Despite the evidence that cognitive behavioural therapy (CBT) is an efficacious treatment for depression (e.g., DeRubeis et al., 2005) and anxiety (e.g., Hofmann & Smits, 2008), there remains considerable variability in its effectiveness. However, researchers have thus far been unable to conclusively identify pre-treatment predictors of therapy outcome. One approach to examining pre-treatment predictors of outcome is to formally assess the suitability of individual patients for CBT using the Suitability for Short-term Cognitive Therapy scale ([SSCT]; Safran, Segal, Shaw, & Vallis, 1990). The present thesis explores suitability for CBT in two longitudinal, prospective treatment outcome studies. In Study 1, there were 256 out-patients with a primary diagnosis of depression or anxiety who were assessed using the SSCT, and rated on pre- and post-treatment symptom severity, using the Clinical Global Impression scale (CGI; Guy, 1976). Results of factor analyzing the SSCT scale revealed two underlying factors: 1) Capacity for Participation in CBT Process and 2) Attitudes Relevant to the CBT Process. A subsequent regression analysis demonstrated that only Capacity for Participation in CBT Process uniquely predicted symptom improvement after CBT. Study 2 examined the association between positive outcome expectancies and avoidance as measured by two SSCT items, optimism for a positive outcome and security operations, respectively. The sample consisted of 51 patients diagnosed with major depressive disorder who, prior to undergoing CBT, were assessed using the SSCT. Patients also completed the Beck Depression Inventory (BDI-II; Beck, Steer & Brown, 1996) before and after treatment. A regression analysis revealed that for patients with lower levels of positive outcome expectancies, lower levels of avoidance predicted greater improvement after CBT, whereas higher levels of avoidance predicted poorer CBT outcomes. Together, the two reported studies in this thesis demonstrate that not only does formal assessment of suitability for CBT furnish information that predicts treatment outcome, but that specific elements of the suitability assessment may be more important than others, and interact with each other to affect outcome. This knowledge can be used to help clinicians make clinical decisions regarding treatment recommendations, and points to ways of enhancing outcomes in CBT. / Malgré les preuves que la thérapie cognitivo-comportementale (TCC) est un traitement efficace pour la dépression (par exemple, DeRubeis et al., 2005) et l'anxiété (par exemple, Hofmann & Smits, 2008), il existe une grande variabilité dans son efficacité. De plus, aucun prédicteur prétraitement de l'efficacité thérapeutique n'a pu être identifié malgré de nombreuses études scientifiques. Une approche possible permettant d'examiner la valeur de prédicteurs pré-traitements sur les résultats thérapeutiques est d'évaluer formellement l'applicabilité de la TCC pour les patients utilisant la suitability for short-term cognitive therapy scale ([SSCT]; Safran, Segal, Shaw, & Vallis, 1990). La thèse actuelle explore l'application de la TCC dans deux études prospectives et longitudinales sur les résultats thérapeutiques. Dans l'étude 1, on comptait 256 patients externes ayant reçu un diagnostic primaire de dépression ou d'anxiété qui ont été évalués en utilisant l'échelle SSCT et cotés, pour la sévérité des symptômes en pré-traitement et en post-traitement, à l'aide de l'échelle d'impression clinique globale (CGI, Guy, 1976). Les résultats des facteurs analysant l'échelle SSCT ont révélé deux facteurs sous-jacents: 1) la capacité de participation au processus de la TCC et 2) des attitudes pertinentes au processus de la TCC. Une analyse de régression subséquente a démontré que seulement la capacité de participation au processus de la TCC prédit uniquement une plus grande amélioration des symptômes après la TCC. L'étude 2 a examiné l'association entre les attentes de résultats positifs et l'évitement tels que mesurés par deux éléments de l'échelle SSCT, l'optimisme d'un résultat positif et les opérations de sécurité, respectivement. L'échantillon était composé de 51 patients diagnostiqués avec un trouble dépressif majeur qui, avant de suivre un traitement par la TCC, ont été évalués en utilisant l'échelle SSCT. Les patients ont également complété l'inventaire de dépression de Beck (IDB-II, Beck, Steer et Brown, 1996), avant et après le traitement. Une analyse de régression a révélé que pour les patients ayant un faible niveau d'attentes de résultats positifs, mais avec de plus bas niveaux d'évitement ont eu une plus grande amélioration après la TCC que ceux qui avaient des niveaux plus élevés d'évitement. Ensemble, les deux études rapportées dans cette thèse démontrent que non seulement l'évaluation formelle de l'applicabilité de le TCC fournit des informations prédisant le résultat du traitement, mais que des éléments spécifiques de l'évaluation de cette applicabilité peuvent être plus importants que d'autres, et interagir les uns avec les autres pour influencer le résultat. Cette connaissance peut être ainsi utilisée pour aider les cliniciens à prendre des décisions cliniques concernant les recommandations de traitement, et indique de possibles façons d'améliorer les résultats de la TCC.

Early theories of the relationship between stress and distress typically assumed that individuals are passive respondents to their contexts; however, more recent models propose that people actively build their environments through their interactions and choices. Hammen (1991) provided early evidence for nonrandom exposure to stress. She found that depressed women reported higher levels of self-generated or dependent events, particularly dependent interpersonal events. Studies have since shown stress generation in adolescents, especially females. Recent research has revealed significant relationships between cognitive and personality vulnerabilities and stress generation. The majority of past research has been with Western samples; it is important, however, to consider generalizability to non-Western cultures. The present thesis examined stress generation in mainland Chinese adolescents and whether previous Western findings would replicate. Also, whether stress generation would be moderated by level of urbanization, given the marked differences between rural, urban and ultra-urban settings. The few studies that have examined stress generation in China are significantly limited due to their reliance on a stress checklist; thus, the present research utilized the gold-standard contextual-threat interview. Study 1 was a cross-sectional investigation of 306 rural and 316 urban adolescents from mainland China. Participants completed self-report measures of dependency, self-criticism, neuroticism, self-perceived competence and current depressive symptoms. Youth then completed a clinical interview for lifetime depression and a contextual-threat interview assessing stressors over the previous 6 months. Logistic regression analyses revealed that the vulnerabilities were associated with dependent events after controlling current and lifetime depression. However, neither gender nor urbanization moderated this relationship. The results of Study 1 provided strong preliminary evidence that Chinese youth also engage in stress generation and that this effect is stronger in those who show pre-existing cognitive and personality vulnerabilities.Study 2 expanded these findings by examining the prospective association between the personality vulnerabilities of dependency and self-criticism, and interpersonal stress generation in a sample of 1116 adolescents, from rural, urban and ultra-urban mainland China. Participants completed self-report measures for dependency, self-criticism, neuroticism, current depressive and anxious symptoms, and completed a clinical interview for lifetime depression. Stressors were evaluated using a contextual-threat interview every six-months for 18-months. Logistic regression analyses showed dependency and self-criticism to be prospectively associated with stress generation after controlling current distress, lifetime depression and trait neuroticism. Girls experienced higher levels of dependent interpersonal events, and dependency predicted interpersonal stress generation in girls only. In addition, urban girls and dependent ultra-urban youth were significantly more likely to report dependent interpersonal events. Ultra-urban youth were more likely to report independent noninterpersonal stressors. Finally, self-critical youth in the mixed urban + rural group, were significantly more likely to report noninterpersonal independent events. Findings from the present thesis provide robust support for stress generation in Chinese adolescents, with enduring vulnerabilities predicting interpersonal stress generation after the effects of lifetime depression, current distress and trait neuroticism. In addition, the results suggest that important differences across gender and differing levels of urbanization may exist. These findings may be particularly important as researchers continue to examine whether Western psychological theories of stress and the etiology of distress can be generalized to non-Western populations. / Les premiers théories de la relation entre le stress et la détresse présupposent que les individus sont passifs face à leurs contextes, tandis que les modèles plus récents proposent qu'ils construisent leur environnement à travers les interactions et choix. Hammen (1991) a démontré cette exposition non-aléatoire au stress. Dans une étude initiale, elle a constaté que les femmes dépressives relataient plus d'évènements auto-générés ou dépendants, particulièrement dans le domaine interpersonnel. La recherche a aussi montré la génération du stress chez les adolescents, surtout les filles. Des études récentes ont révélé une association entre des facteurs de vulnérabilité, et le stress dépendant. La majorité de ces études sont en occident, il est important cependant, de considérer la généralisation de ces théories à des cultures non-occidentales.La présente thèse a examiné la génération du stress chez les jeunes chinois, et si les résultats occidentaux seraient reproduits. Ainsi que la modération par le degré d'urbanisation, compte tenu des différences marquées entre les régions rurales, urbaines et ultra-urbaines. Les rares études existantes en Chine sont limitées due à leur utilisation d'un questionnaire du stress; ainsi, la présente thèse emploi la méthodologie de pointe de "l'entrevue contextuelle-de-menace". L'Étude 1 est une étude transversale avec 306 jeunes ruraux et 316 urbains de la Chine continentale. Les participants ont remplie des questionnaires évaluant la dépendance, l'autocritique, le névrosisme, la compétence et la dépression actuelle. Puis ils ont complété une entrevue clinique mesurant la dépression et une entrevue contextuelle-de-menace sur le stress des 6 mois précédents. La régression logistique a révélé que les vulnérabilités étaient associées à la génération du stress au-delà de la dépression. Toutefois, ni le sexe, ni l'urbanisation ne modéré cette relation. Les résultats de l'Étude 1 constituent de solides preuves préliminaires que les jeunes chinois génèrent aussi du stress. De plus, cet effet est plus robuste chez les jeunes avec des traits de vulnérabilités préexistantes. L'Étude 2 a élargi ces résultats en examinant l'association prospective entre les traits de vulnérabilité de la dépendance et de l'autocritique, et la génération du stress interpersonnel dans 1116 adolescents chinois, de milieu rural, urbain ou ultra-urbain. Les participants ont rempli des questionnaires mesurant la dépendance, l'autocritique, le névrosisme, la détresse actuelle et une entrevue clinique sur la dépression. Le stress a été évaluée avec une entrevue contextuelle-de-menace au six mois pendant 18-mois. La régression logistique a révélé que les vulnérabilités sont prospectivement associées au stress dépendant au-delà de la détresse actuelle, des troubles dépressifs passés et du névrosisme. Les filles démontrent plus de stress interpersonnel dépendant, et la dépendance prédit la génération du stress interpersonnel chez les filles seulement. Par ailleurs, les filles urbaines et les jeunes dépendants de milieu ultra-urbain ont plus de stress interpersonnel dépendant. Les jeunes ultra-urbains démontrent plus de stress noninterpersonal indépendant et enfin, les jeunes du groupe mixte urbain + rural endossant des traits autocritiques, rapportent plus d'évènements indépendants noninterpersonnels. Les résultats de la présente thèse constituent une démonstration solide de l'existence de la génération de stress chez les adolescents chinois, avec des vulnérabilités à la détresse étant associées à la génération du stress interpersonnel, au-delà de la dépression, la détresse actuelle et le névrosisme. De plus, les résultats suggèrent que d'importantes différences entre les sexes et les niveaux d'urbanisation peuvent exister. Ces résultats peuvent s'avérer particulièrement importants tant que les chercheurs continuent d'examiner si les théories psychologiques occidentales peuvent être généralisées aux populations non-occidentales.

<p> The purpose of this study was to analyze the cross-cultural and cross-time measurement invariance of Center for Epidemiological Studies Depression Scale (CES-D). The research data that were collected in 1994-1995 and 1996 respectively were from the National Longitudinal Study of Adolescent Health (Add Health). There were two steps that were used for analyzing the measurement invariance. First, Exploratory Factor Analysis (EFA) was used to analyze the dimension invariance (factor structure) for the Asian American and European American adolescents across two waves. Three-factor model was established for both groups across two waves. Second, Confirmatory Factor Analysis (CFA) was used to check the factor loading and threshold invariance of the items that were dimension invariant. The results showed that the 13-item three-factor CES-D was measurement invariant across the groups and across time. Nevertheless, new sample should be collected in order to implement the new 13 items as a depression screening method across groups.</p>

<p> The field of psychology has traditionally focused on the deleterious effects of adversity to the exclusion of positive effects. However, a literature on positive sequelae of traumatic events has burgeoned over the past decade. The issue of whether individual's reports of positive changes are merely illusory self-enhancing biases or are reflective of objective, quantifiable change is perhaps the most contentious in the posttraumatic growth research at this time. This dissertation begins with a broad overview of the extant research on posttraumatic growth, then presents the evidence supporting each side of the validity debate. As the population studied in this dissertation is adults with traumatic-onset spinal cord injuries, a presentation of research that ties disability to the posttraumatic growth literature follows. Finally, the introductory chapter concludes with an argument for the importance of including a disability perspective in psychological science. Three papers follow, each taking up aspects of this relatively new focus on positive aspects of disability. </p><p> The first paper lays the foundation for the work that follows by exploring the question of whether people with disabilities are, in fact, doing well. Establishing a baseline of subjective well-being would seem necessary before venturing into an exploration of how this happiness may have come to be. In a replication of a classic study, I find that indeed, people with spinal cord injuries report levels of happiness that are equal to both those of controls and lottery winners. In the second study, I use experimental and survey evidence collected over a span of eight-years to explore posttraumatic growth and its relationship to emotion regulation advances. Finally, Paper 3 takes an in-depth look at one of the critical components of posttraumatic growth, a sense of meaning in life, and its relationship to happiness. </p><p> The concluding chapter outlines several limitations of this program of research, and provides directions for research that will carry it forward. Finally, it returns to the validity debate in the posttraumatic growth literature most broadly, making recommendations for future research that will shed light on this issue, and presenting reasons that resolution of this debate is important for academia, clinical practice, and society-at-large.</p>

<p> The homeless are a vulnerable group, and research has consistently shown that the homeless experience higher rates of mental disorders, substance abuse, and physical illness than housed persons. Depressive disorders are particularly common among the homeless and have been reported at 2 to 4 times the rate found among housed individuals. The purpose of this study was to examine the relationship of individual therapy to depressive symptoms among treatment-seeking, homeless men attending a residential substance abuse recovery program in an inner-city mission. The participants were 81 men with a mean age of 39.95 years. The sample was ethnically diverse and had a modal educational level of at least some high school. All of the participants had voluntarily sought individual psychological services as an optional component of their substance abuse program in this archival study. Depressive symptoms were measured with the Beck Depression Inventory, Second Edition (BDI-II). De-identified demographic and background information was obtained from the clinical intake form used in this setting. BDI-IIs were administered at intake and following approximately 6 sessions of individual therapy for all participants. Therapy services were provided by clinical psychology doctoral students, under the supervision of licensed psychologists. The sample obtained a mean BDI-II score at intake of 21.68, indicating moderate severity of symptoms; internal consistency reliability was .935. The mean BDI-II score following approximately 6 therapy sessions was 16.36, indicating mild severity; the BDI-II internal consistency reliability at follow-up assessment was .923. As predicted, BDI-II scores were significantly lower at retest. For the men in this study, participation in individual therapy was associated with significant reduction of depressive symptoms. Participants with prominent mood complaints on the clinic intake evaluation form (n = 38) had significantly higher BDI-II scores at intake assessment than individuals with other primary complaints (n = 43), supporting the validity of the BDI-II as a measure of mood symptoms among homeless men. Other findings, clinical implications, limitations, and suggestions for future research are also explored. The results strongly supported the reliability and validity of the BDI-II as a measure of depressive symptoms and psychological distress among treatment-seeking homeless men.</p>

<p> Researchers have reported increased involvement in reading (Baum and Lynn, 1981) and music-listening (Snodgrass and Lynn, 1989) tasks during hypnosis. We predicted a similar effect for film viewing of greater absorption and involvement in an emotional (<i>The Champ</i>) versus a non-emotional (<i> Scenes of Toronto</i>) film clip. We also examined the effects of hypnosis and film valence on memory and state depersonalization. Our study is the first to use state dissociation to index response to hypnosis. We tested 121 participants who completed measures of absorption and trait dissociation and the Harvard Group Scale of Hypnotic Susceptibility and then viewed the two films (approx. 3min per film) after either an hypnotic induction or a non-hypnotic task (i.e., anagrams). State dissociation was evaluated at four points and recall was evaluated immediately after each film. Absorption and emotional response varied as a function of both hypnotic suggestibility and film valence. Highly hypnotizable participants reported more state depersonalization relative to less hypnotizable participants; however, we observed no significant correlation between hypnotizability and trait dissociation, in keeping with previous research (Kirsch and Lynn, 1998). Contrary to the ASCH, hypnosis failed to improve memory. As predicted, the emotional film was associated with more commission and more omission errors than the non-emotional film.</p>

<p> Childhood sexual abuse (CSA) is a risk factor for the development of depression and posttraumatic stress disorder (PTSD) symptoms, as well as sexual problems. Additionally, previous research supports a relationship between symptoms of depression and PTSD and sexual problems in both sexually abused and non-abused samples. There has been little attempt, however, to explain the mechanisms responsible for this relationship. The current study proposed that abuse-related changes in world views might be one such mechanism and examined whether world view changes mediate longitudinal associations between depression and PTSD symptoms and sexual problems (sexual concerns, dysfunctional sexual behavior, and risky sexual behavior). This study is unique in that it considered the effects of both positive and negative world view changes on this relationship. Over half of youth in the study reported at least one world view change, with the preponderance of changes being negative. Thus, youth appear to be cognizant of ways in which their experiences of CSA have affected their beliefs. No straightforward relationship between early abuse reactions and world views emerged, as neither depression nor PTSD predicted world view changes. Although higher levels of symptomatology and stronger world view changes were related to sexual concerns, they were unrelated to dysfunctional or risky sexual behaviors. The reasons for this differentiation could include the nature of constructs or the measures focus on hyper-sexuality. This study contributes to the extant literature by highlighting the implications of CSA experiences for emerging world views and their associations with emerging sexuality.</p>

<p> Hoarding, the accumulation of a large number of possessions and substantial clutter, is increasingly being recognized as an important public health concern. Emerging consensus suggests that hoarding is an independent phenomenon and it will likely be included as a new diagnosis (Hoarding Disorder) in the forthcoming revision to the <i>DSM.</i> An initial conceptual model of this condition has implicated information processing deficits and emotional distress as key components of hoarding disorder. Although it has shown promise, this model is in need of greater empirical support and verification. The present study reports on an investigation into information processing and affective responses in relation to hoarding. We compared adults meeting criteria for hoarding disorder (<i>N</i>=33) and community controls (<i> N</i>=30) using psychophysiological methodologies based on startle eyeblink responses. Prepulse inhibition of startle (PPI), a measure of sensorimotor gating used in previous studies of schizophrenia and OCD, was used to test for information processing deficits proposed to be involved in hoarding symptoms by the cognitive-behavioral model. Affective valence startle modulation (AVSM) was used to elucidate emotional processing in association with hoarding. We also compared hoarding and control group participants on startle reactivity at baseline and while undergoing a symptom-provocation stressor (discarding task). Contrary to our hypothesis, the hoarding and control group participants demonstrated comparable levels of PPI. There were also no group differences when considering comorbid diagnoses. PPI scores were not related to medication status. AVSM results revealed that both the hoarding and control groups demonstrated a linear pattern of startle modulation to pleasant, neutral and unpleasant stimuli respectively. The hoarding group demonstrated larger general startle reactivity compared to the control group, both at baseline and following the discarding task. We did not find group differences in PPI, indicating that hoarding disorder is not related to sensorimotor gating deficits. The hoarding and control groups had similar affective modulation of startle, but the hoarding group demonstrated higher general startle reactivity. Enhanced general startle suggests that hoarding disorder is characterized by enhanced defensive responding, as is noted in other anxiety disorders such as PTSD and GAD.</p>

<p> This qualitative study explored and analyzed the narrative experiences of senior psychotherapists and their capacity to tolerate and make meaning of uncertainty in their clinical work. While research on therapist development tends to agree that the maturation of the clinician is an ongoing process (Bruss &amp; Kopala, 1993; Eckler-Hart, 1987; Gold, 2005; Guinee 1998; Kaslow &amp; Rice, 1985; Lamb, Baker, Jennings &amp; Yarris, 1982; Solway, 1985; Suran &amp; Sheridan, 1985), little research has been conducted that documents this process from the perspective of the senior analyst. In addition, despite widespread acknowledgment of uncertainty as an ever-present phenomenon among clinicians, there have been few studies that address how a relationship to uncertainty unfolds. In other words, how does one move from a primary position of insecure self-doubt into an openness and tolerance for analytic uncertainty? This study employed a theoretical framework to help organize the inquiry and data analysis. Using Ogden's (1986) interpretation of Klein's (1946/1994) paranoid-schizoid/depressive model, the experiential constructs of analytic uncertainty and insecure self-doubt were explored in the form of an ongoing dialectic. Semistructured interviews were conducted among eight San Francisco Bay Area psychoanalytically oriented psychologists and data were analyzed through open coding. The results yielded a total of 11 core themes and 9 subthemes, distributed among 3 principle sections: Integration of Uncertainty, Early Encounters With Uncertainty and Self-Doubt, and Abstract Analysis: An Ongoing Dialectic. Key findings from the present study include (a) uncertainty is core to analytic work and is what allows for creative discovery; (b) despite its value, uncertainty is difficult to bear; (c) early encounters with clinical uncertainty often lead to feelings of self-doubt; (d) self-doubt, when experienced as a personal failing, has a tendency toward shutting therapists down; (e) therapists' experiences of self-doubt and uncertainty remain in an ongoing dialectic; and (f) faith is the impetus behind tolerance for uncertainty and it enables productive use of self-doubt.</p>

<p> Negative affect can be a highly potent trigger for relapse among those in recovery for alcoholism, whereas self-efficacy has been identified as an important factor for relapse prevention. Much research has attempted to identify factors and interventions that can enhance self-efficacy and improve the coping ability of those in recovery to manage negative affect. This study sought to determine whether dispositional mindfulness might be a useful tool in this regard, by investigating for a possible relationship between this variable and self-efficacy towards coping with negative affect. Additional variables (i.e., length of time abstinent, meditation frequency/duration, history of polysubstance abuse/dependence, and history of psychiatric co-morbidity) were also examined for possible relationships with these two constructs. Adult participants (<i>N</i> = 104) with a history of alcohol abuse/dependence were recruited via online support groups and websites that adhere to the principles of Alcoholics Anonymous (AA), to take an anonymous online survey consisting of: a demographic questionnaire, the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), and the Alcohol Abstinence Self-Efficacy Scale (AASE). Chi-square analyses, and independent samples t tests and one-way ANOVAs, were conducted to provide information regarding possible meaningful relationships between variables and differences between groups within variables. Results of this study lend some support for the assertion that those with higher levels of dispositional mindfulness may also have greater self-efficacy towards successfully managing negative affect. Findings also reveal some evidence for a positive relationship between length of time abstinent, and both mindfulness and self-efficacy. Caution should be taken, however, when drawing conclusions from these findings due to the disproportionate number of participants who reported doing extremely well in their recovery and having high confidence in their ability to abstain from alcohol use. Limitations of the study are discussed.</p>