Mental health disorders are a leading cause of disability and mortality worldwide. Mental health services do not meet demand due to accessibility issues, financial burden, and increasing needs. Technology can provide affordable, accessible mental health care and some research suggests internet-delivered Cognitive Behavior Therapy (iCBT) may be an effective treatment. In iCBTs, participants typically complete Cognitive Behavior Therapy modules and videos and are supported by a therapist. Advantages of iCBT over face-to-face therapy include lower cost, no travel time, easy access, no waitlists, and trackable progress. To our knowledge there have been no naturalistic studies of iCBT programs. Therefore, this study will evaluate the usage and effectiveness of one iCBT program, SilverCloud, in a university counseling center. Participants (N=5568) were students at a large, private western university. Participants were either self-referred to the program, chose to enroll at intake as a standalone intervention, or were referred by their treating clinician as an adjunct to regular treatment. We compared the outcomes and usage of participants using SilverCloud concurrently with psychotherapy to participants using SilverCloud alone, and participants in psychotherapy alone.

Homework assignments that patient work with between sessions is a key component in both face-to-face and Internet-based Cognitive Behavior Therapy (CBT). However, adherence to assignments is often low and it is largely unclear what factors predict or affect treatment adherence, and in the end, treatment outcomes. The overall aim of this thesis was to investigate if treatment presentation and therapist support can affect adherence and treatment outcome in internet-based CBT, whether adherence can be predicted by motivation variables and to compare differences in face-to-face and online conditions in this regard. A randomized controlled trial with a brief online relaxation program for people with stress and anxiety symptoms was conducted (n = 162). Participants in the enhanced support conditions completed a larger proportion of the online treatment but adherence was not affected by enhanced treatment presentation (Study I). Participants reported reduced symptoms of stress and anxiety after the relaxation program but there were no significant additional effects of enhanced presentation or support (Study II). Participants who adhered to the prescribed assignments reported lower symptom levels at study end, regardless of treatment conditions. Adherence to the online treatment was predicted by subject factors such as treatment credibility prior to the treatment and intrinsic motivation during the treatment (Study III). To further elucidate how motivation may affect adherence, an experiment with a one-session psychotherapy model was subsequently conducted (n = 100). Participants who were randomized to the face-to-face condition reported higher motivation for the assignment and completed significantly more of the homework compared to participants in the online condition (Study IV). Self-reported intrinsic motivation could predict adherence in both conditions while new motivational variables were identified specifically for the online condition. The results from these studies confirm that adherence to assignments in Internet-based CBT is difficult to affect with treatment features but can be predicted early in treatment by subject factors such as treatment credibility and motivation. How such motivational variables can be affected to improve treatments is still unclear.

Depression, anxiety, and stress are responsible for an overwhelming number of mental health care visits, and cognitive behavior therapy (CBT) is the most common empirically supported treatment for these conditions. Yet little is known about the effectiveness of CBT with African Americans, Latinos, Asian Americans, and Native Americans — ethnic and racial groups conprising nearly half of the U.S. population. In this volume, Chang, Downey, Hirsch, and Yu show therapists how to adapt cognitive behavioral treatments for use with racial and ethnic minority clients. Contributors demonstrate how a client's particular sociocultural background contextualizes his or her experience and understanding of mental health issues. They examine the influence of sociocultural context on experiences of social anxiety among Asian-Americans, the role of racial identity in the way stress and anxiety are experienced by African American clients, and much more. / https://dc.etsu.edu/etsu_books/1214/thumbnail.jpg

<p>The aim of this study was to evaluate if a population suffering from generalized anxiety disorder could benefit from an Internet based self-help treatment guided via email contact with a therapist. The treatment was based on established cognitive behavioral principles. It was hypothesized that significant improvements would be found as measured by eight self report questionnaires, absence of a clinical diagnoses and global clinical improvement. A total of 89 participants were included and 44 were randomized to a treatment condition and 45 were assigned to a waitlist control. The controls received similar treatment after the first post treatment assessment, conducted eight weeks after the beginning or treatment of the first group. The results showed statistically significant improvements for the treatment group. No changes were observed in the waiting-list control group, with the exception of a minor decrease in depression scores. Large effect sizes were found both within the treatment group and between the two groups in favor of the treatment. In conclusion, Internet treatment can be an efficacious format for treating generalized anxiety disorder.</p>

The aim of this study was to evaluate if a population suffering from generalized anxiety disorder could benefit from an Internet based self-help treatment guided via email contact with a therapist. The treatment was based on established cognitive behavioral principles. It was hypothesized that significant improvements would be found as measured by eight self report questionnaires, absence of a clinical diagnoses and global clinical improvement. A total of 89 participants were included and 44 were randomized to a treatment condition and 45 were assigned to a waitlist control. The controls received similar treatment after the first post treatment assessment, conducted eight weeks after the beginning or treatment of the first group. The results showed statistically significant improvements for the treatment group. No changes were observed in the waiting-list control group, with the exception of a minor decrease in depression scores. Large effect sizes were found both within the treatment group and between the two groups in favor of the treatment. In conclusion, Internet treatment can be an efficacious format for treating generalized anxiety disorder.

Abstract: Binge eating disorder (BED) is the most common eating disorder, affecting approximately 2% of men and 3.5% of women. BED has a complex etiology that includes both physical and psychological co-morbidities. Up to 50% of overweight and obese people seeking weight loss treatment have BED. Treatment includes pharmacological therapy and psychotherapy with the main goals of reducing binge frequency and weight reduction. Three categories of medications have been identified for the pharmacological treatment of BED: antidepressants, centrally acting appetite suppressants, and anticonvulsants Behavioral weight loss (BWL) includes modest weight reduction typically by reducing fat intake, eating regular meals and snacks and increasing weekly exercise. Interpersonal psychotherapy, Cognitive behavioral therapy and dialectical behavior therapy are the most successful forms for psychotherapy used to treat BED. In conclusion, BED etiology is multifaceted and successful treatment must address the complexities of the disorder. / text

Phobic and anxiety disorders are one of the most common, if not the most common and debilitating psychopathological conditions found among children and adolescents. As a result, a treatment research literature has accumulated showing the efficacy of cognitive behavioral treatment (CBT) for reducing anxiety disorders in youth. This dissertation study compared a CBT with parent and child (i.e., PCBT) and child group CBT (i.e., GCBT). These two treatment approaches were compared due to the recognition that a child’s context has an effect on the development, course, and outcome of childhood psychopathology and functional status. The specific aims of this dissertation were to examine treatment specificity and mediation effects of parent and peer contextual variables. The sample consisted of 183 youth and their mothers. Research questions were analyzed using analysis of variance for treatment outcome, and structural equation modeling, accounting for clustering effects, for treatment specificity and mediation effects. Results indicated that both PCBT and GCBT produced positive treatment outcomes across all indices of change (i.e., clinically significant improvement, anxiety symptom reduction) and across all informants (i.e., youths and parents) with no significant differences between treatment conditions. Results also showed partial treatment specific effects of positive peer relationships in GCBT. PCBT also showed partial treatment specific effects of parental psychological control. Mediation effects were only observed in GCBT; positive peer interactions mediated treatment response. The results support the use CBT with parents and peers for treating childhood anxiety. The findings’ implications are further discussed in terms of the need to conduct further meditational treatment outcome designs in order to continue to advance theory and research in child and anxiety treatment.

Despite a considerable progress in developing and testing psychosocial treatments to reduce youth anxiety disorders, much remains to learn about the relation between anxiety symptom reduction and change in youth functional impairment. The specific aims of this dissertation thus were to examine: (1) the relation between different levels of anxiety and youth functional impairment ratings; (2) incremental validity of the Children Global Assessment Scale (CGAS); (3) the mediating role of anxiety symptom reduction on youth functional impairment ratings; (4) the directionality of change between anxiety symptom reduction and youth functional impairment; (5) the moderating effects of youth age, sex, and ethnicity on the mediated relation between youth anxiety symptom reduction and change in functional impairment; and (6) an agreement (or lack thereof) between youths and their parents in their views of change in youth functional impairment vis-à-vis anxiety symptom reduction. The results were analyzed using archival data set acquired from 183 youths and their mothers. Research questions were tested using SPSS and structural equation modeling techniques in Mplus. The results supported the efficacy of psychosocial treatments to reduce the severity of youth anxiety symptoms and its associated functional impairment. Moreover, the results revealed that at posttreatment, youths who scored either low or medium on anxiety levels scored significantly lower on impairment, than youths who scored high on anxiety levels. Incremental validity of the CGAS was also revealed across all assessment points and informants in my sample. In addition, the results indicated the mediating role of anxiety symptom reduction with respect to change in youth functional impairment at posttest, regardless of the youth’s age, sex, and ethnicity. No significant findings were observed with regard to the bidirectionality and an informant disagreement vis-à-vis the relation between anxiety symptom reduction and change in functional impairment. The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed. The emphasis is on the need to enhance existing evidence-based treatments and develop innovative treatment models that will not only reduce youth’s symptoms (such anxiety) but also evoke genuine and palpable improvements in lives of youths and their families.

This study investigated efficacy of an online, preventive intervention program, Children of Divorce-Coping with Divorce (CoD-CoD; Boring, 2011). It extends previous findings to a sample of eight youth from high-conflict families who recently initiated legal divorce proceedings. CoD-CoD is a cognitive-behavioral intervention that targets coping efficacy, coping strategies, and divorce-related cognitive appraisals. A multiple-baseline single case experimental design evaluated change in daily use of active and avoidant coping strategies and corresponding coping efficacy ratings. Individual patterns of change were inspected for the program’s putative mediator variables and overall mental health functioning. Results indicate that daily coping efficacy ratings increased for four participants and decreased for the three participants who reported the highest levels of exposure to interparental conflict. The majority of participants increased use of at least one type of active coping strategy and half decreased use of at least one type of avoidant coping strategy. There were no observed patterns of systematic change in divorce-related cognitive appraisals and changes in mental health functioning were mixed. An exploratory analysis found that youth were classified as "high-risk" on a psychometrically-sound risk index in 100% of cases with documentation of two or more conflict-indicative legal events in the family court file. The study findings are consistent with previous evidence of a moderated program effect on coping efficacy, although positive effects on youth-reported mental health functioning were not replicated. Findings are discussed within the context of a high-conflict sample with temporal proximity to the legal divorce and in light of study limitations. Research directions toward effectively connecting at-risk youth with evidence-based prevention services are detailed.

Research has shown that positive emotions are important to optimal health, functioning, and well-being, and contribute to resilience against psychological dysfunction. However, many clinical disorders, particularly anxiety and mood disorders, are associated with deficits in positive emotion that may contribute to symptoms and inhibit full recovery. Despite accumulating data identifying disturbances in positive emotion and positive emotion regulation in anxiety and depressive disorders, these deficits have received insufficient attention in treatment. The present study represents a preliminary evaluation of the feasibility and utility of a novel augmentation intervention for enhancing positive emotion in anxiety and depressive disorders. Nine patients with a range of principal anxiety disorders who had previously completed an initial course of cognitive-behavioral treatment at the Center for Anxiety and Related Disorders at Boston University (CARD) completed the study. The study utilized a single case experimental design, specifically a multiple baseline across participants design, with participants randomized to 2-, 4-, or 6-week baseline periods to control for the effect of time on outcome variables. Primary outcome variables were assessed weekly during the baseline and intervention phases to permit analysis of functional relationships between individual factors, specific treatment components, and therapeutic outcomes. Major assessments were conducted at baseline, pre-, post-treatment, and a 3-month follow-up. These included both self-report and independent evaluator-rated components. Results indicated that the intervention was effective in improving positive emotion regulation skills for 5 of the 9 of participants. The intervention was associated with significant improvements in anxiety and depressive symptoms, and preliminary effects sizes for pre- to follow-up changes in positive emotion regulation, symptoms, positive and negative emotion, functioning, quality of life, and well-being were moderate to large. Participants reported high acceptability and satisfaction with the study intervention. Qualitative feedback from participants highlighted several areas for improvement in the format and delivery of the intervention, such as increasing the number of sessions and providing a patient workbook, and these changes may increase the effectiveness of the intervention. Future research is needed to confirm the validity of these findings and evaluate the generalizability of these effects across patients and settings.