the efficacy of the SBI and its underlying mechanisms is warranted.
    October 07, 2013   doi: 10.1002/jclp.22052   open full text
  • Introduction: Attachment Theory and Psychotherapy.
    Kenneth N. Levy.
    Journal of Clinical Psychology. October 02, 2013
    In this introduction to the JCLP: In Session 69(11) issue on attachment theory and psychotherapy, the key points of attachment theory (Bowlby, , , 1981) and its relevance to psychotherapy are briefly described. The aim of this issue is to provide case illustrations of how an attachment theory perspective and principles can expand our understanding of psychotherapy practice.
    October 02, 2013   doi: 10.1002/jclp.22040   open full text
  • Shying Away From a Good Thing: Social Anxiety in Romantic Relationships.
    Eliora Porter, Dianne L. Chambless.
    Journal of Clinical Psychology. October 02, 2013
    Objectives To determine whether social anxiety covaries with satisfaction, social support, and intimacy in romantic relationships. Method Undergraduates and their romantic partners (N = 163) completed self‐report questionnaires. Results Higher social anxiety in women, but not men, was associated with wanting, receiving, and providing less support, based on self‐ but not partner‐report measures. Women higher in social anxiety also reported being less satisfied in their romantic relationships and self‐disclosing less to romantic partners than women lower in social anxiety. Further, self‐reported received support mediated the relationship between social anxiety and romantic relationship satisfaction in women. In both sexes, higher social anxiety was related to perceiving intimacy as riskier and romantic relationships as less emotionally intimate. Conclusions Together, results suggest that social anxiety is associated with interpersonal difficulty even in established romantic relationships.
    October 02, 2013   doi: 10.1002/jclp.22048   open full text
  • Narrative Enhancement and Cognitive Therapy (NECT) Effectiveness: A Quasi‐Experimental Study.
    David Roe, Ilanit Hasson‐Ohayon, Michal Mashiach‐Eizenberg, Oren Derhy, Paul H. Lysaker, Philip T. Yanos.
    Journal of Clinical Psychology. October 02, 2013
    Objective Accumulated evidence suggests that approximately one third of people with a serious mental illness (SMI) experience elevated self‐stigma. Narrative enhancement and cognitive therapy (NECT) is a structured group‐based intervention aimed to reduce self‐stigma. The current study aims to examine the effectiveness of NECT. A quasi‐experimental design. Design Baseline and follow‐up data were collected and outcomes were compared between 63 persons with SMI who participated in NECT and 56 persons who received treatment as usual. Results The NECT treatment group showed significant (p < .05) reductions in self‐stigma and increases in self‐esteem, quality of life, and Hope‐Agency scores between pre‐ and posttreatment assessments, compared with the control group. Conclusions The current results provide preliminary support for the use of NECT as an effective treatment to reduce self‐stigma and its implications for treatment and practice are discussed.
    October 02, 2013   doi: 10.1002/jclp.22050   open full text
  • Adult Attachment Anxiety: Using Group Therapy to Promote Change.
    Cheri L. Marmarosh, Giorgio A. Tasca.
    Journal of Clinical Psychology. September 24, 2013
    Group therapy can facilitate changes for members with greater attachment anxiety who tend to struggle with negative self‐perceptions, difficulties regulating emotions, poor reflective functioning, and compromised interpersonal relationships. A clinical example of a therapy group with members who had elevated attachment anxiety and who were diagnosed with binge eating disorder demonstrates how attachment theory can be applied to group treatment. The clinical material from the beginning, middle, and end of group is presented to highlight how attachment anxiety influences members’ emotional reactions and behaviors in the group, how group factors facilitate change, and how the leader fosters the development of a secure base within the group. Pre‐ to posttreatment outcomes indicate positive changes in binge eating, depressive symptoms, and attachment avoidance and anxiety. To facilitate change in individuals with greater attachment anxiety, group therapists may foster a secure base in the group through group cohesion, which will facilitate down regulation of emotions, better reflective functioning, and relationships that are less preoccupied with loss and more secure.
    September 24, 2013   doi: 10.1002/jclp.22044   open full text
  • Sluggish Cognitive Tempo is Associated With Academic Functioning and Internalizing Symptoms in College Students With and Without Attention‐Deficit/Hyperactivity Disorder.
    Stephen P. Becker, Joshua M. Langberg, Aaron M. Luebbe, Melissa R. Dvorsky, Andrew J. Flannery.
    Journal of Clinical Psychology. September 24, 2013
    Objectives The purposes of the present studies were to (a) examine the factor structure of sluggish cognitive tempo (SCT) and attention‐deficit/hyperactivity disorder (ADHD) in college students and (b) examine the associations between SCT and academic functioning and internalizing symptoms in college students with and without ADHD. Method In Study 1, a confirmatory factor analysis of the Barkley Adult ADHD Rating Scale‐IV (BAARS‐IV) was conducted in a sample of 768 college students (aged 17–34 years, 68% female). In Study 2, we examined the relation of SCT to academic functioning and internalizing symptoms in a sample of 72 college students rigorously diagnosed with ADHD (aged 17–35 years, 44% female). Results Study 1 results supported the factor structure of the BAARS‐IV, with the optimal model comprising 4 correlated but distinct factors: SCT, Inattention, Hyperactivity, and Impulsivity. After controlling for correlated demographic variables and ADHD symptoms, SCT was significantly related to academic impairment (including grade point average), anxiety, and depression. In Study 2, SCT again contributed unique variance to internalizing symptoms and academic impairment after controlling for correlated participant characteristics (i.e., sex, age, race, parent education level, family income, ADHD medication use, and mental health service utilization) and ADHD symptom severity. Conclusions These results fill an important gap in the literature by (a) confirming SCT to be distinct from ADHD in emerging adulthood, (b) demonstrating SCT to be strongly linked to college student adjustment, and (c) providing support for the hypothesis that SCT is associated with psychosocial functioning in both individuals with and without ADHD.
    September 24, 2013   doi: 10.1002/jclp.22046   open full text
  • Attention Training Reduces Intrusive Thoughts Cued by a Narrative of Stressful Life Events: A Controlled Study.
    Yasmine Nassif, Adrian Wells.
    Journal of Clinical Psychology. September 24, 2013
    Objectives Intrusive thoughts are common distressing symptoms that occur after exposure to stressful life events. This study tested the idea, based on metacognitive theory, that such intrusions may be ameliorated by the Attention Training Technique (ATT; Wells, ). Method Participants who reported distressing intrusions were randomly allocated to two sessions of ATT (plus homework) or a filler task and were exposed to a narrative recording of their traumatic experience before and after the intervention. Frequencies of intrusions occurring during the narrative were measured. A measure of self‐reported attention flexibility was also examined. Results Participants in the ATT condition showed a significant reduction in intrusion frequency and an increase in attention flexibility compared with the control group. ATT was associated with a 3.4 times greater reduction in the incidence of intrusions. Conclusions ATT may be an effective technique for reducing symptoms of stress exposure, reducing the incidence of intrusions when exposed to stimuli associated with stressful events.
    September 24, 2013   doi: 10.1002/jclp.22047   open full text
  • The Revolting Self: An Interpretative Phenomenological Analysis of the Experience of Self‐Disgust in Females With Depressive Symptoms.
    Philip A. Powell, Paul G. Overton, Jane Simpson.
    Journal of Clinical Psychology. September 24, 2013
    Objective Self‐focused disgust has been implicated in depression and other mental health problems. However, “self‐disgust” as a psychological concept has never been properly defined and remains particularly enigmatic. A qualitative methodology was used to obtain an informed understanding of self‐disgust. Method Nine female participants with clinically relevant depressive symptoms completed semistructured interviews about their understanding and experiences of self‐disgust. These were analyzed using Interpretative Phenomenological Analysis. Results Four superordinate themes emerged: (a) “The subjective experience of self‐disgust” revealed how self‐disgust was perceived as a consuming, visceral experience with trait and state components; (b) “Origins of the revolting self” covered antecedent factors and the role of others in the genesis of self‐disgust; (c) “Consequences of self‐disgust” included the psychological and behavioral results of a disgusting self; and (d) “Associated emotional states” described associations between self‐disgust and other feeling states. Conclusions The current findings suggest self‐disgust is a consuming negative psychological phenomenon, associated with depression, problems with eating, physical appearance, interpersonal relationships, and self‐persecution. Implications for clinical practice and future research on the topic are discussed.
    September 24, 2013   doi: 10.1002/jclp.22049   open full text
  • Virtual Reality Exposure Therapy for the Treatment of Posttraumatic Stress Disorder: A Methodological Review Using CONSORT Guidelines.
    Terri E. Motraghi, Richard W. Seim, Eric C. Meyer, Sandra B. Morissette.
    Journal of Clinical Psychology. September 24, 2013
    Context Virtual reality exposure therapy (VRET) is an extension of traditional exposure therapy and has been used to treat a variety of anxiety disorders. VRET utilizes a computer‐generated virtual environment to present fear‐relevant stimuli. Recent studies have evaluated the use of VRET for treatment of PTSD; however, a systematic evaluation of the methodological quality of these studies has yet to be conducted. Objectives This review aims to (a) identify treatment outcome studies examining the use of VRET for the treatment of PTSD and (b) appraise the methodological quality of each study using the 2010 Consolidating Standards of Reporting Trials (CONSORT) Statement and its 2008 extension for nonpharmacologic interventions. Methods Two independent assessors conducted a database search (PsycINFO, Medline, CINAHL, Google Scholar) of studies published between January 1990 and June 2013 that reported outcome data comparing VRET with another type of treatment or a control condition. Next, a CONSORT quality appraisal of each study was completed. Results The search yielded nine unique studies. The CONSORT appraisal revealed that the methodological quality of studies examining VRET as a treatment for PTSD was variable. Conclusion Although preliminary findings suggest some positive results for VRET as a form of exposure treatment for PTSD, additional research using well‐specified randomization procedures, assessor blinding, and monitoring of treatment adherence is warranted. Movement toward greater standardization of treatment manuals, virtual environments, and equipment would further facilitate interpretation and consolidation of this literature.
    September 24, 2013   doi: 10.1002/jclp.22051   open full text
  • Seven‐Year Follow‐Up Study of Symptoms in Asylum Seekers and Refugees With PTSD Treated With Trauma‐Focused Groups.
    Boris Drožđek, Astrid M. Kamperman, Wietse A. Tol, Jeroen W. Knipscheer, Rolf J. Kleber.
    Journal of Clinical Psychology. September 18, 2013
    ObjectiveTo examine sustainability of symptom outcomes of a 1‐year phase‐based trauma‐focused, multimodal, and multicomponent group therapy in a day treatment program for posttraumatic stress disorder (PTSD) over an average period of 7 years. Method Iranian and Afghan patients (N = 69) were assessed with self‐rated symptom checklists for PTSD, anxiety, and depression symptoms before (T1), after (T2), and up to 11 years upon completion of the treatment (T3). A series of mixed model regression analyses was applied to determine the course of the measured symptoms over time. Results At T2, all symptoms were reduced, but PTSD symptoms showed the strongest reduction. The trend of symptom reduction continued up to 5 years posttreatment and was similar for all the examined symptoms. After 5 years, all symptoms started to worsen, but remained under baseline levels at T3. Conclusions The applied treatment appears to improve mental health of the studied sample on both the short and longer term.
    September 18, 2013   doi: 10.1002/jclp.22035   open full text
  • The Difficulties in Emotion Regulation Scale: Factor Structure in Chronic Pain Patients.
    Gyöngyi Kökönyei, Róbert Urbán, Melinda Reinhardt, Anna Józan, Zsolt Demetrovics.
    Journal of Clinical Psychology. September 03, 2013
    Objective Research suggests that emotions and emotion regulation processes can influence both the sensory (e.g., intensity) and the affective (unpleasantness) components of pain. The purpose of this study was to investigate the factor structure and validity of the Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer, 2004) in medical sample with persistent pain. Method Data were collected from 207 chronic pain patients (82.6% female; mean age = 51.96). We applied confirmatory factor analysis (CFA) to test measurement model of emotion dysregulation and CFA with covariates to test construct and convergent validity of the DERS. Results The original factor structure of the DERS was not supported in our medical sample. However, after some modifications the DERS yielded good fit. Validity of the DERS was confirmed. All the subscales had significant relationship with depression measure, and all the subscales except one correlated with Difficulties in Identifying Feelings component of alexithymia. Conclusions The DERS proved to be an adequate measure of clinically relevant dimensions of emotional dysregulation in chronic pain patients.
    September 03, 2013   doi: 10.1002/jclp.22036   open full text
  • Daily Emotion in Non‐Suicidal Self‐Injury.
    Sarah Elizabeth Victor, E. David Klonsky.
    Journal of Clinical Psychology. September 03, 2013
    Objective While major theories of non‐suicidal self‐injury (NSSI) emphasize the behavior's role in emotion regulation, little is known about the daily emotional experiences of self‐injurers. This study investigated the specific emotions that are characteristic of those who engage in NSSI. Method University students (n = 84) with either no history or a recent history of NSSI completed daily diary and retrospective measures of emotional experience. To evaluate generalizability of findings, the retrospective measure was also administered to a diverse sample of U.S. adults (n = 92) with and without histories of NSSI. Results Results indicate that self‐injurers experience greater negative emotionality, particularly self‐dissatisfaction, compared to individuals with no NSSI history. Self‐injurers also reported less positive emotion, but these effects were smaller. The pattern of results was similar when controlling for Axis I psychopathology and borderline personality disorder symptoms. Conclusions Individuals who engage in NSSI experience more negative emotions, generally, and more self‐dissatisfaction, specifically. Findings contribute to the growing literature on the role of emotion in the etiology and functions of NSSI.
    September 03, 2013   doi: 10.1002/jclp.22037   open full text
  • Patient Interpersonal and Cognitive Changes and Their Relation to Outcome in Interpersonal Psychotherapy for Depression.
    Samantha L. Bernecker, Michael J. Constantino, Angela M. Pazzaglia, Paula Ravitz, Carolina McBride.
    Journal of Clinical Psychology. September 03, 2013
    Objective Despite interpersonal psychotherapy's (IPT) efficacy for depression, little is known about its change‐promoting ingredients. This exploratory study examined candidate change mechanisms by identifying whether patients’ interpersonal and cognitive characteristics change during IPT and whether such changes relate to outcomes. Method Patients were 95 depressed adults receiving manualized IPT. We used multilevel modeling to assess the relation between change in each interpersonal and cognitive domain and outcome. Results Across all interpersonal and cognitive variables measured, patients showed significant improvement. Unexpectedly, reduced romantic relationship adjustment was related to posttreatment depression reduction (β = 2.028, p = .008, self‐rated; β = 1.474, p = .022, clinician‐rated). For the other measured domains, change was not significantly associated with outcome (though changes in some interpersonal variables evidenced a trend‐level relation to outcome). Conclusions Possible reciprocal influences among IPT, depression, and romantic relationship functioning are discussed, as are implications for future research.
    September 03, 2013   doi: 10.1002/jclp.22038   open full text
  • The Moderating Effects of Impulsivity on Chinese Rural Young Suicide.
    Jie Zhang, Lin Lin.
    Journal of Clinical Psychology. September 03, 2013
    Objectives As only about 50% of Chinese suicides have mental disorders, nonpsychiatric factors such as social environment and personality may account for the variance that is not explained by mental problems. We try to explore the effects of impulsivity on Chinese suicides and the role impulsivity plays in the relationship between negative life events (NLEs) and suicidal behavior. Method A total of 392 suicide cases (178 female and 214 male, aged 15–34 years) and 416 community controls (202 males and 214 females) of the same age range were sampled in China. The case‐control data were obtained using psychological autopsy method with structured and semistructured instruments. Results Impulsivity was an important predictor of Chinese rural young suicides and it was a moderator between NLEs and suicide. Conclusions Findings of the study may be translated into practical measures in suicide prevention in China as well as elsewhere in the world.
    September 03, 2013   doi: 10.1002/jclp.22039   open full text
  • Attachment Theory as a Guide to Understanding and Working With Transference and the Real Relationship in Psychotherapy.
    Charles J. Gelso, Beatriz Palma, Avantika Bhatia.
    Journal of Clinical Psychology. September 03, 2013
    Recent decades have witnessed an extraordinary amount of conceptual and empirical work on attachment theory in psychology and psychotherapy. Attachment theory is discussed in the present article as a way of understanding and fostering therapeutic work with 2 other key relationship constructs that have been theorized to be elements of all psychotherapies: client transference and the real relationship existing between the therapist and patient. Fundamental features of attachment, transference, and the real relationship are summarized. Particular emphasis is given to the role of the therapist as a secure base and a safe haven within the real relationship, and to the patient's internal working model as it relates to transference. A case of long‐term psychodynamic psychotherapy conducted by the first author is presented to illuminate the 3 main constructs. The case demonstrates both the usefulness of attachment theory and the fact that any single theory cannot explain all of the complex features of a given treatment.
    September 03, 2013   doi: 10.1002/jclp.22043   open full text
  • Attachment and Object Relations in Patients With Narcissistic Personality Disorder: Implications for Therapeutic Process and Outcome.
    Diana Diamond, Kevin B. Meehan.
    Journal of Clinical Psychology. August 30, 2013
    This article presents a therapeutic approach for patients with severe personality disorders, transference‐focused psychotherapy (TFP), a manualized evidence‐based treatment, which integrates contemporary object relations theory with attachment theory and research. Case material is presented from a narcissistic personality disorder (NPD) patient in TFP whose primary presenting problems were in the arena of sexuality and love relations, and whose attachment state of mind showed evidence of oscillation between dismissing and preoccupied mechanisms. Clinical process material is presented to illustrate the tactics and techniques of TFP and how they have been refined for treatment of individuals with NPD. The ways in which conflicts around sexuality and love relations were lived out in the transference is delineated with a focus on the interpretation of devalued and idealized representations of self and others, both of which are key components of the compensatory grandiose self that defensively protects the individual from an underlying sense of vulnerability and imperfection.
    August 30, 2013   doi: 10.1002/jclp.22042   open full text
  • Putting Up Emotional (Facebook) Walls? Attachment Status and Emerging Adults’ Experiences of Social Networking Sites.
    George C. Nitzburg, Barry A. Farber.
    Journal of Clinical Psychology. August 30, 2013
    Social networking sites (SNS) like Facebook can increase interpersonal connections but also intensify jealousy, envy, and surveillance behaviors. Attachment styles may help explain differences in experiencing SNS. This study investigated the role of attachment in influencing emerging adults’ perceptions and feelings about SNS and their disclosures on SNS. Disorganized and anxious attachment predicted subjects’ use of SNS to avoid more personal face‐to‐face communication, suggesting individuals with these tendencies use SNS to hold relationships at a psychological arm's distance. Anxious attachment also predicted feelings of intimacy when using SNS, perhaps reflecting online needs for comfort from others. A case narrative is presented to show how those with insecure attachment patterns may struggle to avoid interpersonal conflict when being continuously presented with ambiguous social information.
    August 30, 2013   doi: 10.1002/jclp.22045   open full text
  • A Randomized Controlled Trial of an Internet Intervention for Adults with Insomnia: Effects on Comorbid Psychological and Fatigue Symptoms.
    Frances P. Thorndike, Lee M. Ritterband, Linda A. Gonder‐Frederick, Holly R. Lord, Karen S. Ingersoll, Charles M. Morin.
    Journal of Clinical Psychology. August 28, 2013
    Objective Insomnia is frequently comorbid with other medical and psychological disorders. This secondary data analysis investigated whether an Internet‐delivered cognitive behavioral therapy for insomnia (CBT‐I) intervention could also reduce comorbid psychological and fatigue symptoms. Method Data from a pilot randomized controlled trial (RCT) testing the efficacy of Internet‐delivered CBT‐I relative to a waitlist control was used to examine changes in symptoms of depression, anxiety, mental health quality of life (QOL), and fatigue. Results Group by time interactions from repeated measures analyses revealed significant post intervention improvements in Internet participants (n = 22) relative to control participants (n = 22) on all psychological symptoms, mental health QOL, and fatigue. A small post hoc subsample of Internet participants with mild or moderate depression also showed large effect size changes in these constructs (depression, anxiety, mental health QOL, and fatigue). Conclusion Internet‐delivered CBT‐I appears to not only improve sleep but also reduce comorbid psychological and fatigue symptoms.
    August 28, 2013   doi: 10.1002/jclp.22032   open full text
  • Phobias of Attachment‐Related Inner States in the Psychotherapy of Adult Survivors of Childhood Complex Trauma.
    Giovanni Liotti.
    Journal of Clinical Psychology. August 28, 2013
    The clinical case described in this article illustrates the value of taking into account the dynamics of disorganized attachment in the assessment of attachment‐related phobias (phobia of attachment and phobia of attachment loss) during the psychotherapy of chronically traumatized patients. These seemingly opposite phobias typically coexist in the same patient, appear as phobias of both inner states (affect phobias) and relational experiences, and are linked to dissociated representations of self‐with‐other. Theory and research on attachment disorganization provide a clinician‐friendly conceptual framework for capturing both the intrapsychic (e.g., intrusive and nonintegrated mental states) and the relational (e.g., dramatic unsolvable dilemmas in interpersonal exchanges) aspects of the attachment‐related phobias. The therapeutic strategy and the key interventions that logically follow from a case formulation based on this conceptual framework are examined.
    August 28, 2013   doi: 10.1002/jclp.22041   open full text
  • Pathological Narcissism and Depressive Symptoms in Psychiatric Outpatients: Mediating Role of Dysfunctional Attitudes.
    Darko Marčinko, Nenad Jakšić, Ena Ivezić, Milena Skočić, Zsuzsanna Surányi, Mladen Lončar, Tomislav Franić, Miro Jakovljević.
    Journal of Clinical Psychology. August 28, 2013
    Objective The aim of this study was to examine the relationships between pathological narcissism (narcissistic grandiosity and narcissistic vulnerability), dysfunctional attitudes (perfectionism and dependency on other people), and depressive symptoms in psychiatric outpatients. Method A sample of 234 adult psychiatric outpatients (57.3% male; mean age 44.39 years) completed the Pathological Narcissism Inventory, the Dysfunctional Attitudes Scale–Form A, and the Depression, Anxiety, Stress Scales–21. Results Narcissistic vulnerability exhibited unique positive correlations with depressive symptoms, whereas narcissistic grandiosity showed substantially weaker correlations with depressive symptoms. Perfectionism partially mediated the relationship between narcissistic vulnerability and depressive symptoms. The mediating role of dependency was not confirmed. Conclusions Among adult psychiatric outpatients, narcissistic vulnerability is more strongly related to depressive symptoms than narcissistic grandiosity, and dysfunctional perfectionism represents one of the underlying mechanisms of this relationship. The implications of these findings are discussed in relation to the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria and the treatment of pathological narcissism.
    August 28, 2013   doi: 10.1002/jclp.22033   open full text
  • Are “Not Just Right Experiences” (NJREs) Specific to Obsessive‐Compulsive Symptoms?: Evidence that NJREs Span across Symptoms of Emotional Disorders.
    Thomas A. Fergus.
    Journal of Clinical Psychology. August 28, 2013
    Objective“Not just right experiences” (NJREs) represent a mismatch between a perceived current versus desired state of experiences. NJREs are currently considered specific to obsessive‐compulsive symptoms, but results from prior studies might have been affected by the assessment of NJREs that were particularly relevant to only obsessive‐compulsive symptoms. Method A large community sample of adults recruited through the Internet (N = 480, Mean age = 32.9 years, 54.7% female) completed self‐report measures of symptom types and a modified self‐report measure of NJREs. Results Consistent with predictions, NJREs tended to share statistically equivalent zero‐order correlations with all of the assessed symptom types. NJREs were significantly related to only generalized anxiety and obsessive‐compulsive symptoms after accounting for important covariates, including general distress, perfection/certainty, and the overlap among the symptom types. Conclusions These results suggest that NJREs are relevant to a broader range of symptom types than previously thought.
    August 28, 2013   doi: 10.1002/jclp.22034   open full text
  • Telehealth Cognitive Behavior Therapy for Co‐Occurring Insomnia and Depression Symptoms in Older Adults.
    Kenneth L. Lichstein, Forrest Scogin, S. Justin Thomas, Elizabeth A. DiNapoli, Haley R. Dillon, Anna McFadden.
    Journal of Clinical Psychology. August 22, 2013
    Objective Telehealth has proven effective with a wide range of disorders, but there is a paucity of data on the use of telehealth using cognitive‐behavior therapy (CBT) with late‐life insomnia and depression. This pilot study was designed to examine the feasibility and effectiveness of using telehealth to treat older adults with comorbid insomnia and depression living in rural Alabama. Method Five patients received 10 sessions of CBT for insomnia and depression. Patients were engaged in treatment via Skype from their primary care physician's office. Assessments were conducted at baseline, posttreatment, and 2‐month follow‐up. Results Patients exhibited clinically significant improvement in both insomnia (sleep diaries and Insomnia Severity Index) and depression (Hamilton Rating Scale for Depression) at posttreatment, and these gains were well maintained at 2‐month follow‐up. Conclusions These preliminary data suggest that telehealth may be an effective means of providing treatment to older adults, including underserved populations.
    August 22, 2013   doi: 10.1002/jclp.22030   open full text
  • The Effect of Participating in a Trauma‐ and Stressful Event‐Focused Study.
    Sadie E. Larsen, Howard Berenbaum.
    Journal of Clinical Psychology. July 22, 2013
    Objective Researchers have increasingly examined whether participants who have experienced a traumatic event should be considered vulnerable research populations. Studies have typically asked participants in trauma‐focused research whether they were upset by the study or perceived any benefit from it. The current study extends such research by measuring mood and exploring potential moderators of the impact of study participation. Method Participants were 107 women who experienced a traumatic or stressful event and completed an event‐focused research protocol. Negative affect was measured, using the Positive and Negative Affect Schedule, at the time of the study and 1 week later. Results Participants reported significantly lower levels of negative affect in the week after the study than before it. Decreases in negative affect were greatest for those with highest levels of depression at the time of interview. Conclusions Participation in a trauma‐ or stressful‐event‐focused study is not harmful and may even be beneficial, especially among depressed participants.
    July 22, 2013   doi: 10.1002/jclp.22029   open full text
  • The Associations between Loss and Posttraumatic Stress and Depressive Symptoms Following Hurricane Ike.
    Lisa A. Paul, Matthew Price, Daniel F. Gros, Kirstin Stauffacher Gros, Jenna L. McCauley, Heidi S. Resnick, Ron Acierno, Kenneth J. Ruggiero.
    Journal of Clinical Psychology. July 12, 2013
    Disasters can have wide‐ranging effects on individuals and their communities. Loss of specific resources (e.g., household contents, job) following a disaster has not been well studied, despite the implications for preparedness efforts and postdisaster interventions. Objective To provide information about the effects of loss on postdisaster distress, the present study assessed associations between disaster‐related variables, including the loss of specific resources, and postdisaster distress. Method Random‐digit dialing methodology was used to recruit hurricane‐affected adults from Galveston and Chambers, TX, counties one year after Hurricane Ike. Data from 1,249 survivors were analyzed to identify predictors of distress. Results Variables that were significantly associated with posttraumatic stress disorder symptoms included sustained losses, hurricane exposure, and sociodemographic characteristics; similar results were obtained for depressive symptoms. Conclusions Together, these findings suggest risk factors that may be associated with the development of posthurricane distress that can inform preparedness efforts and posthurricane interventions.
    July 12, 2013   doi: 10.1002/jclp.22026   open full text
  • Mindfulness, Emotional Dysregulation, Impulsivity, and Stress Proneness Among Hypersexual Patients.
    Rory C. Reid, Jennifer E. Bramen, Ariana Anderson, Mark S. Cohen.
    Journal of Clinical Psychology. July 12, 2013
    Objective The current study explores relationships between mindfulness, emotional regulation, impulsivity, and stress proneness in a sample of participants recruited in a Diagnostic and Statistical Manual of Mental Disorder Fifth Edition Field Trial for Hypersexual Disorder and healthy controls to assess whether mindfulness attenuates symptoms of hypersexuality. Method Hierarchal regression analysis was used to assess whether significant relationships between mindfulness and hypersexuality exist beyond associations commonly found with emotional dysregulation, impulsivity, and stress proneness in a sample of male hypersexual patients (n = 40) and control subjects (n = 30). Results Our results show a robust inverse relationship of mindfulness to hypersexuality over and above associations with emotional regulation, impulsivity, and stress proneness. Conclusions These results suggest that mindfulness may be a meaningful component of successful therapy among patients seeking help for hypersexual behavior in attenuating hypersexuality, improving affect regulation, stress coping, and increasing tolerance for desires to act on maladaptive sexual urges and impulses.
    July 12, 2013   doi: 10.1002/jclp.22027   open full text
  • Personality Pathology Factors Predict Recurrent Major Depressive Disorder in Emerging Adults.
    Erin S. Sheets, Laramie E. Duncan, Andri S. Bjornsson, Linda W. Craighead, W. Edward Craighead.
    Journal of Clinical Psychology. July 12, 2013
    Objective Prior investigations consistently indicate that personality pathology is a risk factor for recurrence of major depressive disorder (MDD). Lack of emipircal support, however, for the Diagnostic and Statistical Manual of Mental Disorders (DSM) Fourth Edition organization of Axis II disorders supports the investigation of empirically derived factors of personality pathology as predictors of recurrence. Method A sample of 130 previously depressed emerging adults (80% female; aged 18 to 21 years) were assessed for personality disorder symptoms at baseline. Participants were then followed for 18 months to identify MDD recurrence during the first 2 years of college. Results Based on a previous factor analysis of DSM personality disorder criteria, eight personality pathology factors were examined as predictors of MDD recurrence. Survival analysis indicated that factors of interpersonal hypersensitivity, antisocial conduct, and social anxiety were associated with increased risk of MDD recurrence. Conclusions These findings suggest that an empirically based approach to personality pathology organization may yield useful predictors of MDD recurrence during emerging adulthood.
    July 12, 2013   doi: 10.1002/jclp.22028   open full text
  • The Role of Intolerance of Uncertainty in Social Anxiety Subtypes.
    Sara E. Whiting, Whitney S. Jenkins, Anna C. May, Brittany M. Rudy, Thompson E. Davis, Erin T. Reuther.
    Journal of Clinical Psychology. July 10, 2013
    Objectives Intolerance of uncertainty (IU) is thought to underlie several internalizing disorders; however, it has only begun to be explored within social anxiety (SA). This study extends previous findings by examining IU's relation to performance and interaction SA subtypes and by accounting for obsessive‐compulsive symptoms. Methods A total of 472 undergraduates completed measures of IU, SA, perfectionism, worry, obsessions/compulsions, and fear of negative evaluation (FNE). Results IU and obsessions/compulsions predicted performance SA beyond FNE. IU predicted interaction SA beyond FNE. Inhibitory anxiety IU contributed to both SA types but contributed more to performance SA. Prospective anxiety IU was negatively related to performance SA and unrelated to interaction SA, though a trend emerged. Contrasts between those high in one SA type, both, or neither revealed IU was highest when both types were present. Conclusions Inhibitory IU plays a significant role in both SA subtypes and may play a slightly greater role in performance SA.
    July 10, 2013   doi: 10.1002/jclp.22024   open full text
  • Rumination, Substance Use, and Self‐Harm in a Representative Australian Adult Sample.
    Robert J. Tait, Jay Brinker, Carl I. Moller, Davina J. French.
    Journal of Clinical Psychology. July 09, 2013
    Background There are few data on self‐harm in the general population, especially examining the roles of rumination and substance use. Objectives To evaluate the inter‐relationships of rumination, self‐harm, and potential mediating variables. Method A cohort with follow‐up every 4 years involving a random sample of adults aged 20–24 and 40–44 years (at baseline) living in Australia. The survey included items on three common forms of self‐harm. Other measures included rumination, Goldberg Anxiety and Depression scales, substance use, coping style (Brief COPE), and demographic risk factors. Results The sample comprised 2,184 women and 1,942 men with 287 self‐harm cases (7.0%). Depression and coping style were significant mediators of rumination on self‐harm for men, with depression being the only robust mediator for women. For males, age and education were also significantly associated, while for women, age, smoking, trauma, and sexual abuse were significant. Conclusions Men and women differ on mediators of self‐harm.
    July 09, 2013   doi: 10.1002/jclp.22025   open full text
  • Axis I Psychopathology and the Perpetration of Intimate Partner Violence.
    Cory A. Crane, Samuel W. Hawes, Susan Devine, Caroline J. Easton.
    Journal of Clinical Psychology. July 03, 2013
    Objectives Initial evidence suggests that individuals with specific psychiatric conditions may perpetrate intimate partner violence (IPV) at greater frequency than nondiagnosed comparison samples. The present investigation examined the relationship between IPV and specific clinical diagnoses. Method The current investigation utilized data provided by 190 (34% female) adult offenders during court‐mandated substance use evaluations to investigate the incidence of past‐year IPV among samples of dually diagnosed (bipolar, posttraumatic stress disorder [PTSD], and attention deficit‐hyperactivity disorder [ADHD]) clients relative to 3 comparison samples matched on substance use and sociodemographic variables. Results Bipolar and PTSD diagnosed participants were more likely to perpetrate IPV than matched comparison and ADHD participants. Bipolar and PTSD diagnosed participants were equally likely to perpetrate IPV, as were ADHD and matched comparison samples. Conclusions The frequency of IPV perpetration among bipolar and PTSD diagnosed clients may complicate interpersonal and relationship functioning. The development of integrated treatments for IPV and underlying psychopathology is recommended.
    July 03, 2013   doi: 10.1002/jclp.22013   open full text
  • Use of Mindful Reappraisal Coping Among Meditation Practitioners.
    Adam Hanley, Eric L. Garland, David S. Black.
    Journal of Clinical Psychology. July 01, 2013
    Objective By enhancing positive affect and cognitive flexibility, mindfulness practice may promote reappraisal of stressors. We hypothesized that coping through mindful reappraisal would be common among mindfulness practitioners from an array of traditions. Method A sample of 118 meditation practitioners completed an online survey comprising assessments of the prevalence and frequency of mindful reappraisal, as well as measures of well‐being and distress. Results Regular use of mindful reappraisal was reported by over half of the sample and was significantly correlated with years of meditation practice (r = .31, p = .01), meditation practice days per month (r = .30, p = .001), and meditation hours per week (r = .30, p = .001). Controlling for frequency of meditation practice and trait mindfulness, mindful reappraisal frequency explained significant portions of variance in well‐being (P <.001) and distress (P <.001). Conclusions Meditation practitioners commonly employ mindful reappraisal coping as a positive emotion regulatory strategy in stressful contexts.
    July 01, 2013   doi: 10.1002/jclp.22023   open full text
  • Specific Attitudes Which Predict Psychology Students’ Intentions to Seek Help for Psychological Distress.
    Susan J. Thomas, Peter Caputi, Coralie J. Wilson.
    Journal of Clinical Psychology. July 01, 2013
    Objective Although many postgraduate psychology programs address students’ mental health, there are compelling indications that earlier, undergraduate, interventions may be optimal. We investigated specific attitudes that predict students’ intentions to seek treatment for psychological distress to inform targeted interventions. Method Psychology students (N = 289; mean age = 19.75 years) were surveyed about attitudes and intentions to seek treatment for stress, anxiety, or depression. Results Less than one quarter of students reported that they would be likely to seek treatment should they develop psychological distress. Attitudes that predicted help‐seeking intentions related to recognition of symptoms and the benefits of professional help, and openness to treatment for emotional problems. Conclusions The current study identified specific attitudes which predict help‐seeking intentions in psychology students. These attitudes could be strengthened in undergraduate educational interventions promoting well‐being and appropriate treatment uptake among psychology students.
    July 01, 2013   doi: 10.1002/jclp.22022   open full text
  • Quality of Coping Skills Predicts Depressive Symptom Reactivity Over Repeated Stressors.
    Abby D. Adler, Laren R. Conklin, Daniel R. Strunk.
    Journal of Clinical Psychology. June 25, 2013
    Objective The purpose of this study was to examine the quality of coping skills as a predictor of change in depressive symptoms surrounding a series of naturally occurring stressors. Method A total of 213 undergraduate students completed study measures surrounding 3 stressors (involving 6 assessments per participant). Primary analyses focused on occasions of disappointing exam performance. Results Consistent with expectations, coping skill quality was predictive of more adaptive responses (i.e., less depressive symptom reactivity), with this relation being particularly strong among participants with high initial levels of depressive symptoms and on occasions when participants had a marked worsening of mood. The quality of skills used in coping with specific stressors continued to predict depressive symptom reactivity after controlling for a one‐time measure of coping skill quality. Conclusions Our results support the importance of both stressor‐specific coping skill quality and consideration of key contextual factors in understanding depressive symptom reactivity surrounding stressors.
    June 25, 2013   doi: 10.1002/jclp.21993   open full text
  • Enhancing Information Pertaining to Client Characteristics to Facilitate Evidence‐Based Practice.
    Jennifer L. Callahan, Christopher J. Heath, Nicki L. Aubuchon‐Endsley, Frank L. Collins, Gregory L. Herbert.
    Journal of Clinical Psychology. June 25, 2013
    Objective Evidence‐based practice (EBP) includes utilization of empirically supported treatments, application of clinical expertise, and consideration of client characteristics. The following brief report aims to elucidate barriers in the study and dissemination of research regarding these client characteristics. Design Authors examined empirical papers cited on psychologicaltreatments.org (N = 338) and categorized each according to efficacy evidence available pertaining to gender, race/ethnicity, and socioeconomic status (SES). Results Gender was most commonly considered (7% of studies), with less than 2% of studies analyzing efficacy in relation to race/ethnicity or SES. Conclusions Available findings are summarized according to disorder. Researchers are encouraged to attend to client variables in efficacy studies and suggestions are offered for training students to include client variables in EBP.
    June 25, 2013   doi: 10.1002/jclp.21995   open full text
  • Late Onset Eating Disorders in Spain: Clinical Characteristics and Therapeutic Implications.
    B. Bueno, I. Krug, C.M. Bulik, S. Jiménez‐Murcia, R. Granero, L. Thornton, E. Penelo, J.M. Menchón, I. Sánchez, F.J. Tinahones, F. Fernández‐Aranda.
    Journal of Clinical Psychology. June 25, 2013
    Objective The literature on later age of onset (LAO) in women with eating disorders is scarce. We compared the severity of eating disorders, eating disorder subtype, and personality profiles in a clinical sample of consecutively assessed women with eating disorders with later age of onset (LAO, > = 25 years) to women with typical age of onset (TAO, <25 years). Method All eating disorder patients met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM‐IV) criteria and were admitted to the Eating Disorder Unit of the University Hospital of Bellvitge in Barcelona, Spain. Ninety‐six patients were classified as LAO and 759 as TAO. Assessment Measures included the Eating Attitude Test‐40 (EAT‐40), Eating Disorders Inventory‐2 (EDI‐2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist Revised (SCL‐90‐R), and the Temperament and Character Inventory‐Revised (TCI‐R), as well as other clinical and psychopathological indices. Results LAO individuals reported significantly fewer weekly vomiting episodes, fewer self‐harming behaviours, less drug abuse, and lower scores on the BITE symptoms, the EDI‐2 drive for thinness, and the TCI‐R harm avoidance scales than TAO individuals. Conversely, the LAO group reported more current and premorbid obesity than the TAO group. Conclusion LAO eating disorder patients in this sample presented with milder symptomatology and less extreme personality traits. Premorbid obesity may be more relevant to LAO than TAO eating disorders and should be routinely assessed and considered when planning treatment.
    June 25, 2013   doi: 10.1002/jclp.22006   open full text
  • Mindfulness Training in a Heterogeneous Psychiatric Sample: Outcome Evaluation and Comparison of Different Diagnostic Groups.
    Elisabeth H. Bos, Ria Merea, Erik Brink, Robbert Sanderman, Agna A. Bartels‐Velthuis.
    Journal of Clinical Psychology. June 25, 2013
    ObjectivesTo examine outcome after mindfulness training in a heterogeneous psychiatric outpatient population and to compare outcome in different diagnostic groups. Method One hundred and forty‐three patients in 5 diagnostic categories completed questionnaires about psychological symptoms, quality of life, and mindfulness skills prior to and immediately after treatment. Results The mixed patient group as a whole improved significantly on all outcome measures. Differential improvement was found for different diagnostic categories with respect to psychological symptoms and quality of life: Bipolar patients did not improve significantly on these measures. This finding could be explained by longer illness duration and lower baseline severity in the bipolar category. Conclusion Mindfulness training is associated with overall improvement in a heterogeneous outpatient population. Differences in outcome between diagnostic categories may be ascribed to differences in illness duration and baseline severity.
    June 25, 2013   doi: 10.1002/jclp.22008   open full text
  • The Organization of Irrational Beliefs in Posttraumatic Stress Symptomology: Testing the Predictions of REBT Theory Using Structural Equation Modelling.
    Philip Hyland, Mark Shevlin, Gary Adamson, Daniel Boduszek.
    Journal of Clinical Psychology. June 25, 2013
    Objective This study directly tests a central prediction of rational emotive behaviour therapy (REBT) that has received little empirical attention regarding the core and intermediate beliefs in the development of posttraumatic stress symptoms. Method A theoretically consistent REBT model of posttraumatic stress disorder (PTSD) was examined using structural equation modelling techniques among a sample of 313 trauma‐exposed military and law enforcement personnel. Results The REBT model of PTSD provided a good fit of the data, χ2 = 599.173, df = 356, p < .001; standardized root mean square residual = .05 (confidence interval = .04–.05); standardized root mean square residual = .04; comparative fit index = .95; Tucker Lewis index = .95. Results demonstrated that demandingness beliefs indirectly affected the various symptom groups of PTSD through a set of secondary irrational beliefs that include catastrophizing, low frustration tolerance, and depreciation beliefs. Conclusions Results were consistent with the predictions of REBT theory and provides strong empirical support that the cognitive variables described by REBT theory are critical cognitive constructs in the prediction of PTSD symptomology.
    June 25, 2013   doi: 10.1002/jclp.22009   open full text
  • Stressful Life Events and Depression Symptoms: The Effect of Childhood Emotional Abuse on Stress Reactivity.
    Benjamin G. Shapero, Shimrit K. Black, Richard T. Liu, Joshua Klugman, Rachel E. Bender, Lyn Y. Abramson, Lauren B. Alloy.
    Journal of Clinical Psychology. June 25, 2013
    Objective Stressful life events are associated with an increase in depressive symptoms and the onset of major depression. Importantly, research has shown that the role of stress changes over the course of depression. The present study extends the current literature by examining the effects of early life stress on emotional reactivity to current stressors. Method In a multiwave study (N = 281, mean age = 18.76; 68% female), we investigated the proximal changes that occur in depressive symptoms when individuals are faced with life stress and whether a history of childhood emotional abuse moderates this relationship. Results Results support the stress sensitivity hypothesis for early emotional abuse history. Individuals with greater childhood emotional abuse severity experienced greater increases in depressive symptoms when confronted with current dependent stressors, controlling for childhood physical and sexual abuse. Conclusions This study highlights the importance of emotional abuse as an indicator for reactivity to stressful life events.
    June 25, 2013   doi: 10.1002/jclp.22011   open full text
  • Health‐Related Dysfunctional Beliefs and Health Anxiety: Further Evidence of Cognitive Specificity.
    Thomas A. Fergus.
    Journal of Clinical Psychology. June 25, 2013
    Objective The specificity of Salkovskis and Warwick's (2001) 4 health‐related dysfunctional beliefs to health anxiety was examined. Method Specificity was examined using a medically healthy sample of community members recruited through the Internet (N = 410, mean age = 32.9 years, 55.4% female). Structural equation modeling was used to compare the equivalence of latent correlations and partial path coefficients that controlled for the overlap among the targeted dysfunctional beliefs. Results Health‐related dysfunctional beliefs were significantly more strongly related to health anxiety than obsessive‐compulsive symptoms. Further, health‐related dysfunctional beliefs continued to share robust relations with health anxiety after controlling for related dysfunctional beliefs, although anxiety sensitivity appeared particularly relevant to health anxiety as well. Conclusions These results support the specificity of Salkovskis and Warwick's health‐related dysfunctional beliefs to health anxiety, as well as the importance given to dysfunctional beliefs within cognitive‐behavioral models and treatments of health anxiety.
    June 25, 2013   doi: 10.1002/jclp.22012   open full text
  • Co‐Occurring Eating and Psychiatric Symptoms in Taiwanese College Students: Effects of Gender and Parental Factors.
    Mei‐Chih Meg Tseng, Susan Shur‐Fen Gau, Wan‐Ling Tseng, Hai‐Gwo Hwu, Ming‐Been Lee.
    Journal of Clinical Psychology. June 25, 2013
    Objective To test whether gender and parental factors moderate the relationships between symptoms of eating disorder (ED) and other psychiatric symptoms. Methods A total of 5,015 new entrants completed several questionnaires and 541individuals with ED symptoms were identified by the Adult Self‐Report Inventory‐4 that assessed a wide range of Diagnostic and Statistical Manual of Mental Disorders Fourth Edition psychopathology. The participants also reported on their parents’ attitude toward them before their ages of 16. Results ED symptoms, female gender, less parental care, and more parental protection were associated with more severe co‐occurring psychiatric symptoms. Gender and parental factors also demonstrated differential moderating effects on the relationships between ED and co‐occurring psychiatric symptoms. Conclusions Parenting counseling may be individualized to young adults with ED symptoms and different co‐occurring psychiatric symptoms.
    June 25, 2013   doi: 10.1002/jclp.22014   open full text
  • Testing Three Different Sequential Mediational Interpretations of Beck's Cognitive Model of the Development of Depression.
    Patrick Pössel, Stephanie Winkeljohn Black.
    Journal of Clinical Psychology. June 24, 2013
    Objectives This study tested and compared three sequential interpretations of Beck's cognitive model of the development of depression (1996). The causal mediational interpretation identifies dysfunctional attitudes as most distal to depressive symptoms, followed by cognitive distortions, the cognitive triad, and negative automatic thoughts, with each construct successively more proximal to depressive symptoms. By contrast, the symptom model reverses the causal chain with negative automatic thoughts as the most proximal consequence and dysfunctional attitudes as the most distal consequence of depression. The bidirectional model merges both interpretations into one model. Previous studies on sequential interpretations of Beck's model have not included cognitive distortions or the cognitive triad and did not test the bidirectional model finding contradictory empirical evidence for the sequential order. Method In the 3‐wave longitudinal study, 308 German university students without clinically significant depressive symptoms (245 female, average age: 23.69 years) completed self‐report questionnaires measuring their dysfunctional attitudes, cognitive distortions, cognitive triad, negative automatic thoughts, and depressive symptoms. Results The bidirectional model with partial mediation fit the data best and cognitive distortions mediated the relationship between dysfunctional attitudes and negative automatic thoughts and vice versa. Conclusions The findings have important consequences for the prevention of depression. Prevention programs may want to focus on cognitive distortions, the only construct in Beck's model that influences every other construct in the model.
    June 24, 2013   doi: 10.1002/jclp.22001   open full text
  • Transient Insomnia Versus Chronic Insomnia: A Comparison Study of Sleep‐Related Psychological/Behavioral Characteristics.
    Chien‐Ming Yang, Shih‐Chun Lin, Chung‐Ping Cheng.
    Journal of Clinical Psychology. June 24, 2013
    Objectives Vulnerability to transient insomnia is regarded as a predisposing factor for chronic insomnia. However, most individuals with transient insomnia do not develop chronic insomnia. The current study investigated the differential contributing factors for these two conditions to further the understanding of this phenomenon. Method Chronic insomnia patients and normal sleepers with high and low vulnerability to transient insomnia completed measures of pre‐sleep arousal, dysfunctional sleep beliefs, and sleep‐related safety behaviors. Results Both cognitive and somatic pre‐sleep arousals were identified as significant predictors for transient insomnia. Dysfunctional beliefs regarding worry about insomnia and cognitive arousal were predictors for chronic insomnia. Sleep‐related safety behavior, although correlated with insomnia severity, was not a significant predictor for both conditions. Conclusions Dysfunctional beliefs associated with worry and losing control over sleep are the most critical factors in differentiating chronic insomnia from transient insomnia. These factors should be addressed to help prevent individuals with high sleep vulnerability from developing chronic sleep disturbance.
    June 24, 2013   doi: 10.1002/jclp.22000   open full text
  • Role of Meaning in the Prediction of Depressive Symptoms Among Trauma‐Exposed and Nontrauma‐Exposed Emerging Adults.
    Candice R. S. Woo, Elissa J. Brown.
    Journal of Clinical Psychology. June 24, 2013
    Objectives This study investigated the role of searching for meaning, finding meaning, trauma exposure, and their interaction in the prediction of depressive symptoms among trauma‐exposed and nontrauma‐exposed emerging adults. Method Eight thousand seven hundred and eighty‐four college students (73% female; mean age of 19.8 years) completed self‐report measures. Hierarchical regression analysis was conducted to evaluate the three‐way interaction in the prediction of depressive symptoms. Results Searching for and finding meaning as well as the three‐way interaction significantly contributed to the prediction of depression. Specifically, searching for meaning was associated with increased symptoms, irrespective of meaning levels among nontrauma‐exposed and low frequency trauma‐exposed emerging adults. Among high frequency trauma‐exposed individuals, an increase in the search‐by‐find meaning interaction predicted fewer symptoms. Conclusions The findings suggest that searching for and finding meaning are important mechanisms in the prediction of depression among emerging adults facing daily stressors and traumatic events. Clinical implications are discussed.
    June 24, 2013   doi: 10.1002/jclp.22002   open full text
  • Examination of Proposed DSM‐5 Changes to Pathological Gambling in a Helpline Sample.
    Jeremiah Weinstock, Carla Rash, Steve Burton, Sheila Moran, Warren Biller, Kathleen O'Neil, Norman Kruedelbach.
    Journal of Clinical Psychology. June 24, 2013
    Objectives To examine the effect of proposed the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM‐5) changes to pathological gambling relative to DSM‐IV criteria in a large gambling helpline sample (N = 2,750). Changes in prevalence rates, the diagnostic utility of the illegal acts criterion, and severity of alternative diagnostic formulation thresholds were examined. Method Callers to the helpline completed a semistructured interview and DSM‐IV criteria were assessed. Results Without lowering the diagnostic threshold, removal of the illegal acts criterion resulted in loss of diagnostic status in less than 2% of helpline callers. The DSM‐IV prevalence rate in this sample was 81.2%, and DSM‐5 formulations with lowered thresholds of 4, 3, and 2 symptoms increased prevalence rates by 9% to 17%. However, item‐level symptom endorsement suggested that subclinical gamblers experience significant adverse consequences. Conclusions Lowered thresholds may lead to earlier provision of treatment to gamblers and prevent escalation of the disorder, while being more consistent with diagnostic thresholds of other addiction disorders.
    June 24, 2013   doi: 10.1002/jclp.22003   open full text
  • Adolescent Identity Development and Distress in a Clinical Sample.
    Rachel E. Wiley, Steven L. Berman.
    Journal of Clinical Psychology. June 24, 2013
    ObjectiveThe purpose of this study was to examine the relationships of identity development and identity distress to psychological adjustment within adolescents affected by psychological problems. MethodParticipants included 88 adolescents (43.2% female) ranging from 11 to 20 years of age who were receiving services from a community mental health center. ResultsA high proportion of the participants (22.7%) met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for Identity Problem. Regression analyses found psychopathology symptom score was associated with identity distress, identity exploration, and identity commitment, while identity distress was only related to psychopathology symptom score and not the other two identity variables. ConclusionsAdolescents with a clinical diagnosis may report significant levels of identity distress. Given that the relationship between psychopathology and identity distress may be reciprocal, assessing for identity issues might be prudent when conducting clinical diagnostic interviews and useful in treatment planning.
    June 24, 2013   doi: 10.1002/jclp.22004   open full text
  • Relations Between Hopelessness, Depressive Symptoms and Suicidality: Mediation by Reasons for Living.
    Courtney L. Bagge, Dorian A. Lamis, Michael Nadorff, Augustine Osman.
    Journal of Clinical Psychology. June 24, 2013
    ObjectiveThe present study examined whether reasons for living (RFL) would partially account for the associations between traditional risk factors (depressive symptoms, hopelessness) and suicidal ideation and attempts. Method Data were collected from 1,075 undergraduate college students who completed a battery of online assessments. Results Results from a series of simultaneous mediational models indicated that the relations between risk factors and current suicidal ideation were partially mediated by total RFL (and Coping Beliefs and Self‐Evaluation subscales). Further, total RFL (and the Coping Beliefs subscale) fully mediated the relation between hopelessness and past‐year suicide attempt, and partially mediated the depressive symptoms‐suicide attempt relation. Conclusions This study demonstrates the importance of assessing for the presence of these suicide risk and protective factors. Implications for the improved identification and treatment of young adults at risk for suicide are discussed.
    June 24, 2013   doi: 10.1002/jclp.22005   open full text
  • Premenstrual Disorders and Rumination.
    Julia R. Craner, Sandra T. Sigmon, Amber A. Martinson, Morgan L. McGillicuddy.
    Journal of Clinical Psychology. June 24, 2013
    Objectives Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) involve emotional, behavioral, and physical symptoms; however, there is little understanding of psychological factors that contribute to these disorders. It was hypothesized that rumination, a form of depressive self‐focused attention, is related to premenstrual distress. Method Study 1 involved women (N = 735) meeting criteria for No/Mild PMS, Moderate/Severe PMS, and PMDD using retrospective self‐report. Study 2 involved women (N = 85) meeting diagnostic criteria for PMS or PMDD (i.e., PMD group) and healthy controls (i.e., No PMD group) following 60‐day symptom monitoring. Participants in both studies completed questionnaires of rumination, anxiety sensitivity, and coping styles. Results Rumination was strongly related to premenstrual disorders using both retrospective and prospective reports, as well as both categorical and continuous approaches to classification of premenstrual distress. Conclusions Rumination, a transdiagnostic factor in psychopathology, may contribute to the onset and maintenance of premenstrual distress.
    June 24, 2013   doi: 10.1002/jclp.22007   open full text
  • Comparing the Interpersonal Behavior of Distressed Couples With and Without Depression.
    Lynne M. Knobloch‐Fedders, Leanne K. Knobloch, C. Emily Durbin, Andrea Rosen, Kenneth L. Critchfield.
    Journal of Clinical Psychology. June 21, 2013
    Objective This study compared the interpersonal behavior of distressed couples with depression in one partner (n = 23) to distressed couples without depression in either partner (n = 38). Method Participants (mean age = 44 years old) were recruited at an urban outpatient mental health center. Couples discussed the three best things in their relationship, and their interactions were coded using Structural Analysis of Social Behavior (Benjamin, 1987). Results Self‐ and partner‐focused hostility were associated with actors’ and partners’ relationship distress. Actors’ hostility towards partners was positively associated with partners’ depression status, but negatively associated with partners’ depression symptoms. Actors’ control behavior was positively associated with their relationship distress. Whereas the behavior of depressed individuals did not differ from a control sample of nondepressed individuals, partners of depressed individuals displayed more partner‐focused hostility and submissiveness than controls. Conclusions Results underscore the importance of considering partner effects when conceptualizing depression within distressed relationships.
    June 21, 2013   doi: 10.1002/jclp.21998   open full text
  • The Metacognitions About Desire Thinking Questionnaire: Development and Psychometric Properties.
    Gabriele Caselli, Marcantonio M. Spada.
    Journal of Clinical Psychology. June 21, 2013
    Objectives Recent research has suggested that specific metacognitions may play a role in the activation and escalation of desire thinking and craving. The goal of this research project was to develop the first self‐report instrument of metacognitions about desire thinking. Method We conducted three studies with nonclinical samples (N = 213, N = 279, N = 60) to construct the Metacognitions about Desire Thinking Questionnaire (MDTQ) and test its structure and psychometric properties. A fourth study was added to test the predictive validity of MDTQ in a sample of alcohol abusers (N = 75). Results Explorative and confirmatory factor analysis supported a 3‐factor solution: positive metacognitions about desire thinking, negative metacognitions about desire thinking, and need to control desire related thoughts. Internal consistency, divergent validity, temporal stability were also examined in a community sample and predictive validity was confirmed even in a sample of alcohol abusers. Conclusions The MDTQ was shown to possess good psychometric properties, as well as divergent and predictive validity within the populations that were tested.
    June 21, 2013   doi: 10.1002/jclp.21999   open full text
  • Is There a Family Profile of Addictive Behaviors? Family Functioning in Anorexia Nervosa and Drug Dependence Disorder.
    Karyn Doba, Jean‐Louis Nandrino, Vicent Dodin, Pascal Antoine.
    Journal of Clinical Psychology. June 21, 2013
    Objectives The objective of the study was to determine whether family profiles differ between patients with anorexia nervosa or drug dependence disorder. Method 25 families of patients with anorexia nervosa and 26 families of patients with drug dependence disorder responded to a battery of self‐reports (Interpersonal Dependence Inventory, Family Adaptability and Cohesion Evaluation Scales, and Family Questionnaire). Results A lack of social self‐confidence was observed in patients with anorexia nervosa or drug dependence disorder and their parents. Family disturbances characterized by low cohesion and emotional reliance on another person were observed in the families of patients with anorexia nervosa or drug dependence disorder. Conclusions The present study suggests that there are differing levels of severity of family disturbances among fathers, mothers, and patients in both anorexia nervosa and drug dependence disorder.
    June 21, 2013   doi: 10.1002/jclp.21977   open full text
  • “Love Hurts”: Romantic Attachment and Depressive Symptoms in Pregnant Adolescent and Young Adult Couples.
    Alethea Desrosiers, Heather Sipsma, Tamora Callands, Nathan Hansen, Anna Divney, Urania Magriples, Trace Kershaw.
    Journal of Clinical Psychology. June 21, 2013
    Objective The current study investigates the relationship between romantic attachment style and depressive symptoms between both members of pregnant adolescent and young adult couples. Method Participants were 296 pregnant young females (mean age = 18.7) and their male partners (mean age = 21.3; 592 total participants) who were recruited from obstetrics and gynecology clinics in Connecticut. The dimensions of avoidant and anxious romantic attachment were assessed using the Experiences in Close Relationships Inventory. Depressive symptoms were measured using the Center for Epidemiological Studies‐Depression Scale. Results Results showed that avoidant attachment and anxious attachment were significantly positively related to depressive symptoms. Multilevel modeling for partner effects revealed that anxious attachment and depressive symptoms in partners were significantly positively associated with depressive symptoms Conclusion Findings underscore the importance of considering couples‐based approaches to supporting the transition to parenthood and developing the necessary self and relationship skills to manage attachment needs and relationship challenges.
    June 21, 2013   doi: 10.1002/jclp.21979   open full text
  • Investigating the Five Facet Mindfulness Questionnaire (FFMQ): Construction of a Short Form and Evidence of a Two‐Factor Higher Order Structure of Mindfulness.
    Ulrich S. Tran, Tobias M. Glück, Ingo W. Nader.
    Journal of Clinical Psychology. June 19, 2013
    Objectives Past research of the Five Facet Mindfulness Questionnaire (FFMQ) lacks clear results regarding its factorial validity, item fitting, mindfulness in the general population, and on the higher order structure of mindfulness. We derived an alternative two‐factor higher order structure for the FFMQ, delineating the attentional and experiential aspects of mindfulness. Method Data of 640 persons from the Austrian community were used for primary analyses, and data of 333 Austrian students were used for cross‐validation. Confirmatory analyses and exploratory structural equation modeling (ESEM) were utilized to investigate psychometric and structural properties. Associations with related variables and indicators of mental health were examined. Results Confirmatory models fitted only poorly on the full 39‐item FFMQ. Fit was acceptable in an abridged 20‐item version in both samples. The Nonreact scale had only weak psychometric properties. ESEM analyses suggested a good fit of two higher order factors and revealed structural differences between the samples. Beneficial effects of mindfulness appeared to be uniquely associated with the experiential aspects of mindfulness. Strategies of emotion regulation showed differential associations with the two higher order factors in the two samples. Conclusions Our findings are relevant both with regard to conceptual issues on mindfulness and the assessment of mindfulness with the FFMQ. Replications in meditating samples and in patients are needed.
    June 19, 2013   doi: 10.1002/jclp.21996   open full text
  • Symptoms of Attention‐Deficit/Hyperactivity Disorder (ADHD) Moderate Suicidal Behaviors in College Students With Depressed Mood.
    Connor H. G. Patros, Kristen L. Hudec, R. Matt Alderson, Lisa J. Kasper, Collin Davidson, LaRicka R. Wingate.
    Journal of Clinical Psychology. June 17, 2013
    Objective College students with attention‐deficit/hyperactivity disorder‐related hyperactive/impulsive (HI) and/or inattentive (IA) symptoms may be at greater risk for suicidal behavior due to core and secondary symptoms that increase their potential to engage in behaviors that put them at risk for suicidal behavior. Consequently, the current study examined the moderating effect of combined HI/IA symptoms, in addition to independent HI and IA symptoms on the relationship between depressed mood and suicidal thoughts and behavior. Method A sample of 1,056 undergraduate students (61.5% female, 96.4% aged 18–24 years) provided self‐report ratings of mood, suicidal behavior (thoughts, self‐harm, attempts, and need for medical attention), and current HI/IA symptoms. Results Significant moderation effects were detected, such that greater HI/IA symptoms were associated with a stronger relationship between depressed mood and suicidal ideation and attempts, but not self‐harm. Current HI and IA symptoms significantly moderated the relationship between depressed mood and suicidal thoughts and suicide attempts, but did not moderate the relationship between depressed mood and self‐harm and need for medical attention. Conclusions The current findings suggest that the presence of combined HI/IA symptoms conveys increased suicide risk for depressed college students. Additionally, results suggest a complex relationship between independent HI and IA symptoms and severe suicidal outcomes.
    June 17, 2013   doi: 10.1002/jclp.21994   open full text
  • Factor Structure of the CES‐D and Measurement Invariance Across Gender in Mainland Chinese Adolescents.
    Mengcheng Wang, Cherie Armour, Yan Wu, Fen Ren, Xiongzhao Zhu, Shuqiao Yao.
    Journal of Clinical Psychology. June 17, 2013
    Objectives The primary aim was to examine the depressive symptom structure of Mainland China adolescents using the Center for Epidemiologic Studies Depression Scale (CES–D). Design Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were simultaneously conducted to determine the structure of the CES‐D in a large scale, representative adolescent samples recruited from Mainland China. Multigroup CFA (N = 5059, 48% boys, mean = 16.55±1.06) was utilized to test the factorial invariance of the depressive symptom structure, which was generated by EFA and confirmed by CFA across gender. Results The CES‐D can be interpreted in terms of 3 symptom dimensions. Additionally, factorial invariance of the new proposed model across gender was supported at all assuming different degrees of invariance. Conclusion Mainland Chinese adolescents have specific depressive symptom structure, which is consistent across gender.
    June 17, 2013   doi: 10.1002/jclp.21978   open full text
  • The Role of Therapeutic Alliance in Mindfulness Interventions: Therapeutic alliance in Mindfulness Training for Smokers.
    Simon B. Goldberg, James M. Davis, William T. Hoyt.
    Journal of Clinical Psychology. June 17, 2013
    Objective Mindfulness‐based interventions have enjoyed a marked increase in support within biomedical and psychological research and practice in the past two decades. Despite the widespread application of these treatments for a range of psychological and medical conditions, there remains a lack of consensus regarding mechanisms through which these interventions effect change. One plausible yet underexplored mechanism is the therapeutic alliance between participants and mindfulness instructors. Methods In this report, data are presented on therapeutic alliance from the mindfulness arm (n = 37) of a randomized controlled trial of a mindfulness‐based smoking cessation treatment. Results Results suggest that client‐reported therapeutic alliance measured midtreatment did not significantly predict primary smoking outcomes. Alliance did predict improvement in posttreatment scores on several outcome variables linked to mindfulness practice, including emotion regulation (β = −.24, p = .042), mindfulness (β = .33, p = .007), negative affect (β = −.33, p = .040), as well as treatment compliance (β = .39, p = .011). Conclusion Implications of these relationships and the possible role of therapeutic alliance in mindfulness treatments are explored.
    June 17, 2013   doi: 10.1002/jclp.21973   open full text
  • A Qualitative Description of Female Veterans’ Deployment‐Related Experiences and Potential Suicide Risk Factors.
    Peter M. Gutierrez, Lisa A. Brenner, Jeffrey A. Rings, Maria D. Devore, Patricia J. Kelly, Pamela J. Staves, Caroline M. Kelly, Mark S. Kaplan.
    Journal of Clinical Psychology. June 17, 2013
    Objective A qualitative study among female Veterans from recent conflicts was conducted to explore the women's experiences and potential suicide risk factors according to the Interpersonal Psychological Theory of Suicide, including burdensomeness, failed belongingness, and acquired ability. Methods The presented paper is an extension of published work by Brenner et al. (2008) regarding mostly male combat Veterans. The methodology employed was qualitative descriptive with hermeneutic hues (Sandelowski, 2000). Interviews were conducted with 19 women, aged 24–52 years, all of whom had been deployed to combat zones in Iraq and/or Afghanistan. Results Transcripts were reviewed and themes emerged regarding women being a minority within their environment and deployment‐related stressors. These experiences seemed to influence participants’ views of the world and ways of coping. Conclusions Among the interviewed female Veterans, preliminary support was provided for Joiner's concepts. Therapeutic strategies for applying themes to clinical practice (e.g., peer support, family therapy, interventions aimed at increasing distress tolerance) are provided.
    June 17, 2013   doi: 10.1002/jclp.21997   open full text
  • Online Counseling: A Narrative and Critical Review of the Literature.
    Derek Richards, Noemi Viganó.
    Journal of Clinical Psychology. April 29, 2013
    Objective This article aimed to critically review the literature on online counseling. Method Database and hand‐searches were made using search terms and eligibility criteria, yielding a total of 123 studies. Results The review begins with what characterizes online counseling. Outcome and process research in online counseling is reviewed. Features and cyberbehaviors of online counseling such as anonymity and disinhibition, convenience, time‐delay, the loss of social signaling, and writing behavior in cyberspace are discussed. Ethical behavior, professional training, client suitability, and clients’ and therapists’ attitudes and experiences of online counseling are reviewed. Conclusion A growing body of knowledge to date is positive in showing that online counseling can have a similar impact and is capable of replicating the facilitative conditions as face‐to‐face encounters. A need remains for stronger empirical evidence to establish efficacy and effectiveness and to understand better the unique mediating and facilitative variables.
    April 29, 2013   doi: 10.1002/jclp.21974   open full text
  • Coping Strategies Predictive of Adverse Outcomes among Community Adults.
    Erin L. Woodhead, Ruth C. Cronkite, Rudolf H. Moos, Christine Timko.
    Journal of Clinical Psychology. April 29, 2013
    Objectives To examine associations between coping strategies at baseline and adverse outcomes 13 years later, and whether gender and age moderated these associations. Method Participants (N = 651) completed a survey on demographic characteristics, coping strategies, and psychosocial outcomes (negative life events, alcohol consumption, drinking problems, and suicidal ideation). Results At the follow‐up (N = 521), more use of avoidance coping was associated with more drinking problems and suicidal ideation at follow‐up. Men high in avoidance coping reported more alcohol consumption and suicidal ideation at follow‐up than did men low on avoidance coping. Younger adults high in avoidance coping reported more negative life events at follow‐up than did younger adults low on avoidance coping. Conclusions Reliance on avoidance coping may be especially problematic among men and younger adults.
    April 29, 2013   doi: 10.1002/jclp.21924   open full text
  • Efficacy of a Cognitive‐Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD.
    Skye Ochsner Margolies, Bruce Rybarczyk, Scott R. Vrana, David J. Leszczyszyn, John Lynch.
    Journal of Clinical Psychology. April 29, 2013
    Objective Sleep disturbances are a core and salient feature of posttraumatic stress disorder (PTSD). Pilot studies have indicated that combined cognitive‐behavioral therapy for insomnia (CBT‐I) and imagery rehearsal therapy (IRT) for nightmares improves sleep as well as PTSD symptoms. Method The present study randomized 40 combat veterans (mean age 37.7 years; 90% male and 60% African American) who served in Afghanistan and/or Iraq (Operation Enduring Freedom [OEF] / Operation Iraqi Freedom [OIF]) to 4 sessions of CBT‐I with adjunctive IRT or a waitlist control group. Two thirds of participants had nightmares at least once per week and received the optional IRT module. Results At posttreatment, veterans who participated in CBT‐I/IRT reported improved subjectively and objectively measured sleep, a reduction in PTSD symptom severity and PTSD‐related nighttime symptoms, and a reduction in depression and distressed mood compared to the waitlist control group. Conclusion The findings from this first controlled study with OEF/OIF veterans suggest that CBT‐I combined with adjunctive IRT may hold promise for reducing both insomnia and PTSD symptoms. Given the fact that only half of the patients with nightmares fully implemented the brief IRT protocol, future studies should determine if this supplement adds differential efficacy to CBT‐I alone.
    April 29, 2013   doi: 10.1002/jclp.21970   open full text
  • Borderline Personality Features and Harmful Dysregulated Behavior: The Mediational Effect of Mindfulness.
    Peggilee Wupperman, Melissa Fickling, David H. Klemanski, Matthias Berking, Jeannie B. Whitman.
    Journal of Clinical Psychology. March 04, 2013
    Objectives The current preliminary study investigated whether deficits in mindfulness (awareness, attentiveness, and acceptance of the present experience) may underlie the relationship of borderline personality disorder (BPD) features to self‐injury and overall acts of harmful dysregulated behavior. Method Nonparametric bootstrapping procedures were used to examine theoretical relationships among variables in a psychiatric sample of adults (N = 70). Participants were asked to imagine themselves in distress‐inducing situations and then write what they would actually do to decrease distress in such situations. Results As hypothesized, mindfulness statistically mediated the relationship of BPD features to reported acts of (a) self‐injury and (b) overall harmful dysregulated behaviors. Conclusions Difficulties in the ability to be aware, attentive, and accepting of ongoing experience may play a role in the relationship of BPD features to harmful dysregulated behaviors. Future research should clarify potential reciprocal effects between BPD features and mindfulness with prospective, multioccasion designs.
    March 04, 2013   doi: 10.1002/jclp.21969   open full text
  • Changes in Early Maladaptive Schemas After Residential Treatment for Substance Use.
    Ryan C. Shorey, Gregory L. Stuart, Scott Anderson, David R. Strong.
    Journal of Clinical Psychology. February 04, 2013
    Objectives Early maladaptive schemas are cognitive and behavioral patterns that cause considerable distress and are theorized to underlie mental health problems. Research suggests that early maladaptive schemas may underlie substance abuse and that the intensity of early maladaptive schemas may decrease after brief periods of abstinence. The current study examined changes in early maladaptive schemas after a 4‐week residential substance use treatment program. Method Preexisting records of a sample of male alcohol‐ and opioid‐dependent treatment seeking adults (N = 97; mean age = 42.55) were reviewed for the current study. Results Pre‐post analyses demonstrated that 8 of the early maladaptive schemas significantly decreased by the end of the 4‐week treatment. Conclusions Findings indicate that early maladaptive schemas can be modified during brief substance use treatment and may be an important component of substance use intervention programs. Implications of these findings for substance use treatment are discussed.
    February 04, 2013   doi: 10.1002/jclp.21968   open full text
  • Youth Psychotherapy Change Trajectories and Early Warning System Accuracy in a Managed Care Setting.
    Philip L. Nelson, Jared S. Warren, Robert L. Gleave, Gary M. Burlingame.
    Journal of Clinical Psychology. February 04, 2013
    Objectives To examine change trajectories in routine outpatient mental health services for children and adolescents in a managed care setting, and to use these trajectories to test the accuracy of two variations of an early warning system designed to identify cases at risk for deterioration. Method Multilevel modeling procedures were used to examine longitudinal Youth Outcome Questionnaire (YOQ) data for 16,091 youth aged 4‐17 years (39% female, mean age 10.5) referred for treatment in a managed care system. Results Clients with more frequent YOQ administrations had slightly lower baselines and faster rates of change. Both the traditional and simplified versions of the early warning system demonstrated good accuracy in identifying clients who deteriorated, with a sensitivity of .63, specificity of .83, and hit rate of .81. Conclusions Results provide further evidence that patient‐focused early warning systems can accurately identify most youth who are at risk for negative outcomes in routine mental health services.
    February 04, 2013   doi: 10.1002/jclp.21963   open full text
  • Evidence of a Pronounced Preference for Therapy Guided by Common Factors.
    Lawton K. Swan, Martin Heesacker.
    Journal of Clinical Psychology. February 04, 2013
    Objective Recent evidence presented in this journal (Swift & Callahan, 2010) suggests that psychotherapy clients may place more value on nonspecific common factors—such as a warm and relatable therapist—than on the level of empirical support for a particular intervention. The present study investigated the possibility that this trend would also extend to those who have never received professional psychological help. Method Three hundred and twenty‐nine adults from across the United States (60.2% female, mean age = 35.92) each rated their attitudes toward seeking two varieties of psychotherapy: one emphasizing nonspecific common factors, and one emphasizing specific evidence‐based therapy ingredients. Results Analyses revealed a pronounced preference for therapy guided by common factors among clients and nonclients alike, even when controlling for a host of individual difference variables. Conclusions These data conceptually replicate Swift and Callahan's findings and indicate that potential clients may seek help more readily from providers who accentuate the nonspecific aspects of therapy.
    February 04, 2013   doi: 10.1002/jclp.21967   open full text
  • The More the Merrier? Working Towards Multidisciplinary Management of Obstructive Sleep Apnea and Comorbid Insomnia.
    Jason C. Ong, M. Isabel Crisostomo.
    Journal of Clinical Psychology. February 04, 2013
    Objectives The goal of this article was to provide an overview of the diagnostic considerations, clinical features, pathophysiology, and treatment approaches for patients with obstructive sleep apnea (OSA) and comorbid insomnia. Method We begin with a review of the literature on OSA and comorbid insomnia. We then present a multidisciplinary approach using pulmonary and behavioral sleep medicine treatments. Results OSA and insomnia co‐occur at a high rate and such patients have distinct clinical features. Empirically supported treatments are available for OSA and insomnia independently but there are no standards or guidelines for how to implement these treatments for patients who suffer from both disorders. Conclusions Multidisciplinary treatment holds promise for patients with comorbid sleep disorders. Further research should be aimed at optimizing treatments and developing standards of practice for this population.
    February 04, 2013   doi: 10.1002/jclp.21958   open full text
  • Emotional Cascades and Self‐Injury: Investigating Instability of Rumination and Negative Emotion.
    Edward A. Selby, Joe Franklin, Amanda Carson‐Wong, Shireen L. Rizvi.
    Journal of Clinical Psychology. February 04, 2013
    Objective Nonsuicidal self‐injury (NSSI) is a public health concern and risk factor for suicide. The Emotional Cascade Model (ECM) proposes that NSSI partially functions as a distraction from cascades of negative affect and rumination. The purpose of this study was to examine the roles of trait rumination, and momentary instability of rumination and negative emotion, in NSSI. Method Experience sampling methods were used to monitor thoughts, emotions, and behaviors in 47 individuals reporting dysregulated behaviors including NSSI. Instability indices were generated for rumination and negative emotion using the momentary assessments. Results Twenty‐five episodes of NSSI were reported during monitoring. Trait rumination prospectively predicted NSSI episodes, and the instability indices interacted to predict NSSI. Conclusions Consistent with the ECM, the interaction between rumination instability and negative affect instability during monitoring significantly predicted NSSI, with the strongest effects occurring for sadness and rumination about past. These findings may enhance conceptualization and treatment of patients with NSSI.
    February 04, 2013   doi: 10.1002/jclp.21966   open full text
  • Priming of Courageous Behavior: Contrast Effects in Spider Fearful Women.
    Jesse R. Cougle, Kirsten A. Hawkins.
    Journal of Clinical Psychology. January 24, 2013
    Objective Recently, researchers have called for therapeutic applications of behavioral primes (Shalev & Bargh, 2011). We evaluated whether courageous approach behavior might be facilitated through priming in a sample of spider fearful women. Method Undergraduate student women reporting elevated spider fear (N = 33, Age mean = 18.88) were recruited for this study. Participants completed self‐report measures of spider fear and dispositional courage. They then completed either a courage or neutral word search prime, which was followed by a behavioral approach task involving a tarantula. Results Consistent with predictions, among those reporting lower dispositional courage, the courage prime led to reduced approach behavior relative to the neutral prime. However, no group differences were found among those high in dispositional courage. Conclusions These findings point to the importance of self‐perceptions in moderating the effects of behavioral primes and suggest limitations to the use of such interventions with individuals with psychological dysfunction.
    January 24, 2013   doi: 10.1002/jclp.21961   open full text
  • The Future of Cognitive Behavioral Therapy for Insomnia: What Important Research Remains to Be Done?
    Michael V. Vitiello, Susan M. McCurry, Bruce D. Rybarczyk.
    Journal of Clinical Psychology. January 24, 2013
    The efficacy of cognitive‐behavioral therapy for insomnia (CBT‐I) to improve both short‐ and long‐term outcomes in both uncomplicated and comorbid insomnia patients has been repeatedly and conclusively demonstrated. Further demonstrations of efficacy, per se, in additional comorbid insomnia populations are likely not the best use of limited energy and resources. Rather, we propose that future CBT‐I research would be better focused on three key areas: (a) increasing treatment efficacy, particularly for more clinically relevant outcomes; (b) increasing treatment effectiveness and potential for translation into the community, with a particular focus on variants of CBT‐I and alternative delivery modalities within primary healthcare systems; and (c) increasing CBT‐I practitioner training and dissemina‐tion.
    January 24, 2013   doi: 10.1002/jclp.21948   open full text
  • The Discrepancy between Subjective and Objective Measures of Sleep in Older Adults Receiving CBT for Comorbid Insomnia.
    Hannah G. Lund, Bruce D. Rybarczyk, Paul B. Perrin, David Leszczyszyn, Edward Stepanski.
    Journal of Clinical Psychology. December 20, 2012
    Objective To examine the effect of cognitive‐behavioral therapy for insomnia (CBT‐I) on the underreporting of sleep relative to objective measurement, a common occurrence among individuals with insomnia. Method Pre‐treatment and post‐treatment self‐report measures of sleep were compared with those obtained from home‐based polysomnography (PSG) in 60 adults (mean age = 69.17; 42 women) with comorbid insomnia. The self‐report data were published previously in a randomized controlled trial demonstrating the efficacy of CBT‐I compared with a placebo treatment. Results Self‐report measures significantly underestimated sleep at pre‐treatment and CBT‐I led to a correction in this discrepancy. There were no significant changes in PSG after CBT‐I. Path analysis showed that an increase in an objective proxy measure of sleep quality (i.e., decreased stage N1 sleep) after CBT‐I was significantly related to improvements in self‐report of sleep, with full mediation by reductions in discrepancy. Conclusions This is the first CBT‐I outcome study to analyze discrepancy changes and demonstrate that these changes account for a significant portion of self‐report outcome. In addition, improved sleep quality as measured by a decrease in percentage of stage N1 sleep following treatment may be one mechanism that explains why sleep estimation is more accurate following CBT‐I.
    December 20, 2012   doi: 10.1002/jclp.21938   open full text
  • Effectiveness of Abbreviated CBT for Insomnia in Psychiatric Outpatients: Sleep and Depression Outcomes.
    J. Nile Wagley, Bruce Rybarczyk, William T. Nay, Steven Danish, Hannah G. Lund.
    Journal of Clinical Psychology. October 26, 2012
    ObjectiveTo test the efficacy of cogntive‐behavioral therapy for insomnia (CBT‐I) as a supplement treatment for psychiatric outpatients. Comorbid insomnia is prevalent among individuals with varied psychiatric disorders and evidence indicates that CBT‐I may be effective for reducing insomnia and other psychiatric symptoms. Method The present study randomly assigned 30 psychiatric outpatients (mean duration of treatment = 3.6 years) with low sleep quality and residual depressive symptoms to two sessions of CBT‐I or a treatment as usual control group. Assessment included the Pittsburgh Sleep Quality Index (PSQI) for insomnia and the Patient Health Questionnaire (PHQ‐9) for depression at pretreatment and 4 and 8 weeks posttreatment. Results Patients who received CBT‐I demonstrated within group changes in PSQI and the PHQ‐9 scores at both 4 and 8 weeks posttreatment, but did not show between‐group differences. Additionally, 38% of the treatment participants achieved normal sleep at follow‐up compared with none in the control condition. Conclusions This study provides preliminary evidence that abbreviated behavioral treatment has beneficial effects on residual insomnia and depression in long‐term psychiatric outpatients.
    October 26, 2012   doi: 10.1002/jclp.21927   open full text
  • Sleep Quality as a Potential Mediator Between Psychological Distress and Diabetes Quality of Life in Veterans With Type 2 Diabetes.
    Antonia V. Seligowski, Anica P. Pless Kaiser, Barbara L. Niles, DeAnna L. Mori, Lynda A. King, Daniel W. King.
    Journal of Clinical Psychology. May 25, 2012
    Objective The goal of this study was to explore sleep quality as a potential mediator between depression symptoms and diabetes quality of life (DQOL), and anxiety symptoms and DQOL. Method Participants were 83 male and 3 female veterans with type 2 diabetes (Mage = 62.4). Self‐report measures were completed during the baseline assessment of a larger intervention study conducted at the VA Boston Healthcare System. Results Depression symptoms, anxiety symptoms, and sleep quality were all associated with DQOL. Additionally, sleep quality had a partial indirect effect on the relationships between depression symptoms and DQOL, and between anxiety symptoms and DQOL. Conclusions These findings suggest that sleep quality may have an important role in the way that psychological distress affects diabetes quality of life. © 2012 Wiley Periodicals, Inc. J. Clin. Psychol. 00:1‐11, 2012.
    May 25, 2012   doi: 10.1002/jclp.21866   open full text
  • Acculturation and Well‐Being Among College Students From Immigrant Families.
    Seth J. Schwartz, Alan S. Waterman, Adriana J. Umaña-Taylor, Richard M. Lee, Su Yeong Kim, Alexander T. Vazsonyi, Que-Lam Huynh, Susan Krauss Whitbourne, Irene J. K. Park, Monika Hudson, Byron L. Zamboanga, Melina M. Bersamin, Michelle K. Williams.
    Journal of Clinical Psychology. April 30, 2012
    ObjectiveThe present study was designed to ascertain the associations between acculturation and well‐being in first‐generation and second‐generation immigrant college students. Acculturation was operationalized as a multidimensional construct comprised of heritage and American cultural practices, values (individualism and collectivism), and identifications, and well‐being was operationalized in terms of subjective, psychological, and eudaimonic components.MethodParticipants were 2,774 first‐generation and second‐generation immigrant students (70% women), from 6 ethnic groups and from 30 colleges and universities around the United States. Participants completed measures of heritage and American cultural practices, values, and identifications, as well as of subjective, psychological, and eudaimonic well‐being.ResultsFindings indicated that individualistic values were positively related to psychological and eudaimonic well‐being, and positively, although somewhat less strongly, linked with subjective well‐being. American and heritage identifications were both modestly related to psychological and eudaimonic well‐being. These findings were consistent across gender, immigrant generation (first versus second), and ethnicity.ConclusionsPsychological and eudaimonic well‐being appear to be inherently individualistic conceptions of happiness, and endorsement of individualistic values appears linked with these forms of well‐being. Attachments to a cultural group—the United States, one's country of origin, or both—appear to promote psychological and eudaimonic well‐being as well. The present findings suggest that similar strategies can be used to promote well‐being for both male and female students, for students from various ethnic backgrounds, and for both first‐generation and second‐generation immigrant students. © 2012 Wiley Periodicals, Inc. J. Clin. Psychol. 00:1–21, 2012.
    April 30, 2012   doi: 10.1002/jclp21847   open full text