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Background: Cognitive behavioral therapy (CBT) is an effective treatment modality for adolescents suffering from depression. Yet, it is often under-utilized among family nurse practitioners (FNPs) in the primary care setting. Known barriers exist within the realm of providers' lack of use of CBT in the primary setting, however, there is little research specifically on FNPs usage of the modality. Purpose: This paper seeks to understand FNPs' use of CBT in the primary care setting to treat adolescents with depression. Method and Sampling: A qualitative design was used to understand FNPs' use of CBT for adolescents suffering from depression. A faculty member and I recruited FNP participants through email. Ten FNPs currently working in the primary care setting with experience ranging from one to ten years participated in the study. Two focus group interviews were conducted in order to have a deeper understanding of the use of CBT in practice to treat adolescent depression. The interviews were audio taped and analyzed to reveal emerging themes. Results: After analyzing the audio recordings two common themes emerged: Unpreparedness and role conflict. Subthemes emerged within the area of unpreparedness that included knowledge regarding screening for depression in the adolescent population, utilization of clinical practice guidelines, available community resources and referrals, and the application of CBT in the treatment of adolescent depression. The theme of role conflict was associated with time constraints within the allotted time frame per patient and the conflict of providing mental health services when feeling as though their primary training is that of a family practice provider. Conclusion: The findings showed that the lack of use of CBT is multifactorial with knowledge being the greatest inhibiting factor. CBT is a recommended, first-line treatment option within the clinical practice guidelines for the treatment of adolescent depression. However, FNPs are not currently utilizing CBT in their practice to treat adolescent depression. There is much to be learned about adolescent depression in its entirety prior to incorporating CBT into practice.

Authorware is an icon-based multimedia authoring tool which allows the rapid development of complex interactive multimedia projects, particularly courseware and kiosk applications, for both the Macintosh and Microsoft Windows operating systems. This project consists of three main elements: interactive courseware, written in Authorware, which teaches the student basic concepts involved in Authorware programming, and demonstrates the function of each of the icons used to program in Authorware; a tutorial through which students are given the opportunity to use Authorware to incorporate various media elements, including written audio, graphics, video, and text, into their own interactive courseware; and various course materials, including a statement of objectives, study questions, and quiz questions. These materials were developed for use in the Virginia Tech Computer Science course CS4984 (Multimedia, Hypertext, and Information Access) as part of the unit on System and Application Construction. / Master of Science

Clinical psychological science has developed efficacious treatments for trauma-related disorders in youth. However, randomized trials investigating these treatments have disproportionally been conducted by American, university-based research labs. Dissemination and implementation of trauma-focused treatment in broader global and lower-resourced settings are needed. The current presentation describes efforts to adapt trauma-focused CBT (TF-CBT) for successful deployment in Puerto Rico after undergoing multiple natural disasters (Hurricanes Irma and Maria, and earthquakes) and a global pandemic. Presentation in J. Cohen's Successful Strategies for Treating Traumatized Children in Challenging Circumstances.

Conceptualizing mental health difficulties among a pediatric oncology population from a traumatic stress perspective is gaining speed. Research has shown support for the development of posttraumatic stress reactions among chronically ill children and their family members. Despite this evidence, the majority of intervention studies have not incorporated key trauma-informed intervention components that have proven to be effective in symptom reduction for trauma-exposed children. Examining key aspects of both the child trauma and pediatric psychology fields have enabled researchers to meld their strengths into one comprehensive approach. This revised perspective has clinical implications for the development of prevention and intervention techniques that are more likely to yield superior outcomes. Yet, an evidence-based, trauma-informed intervention for youth has not yet been empirically examined among a pediatric oncology population. Thus, the purpose of this study was to examine the efficacy of TF-CBT intervention program for children/adolescents diagnosed with cancer and their parents. Methods: This was a prospective longitudinal study that utilized a single-subject, non-concurrent multiple baseline design to assess the efficacy of TF-CBT intervention. A sample of five youth (ages 9 to 15) and seven parents enrolled in the study; three youth and five parents completed their participation in the study. Manualized treatment consisted of six sessions lasting approximately two hours per session (including child and parent) that targeted psychoeducation, relaxation training, affective identification and expression skills, cognitive processes, coping strategies, trauma processing, and family processes. Examined constructs, including posttraumatic stress symptomatology, depression, quality of life, parenting stress, coping utilization, coping efficacy, somatization, internalizing, and externalizing symptoms, were assessed by child self-report, parent report, and parent self-report at enrollment (baseline), post-treatment, and one-, and three-month follow-up. Results: Simulation Modeling Analysis (SMA) revealed a statistically significant reduction, from baseline to intervention, for one parent's PTSS (R = -0.711, p = .027) and another parent's PTSS reduction approached significance (R = -0.747, p = .055). Comparatively, no significant reduction was found for child PTSS. One child showed a significant improvement in coping efficacy (R = 0.619, p = .048) as a function of the intervention, and an additional two child participants approached significance (R = 0.618, p = .055; R = 0.689, p = .094). Visual inspection of the data did reveal noteworthy reductions for some study participants in both domain specific (i.e., PTSS) and broader psychological outcomes (e.g., quality of life, somatization, internalizing and externalizing symptoms, etc.). Conclusions: These results provide some support for a trauma-informed CBT intervention for pediatric oncology patients in remission and their parents. / Ph. D.

College students with Autism Spectrum Disorder (ASD), though academically capable, can have serious difficulty adapting to the college environment. There is a growing need for the identification and development of efficacious interventions and supports for these young adults. The present study sought to address this need by adapting and piloting a group-based cognitive-behavioral intervention program, Problem-Solving Skills: 101 (PSS:101), to promote problem solving ability in college students with ASD. Primary aims of the study were to adapt a well-established problem solving treatment for college students with ASD into a treatment manual, and to collect data on the feasibility of PSS:101. An exploratory aim was to collect preliminary data on the short-term efficacy of this intervention. Five students with ASD from a public, technology and engineering focused university participated in this nine-week, group-based program. Therapists met all treatment integrity objectives across sessions. Four of the five participants completed at least 8 of the 9 sessions and assigned between-session assignments were generally completed (83% completion rate), indicating a high level of treatment adherence. Independent evaluators' ratings of participant engagement, therapeutic relationship, and group process were relatively high. Preliminary efficacy data suggested mixed results across participants. Further evaluation of the program appears warranted. / Ph. D.

Introduction: With increasing longevity the population of the world is becoming older and there are growing numbers of people over the age of 65 years. This has implications for services providing psychological treatment to older people as there is likely to be an increasing demand for evidenced-based treatments such as Cognitive Behaviour Therapy (CBT) in the coming years. There are, however, relatively few clinical psychologists specialising in working with older people and therefore additional ways of dealing with the growing demands are essential. Computerised Cognitive Behaviour Therapy (CCBT) offers one potential option and NICE recommends Beating the Blues (BTB) as the most clinically and cost-effective package for treating depression. However, no study to date has explored the use of BTB with older people. Objective: The objective of the study was to address this gap in the literature and had the following aims: 1) to explore the uptake rate of BTB with older people; 2) to explore the characteristics of older people opting to receive BTB; 3) to explore the drop-out rate from BTB with older people; and 4) to determine if BTB was effective in reducing symptoms of depression and anxiety in older people experiencing these difficulties. The findings were compared to previous research on BTB with younger adults. Methodology: A between-groups, repeated measures design (with assessment time as the repeated measure) was used. Participants were given a free choice of receiving BTB plus treatment as usual (BTB+TAU) or treatment as usual alone (TAU). Treatment as usual was provided by clinicians from older people community mental health teams (e.g. psychiatric nurses) and the only constraint that was placed in this was that no face-to-face psychological therapy from an accredited therapist could be provided. The participants opting to receive BTB also completed eight sessions of BTB on a weekly basis. All participants completed a range of outcome measures prior to commencing treatment (pre), after eight weeks (post) and after a further 4 weeks (one month follow-up). Results & Discussion: The results indicated that 56.9 per cent of the participants opted to receive BTB and they reported having significantly more experience and confidence using a computer than those who declined BTB. It was also found that 72.7 per cent of older people completed all eight sessions of BTB (27.3 per cent discontinuation rate). This was comparable to what has been found in previous studies of BTB with younger adults. A two (treatment group) x three (time) repeated measures ANOVA revealed that, in comparison to the TAU group, the BTB+TAU group showed statistically significant greater improvements on measures of depression and anxiety by the end of treatment. This was maintained at one month follow-up. Furthermore, in comparison to the TAU group the BTB had a higher percentage of participants who met criteria for clinically significant improvement by the end of treatment and at one-month follow-up. The results suggest that BTB is an acceptable and effective treatment for older people experiencing depression and anxiety and the implications of these findings are discussed.

Systematic Review: Chronic pain and insomnia are highly comorbid, and evidence suggests a reciprocal relationship between these. CBT-I has been shown to improve sleep in those with chronic pain, therefore the potential of improved sleep leading to improvements in pain symptoms is a possibility. This led to the question: Does CBT-I improve pain symptoms in those with chronic pain and insomnia? A systematic review of the literature was conducted resulting in eight papers regarding six studies. Evidence was moderate that CBT-I improved sleep and pain related disability, but did not improve self reported pain levels. This discrepancy between improvements in pain related disability and no changes in self-reported pain levels led to the research question for the empirical element of the current thesis. Empirical Element of Thesis Objective: Chronic low back pain (CLBP) is a common form of chronic pain that affects a large population each year. Chronic pain and insomnia are highly comorbid conditions, yet knowledge about how patients perceive their interaction is limited. This qualitative study aims to inform our understanding of the patient experience with particular reference to beliefs and attributions surrounding pain, poor sleep and their interaction. Methods: 11 outpatients from a chronic pain clinic were recruited who suffered CLBP as their main symptom, and who had subsequently developed insomnia as a result. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Qualitative analysis produced five super-ordinate themes: 1) the privacy of pain and solitude of sleep; 2) sleep/pain interaction; 3) night-time thinking; 4) adjustment and acceptance; and 5) self-management. Discussion: The first three themes combine to create the individual experience of CLBP: the visceral, emotional experience; the pre-existing and shifting beliefs; and the thought content. Once this is in place, the individual can reflect on what this means to them, and through acceptance, move through to adjustment. The individual accepts elements of their current experience, but where they see the opportunity to take control, these adjustments are translated into actions relating to self-management. These themes suggest CBT-I should be adapted to include pain specific beliefs to form a CBT for Insomnia and Chronic Pain (‘CBT-CPI’).

Improving treatment for early adolescent girls with depression by understanding factors that promote the maintenance of treatment effects is an important area of research given the association of depression with functional impairment and negative future outcomes. The effectiveness of CBT for treating depressed youth in the short-term has been well-established. However, limited research exists on the impact of CBT beyond one year post-treatment and on factors that enhance treatment maintenance for children and adolescents with depression. An intervention strategy that may yield the maintenance of treatment effects is the inclusion of primary caregivers. However, there is presently insufficient evidence to ascertain whether including primary caregivers in girls’ depression treatment produces additional benefits because they have rarely been incorporated into clinical trials of depression treatment for youth. This approach warrants study since families of depressed youngsters are often characterized by disturbances in family functioning and because aspects of the family environment are related to the development and maintenance of depressive disorders in youth. The current study addressed gaps in the existing literature about the maintenance of treatment effects for girls with depression by examining the impact of a parent training (PT) component added to a school-based, group-administered CBT intervention on girls’ depressive symptoms and key areas of family functioning (i.e., conflict, cohesion, communication, and family sociability). Participants included 9- to 14-year-old girls with a depressive disorder, one primary caregiver for each girl who completed measures, and caregivers in the parental treatment component. Girls were randomly assigned to a CBT, CBT+PT, or minimal contact control condition. Ratings of girls’ depressive symptoms and the family functioning variables were obtained from girls and primary caregivers at pre-treatment, post-treatment, and annually for up to four years following treatment. Results from growth curve modeling using hierarchical linear models indicated no significant differences in rate of change of girls’ depressive symptoms over time depending on whether they were in the CBT or CBT+PT condition. However, subsequent analyses revealed two significant factors associated with treatment maintenance: child attendance at CBT meetings and parental attendance at PT meetings. Specifically, higher rates of child and parental attendance were generally predictive of a sustained decline in girls’ depressive symptoms over time. In addition, findings supported the positive impact of CBT with PT on aspects of the family environment from pre- to post-treatment, but not from post-treatment through the four years of follow-up assessment. Implications, limitations, and recommendations for further areas of research are discussed. / text

Thesis (M.S.)--West Virginia University, 2009. / Title from document title page. Document formatted into pages; contains vi, 107 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 61-64).