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Childhood depression is a widespread disorder, with Latina girls experiencing higher rates of depression. Cognitive-Behavioral therapy is an empirically supported intervention for the treatment of depression. Group processes occurring during therapy, such as group cohesion, have been proposed as mechanisms through which positive change occurs, though their effectiveness have only begun to be explored. The proposed study will examine the effects of group cohesion in the context of a group CBT treatment on changes in depressive symptoms in biethnic youth. Specifically, this study will analyze self-reports of group cohesion and pre- and post-treatment depression scores of 8- to 14-year old Latina and European-American girls undergoing a CBT treatment for depression. It is hoped that this study will lead to an increased discernment in cultural sensitivity with regards to the delivery of interventions for the treatment of depression. / text

The time of cancer diagnosis and treatment may be marked by an increase in stressors, which may be associated with poorer psychosocial and physical adaptation and increased sleep difficulty. Prior work has shown that psychosocial interventions that teach stress management skills can improve indicators of psychosocial and physical adaptation in women with breast cancer, mostly in cancer survivors who have completed treatment. The extant literature does not examine the effects of stress management on sleep, or the role that sleep plays in mediating psychosocial and physical adaptation outcomes, among women in the midst of treatment for non-metastatic breast cancer (BCa). Two hundred forty (240) women, recruited post-surgery from oncology practices, were randomly assigned to a 10-week group-based cognitive behavioral stress management intervention (CBSM; n = 120) or 1-day psychoeducation (PE) control (n = 120). The intervention consisted of didactics, CBSM techniques, and relaxation exercises, but did not specifically target sleep or sleep quality (SQ). Women assigned to the PE condition attended a one-day group seminar where they learned some of the material covered in the CBSM intervention, without the therapeutic group environment, role play techniques, and home practice. Participants completed self-report questionnaires at baseline, and at 6- and 12-month follow-ups. After controlling for days since surgery, participants in the CBSM group reported improved SQ, as well as increased positive states of mind, decreased disruption in social recreational functioning, and reduced fatigue-related daytime dysfunction for up to 8 - 12 months after baseline. There were marginally significant improvements in functional well-being and social functioning. CBSM was not associated with improvements in fatigue intensity. Improvements in SQ mediated CBSM-associated improvements in positive states of mind, social disruption, and fatigue-related daytime dysfunction. Thus, the CBSM intervention had beneficial effects on several indicators of functional adaptation that were in part explained by improvements in the quality of sleep. Future work should test the combined effects of stress management and sleep management interventions for women initiating treatment for BCa.

Prior work has provided support that women with breast cancer are hyper-responsive to stressful challenges and that Cognitive-Behavioral Stress Management (CBSM) interventions can lead to reductions in cortisol, a measure of physiological stress. It may follow that breast cancer patients would show decreases in cortisol levels if they are taught stress management techniques. The purpose of this study was to investigate post-intervention psychosocial processes (i.e., participants' perceptions of achieved specific skills targeted by CBSM and non-specific changes associated with the group experience) that may explain intervention-related changes in cortisol among a sample of women as they moved through medical treatment for non-metastatic breast cancer. It was hypothesized that (a) women receiving a 10-week, group-based stress management intervention during ongoing medical treatment for breast cancer would show reductions in late afternoon serum cortisol levels and (b) perceived ability to implement stress management skills or other experiences gained in the supportive group environment may explain changes in cortisol. Participants (N = 128) were women recruited 4-8 weeks post-surgery for non-metastatic breast cancer. Women were randomly assigned to receive either the 10-week CBSM intervention (N = 63) or a one-day psychoeducational seminar (n = 65). The intervention aimed to teach relaxation, cognitive restructuring, and interpersonal skills. Participants were assessed at study entry, 6 month follow-up (i.e., 3 months post-intervention) and 12 month follow-up (i.e., 6 months post-intervention). Latent Growth Curve Modeling (LGM) was used to test for differential effects of study condition on change over time in cortisol and the effects of specific and non-specific group processes on change in cortisol. Results indicated there was a significant effect of study condition on change over time in cortisol, relaxation skills, and assertiveness skills. There were not significant relationships between changes in cortisol and any of the components analyzed and mediation was not established using LGM. There was, however, a significant association between changes in an item that assessed cognitive restructuring and cortisol. Exploratory analyses of lagged (Time 2 controlling for Time 1) psychosocial processes mediating (Time 3 controlling for Time 2) cortisol changes were then conducted. Results indicated that condition's effect on cortisol approached significance and condition had a significant effect on the muscle relaxation component and cognitive restructuring item. Furthermore, there was evidence that intervention-related changes in confidence about using muscle relaxation and cognitive restructuring may help explain decreases in cortisol levels among this sample of women. Overall, this study demonstrated that a 10-week, CBSM intervention was associated with decreased cortisol levels and increased relaxation and assertiveness skills. Furthermore, there was a strong relationship between changes in cognitive restructuring and cortisol. Future research should investigate how changes in cortisol may be related to health behaviors and health outcomes among breast cancer patients.

Childhood depression is a widespread, stable disorder, and recurring disorder (Kovacs, Feinberg, Crouse-Novak, Paulauskas, & Finkelstein, 1984). Cognitive-Behavioral therapy is an empirically supported intervention for the treatment of depression (Weersing & Weisz, 2002; Weisz, McCarty, & Valeri, 2006). CBT for depression is often comprised of cognitive, behavioral, problem-solving, and relational interventions (McCarty & Weisz, 2007). While it is evident that CBT as a whole is efficacious, there exists a dearth of knowledge concerning the specific components within CBT, which contribute to symptom reduction in youth (Kazdin & Weisz, 1998; Kennard et al., 2009). Therefore, the manner in which CBT accomplishes change is not well understood (Shirk & Karver, 2006). Specifically, while cognitive theories assert that interventions targeted at modifying negative cognitions reduce depression (Beck, 1967), few studies, particularly with regards to depressed youth, have addressed this (Stice, Rohde, Seeley, & Gau, 2010). As such, this hypothesis concerning the role of depressogenic cognitions as mediators between certain CBT interventions and symptom reduction remains unsubstantiated (Weersing, Rozenman, & Gonzales, 2009). The current study assessed whether higher levels of cognitive, behavioral, problem solving, and relational components were associated with lower levels of post-treatment depression, as well as whether they were mediated through changes in the cognitive triad, a measure of depressogenic thinking. No studies have assessed the effectiveness of discrete interventions incorporated in CBT treatments for depression in youth, further examining whether noted changes in depression are mediated through cognitions, specifically the cognitive triad. Participants included 40 depressed females, aged 9 to 14, assessed using self-report measures and a diagnostic interview for depression, who engaged in treatment using a manualized group CBT treatment protocol. Results from hierarchical linear models indicated that higher participant cognitive triad scores and higher relational interventions were associated with lower post-treatment depression scores. However, subsequent analyses revealed that higher aggregated behavioral-problem-solving interventions scores were associated with lower post-treatment depression scores, while higher aggregated cognitive-relational intervention scores were associated with higher post-treatment depression scores. Implications, limitations, and recommendations for further areas of research are discussed. / text

Depression in youth is a serious mental health concern affecting many different domains of functioning. Currently, cognitive behavioral therapy (CBT) is the most extensively studied psychosocial treatment for depression; however, there is limited research on how the specific components of CBT function to produce effective treatment outcomes. In addition to identifying the components responsible for effective treatment outcome, it is also important to investigate the changes in youth with depression that account for the reduction of symptomatology. Problem-solving is one of the effective CBT strategies used to improve depressive symptoms. The purpose of the current study was to investigate the association between problem-solving interventions and depression. The current study also sought to investigate if depressive symptoms are mediated through changes in the view of the future. Participants were 40 girls, aged 9 to 14, who completed a manualized CBT protocol for depression in a group format. Participants completed a diagnostic interview for depression and self-report measures assessing the view of the future dimension of the cognitive triad. Group therapy sessions were coded for problem-solving interventions using an investigator developed coding system. The results indicated that the level of problem-solving intervention implemented by the therapist failed to predict a decrease in depressive symptoms, after controlling for the girls’ initial levels of depression severity. Level of problem-solving intervention was significantly related to positive future views on the cognitive triad, after controlling for initial levels of the future subscale on the cognitive triad. Results also indicated that participants with a more positive view of their future were less depressed at post-treatment. Treatment specificity could not be conducted because the relation between problem-solving interventions and treatment outcome was not significant. An exploratory analysis was conducted with additional control variables. After controlling for mastery of problem-solving skills, level of expectancies for change, and initial level of depression, problem-solving intervention was a significant predictor of treatment outcome. Exploratory analysis also concluded that levels of consequential thinking and levels of brainstorming were related to treatment outcome. Implications, limitations, and recommendations for future research are presented. / text

This study compared the effectiveness of two group treatment procedures in reducing adolescent anxiety in a school setting. The interventions included group cognitive-behavioral treatment, group relaxation training, and study skills (control group). Participants were students in Grades 5-12 who were parent, teacher, or school personnel nominated. The adolescents had to exhibit T scores of > 60 on an anxiety scale of the Youth Self Report for ages 11-18 or Multidimensional Anxiety Scale for Children (MASC), self-report rating scales, a parent rating scale or teacher report form for ages 6-18 of the Child Behavior Checklist (CBCL). Measurements were collected at preintervention, postintervention, and a 6-week follow up for the treatment groups. The control group was assessed at preintervention and postintervention only. The data gathered consisted of an overall student anxiety scale score from the MASC, and anxious/ depressed, anxiety problems, and internalizing problems scale scores from the student, teacher, and parent CBCL rating scales.All three groups exhibited lower scores from preintervention to postintervention on the student self-reported MASC. No differences were found among the groups in the reduction of teacher or parent reported anxiety levels from preintervention to postintervention except on the parent ratings of the CBCL anxious/depressed scale. A statistically significant group by time interaction indicated that the students in the CBT group showed significantly lower posttest scores than the relaxation and study skills groups. The significant interaction of group by time from preintervention to postintervention on the parent CBCL anxious/depressed scale score was expanded to the follow-up measure; however, no significant interaction between group and time was found. The main effect of time was significant and post hoc comparisons of the anxious/depressed scale found that the CBT and relaxation groups were significantly lower at postintervention than at preintervention and significantly lower at follow up than at preintervention. However, the sample was not significantly different from postintervention to follow up.The results were discussed in relation to the research literature on cognitive-behavioral treatment of fears and related anxieties in children and adolescents.

Anxiety and depressive disorders are common conditions for adolescents and are associated with significant impairments in functioning. Cognitive behavior therapy (CBT) is an effective treatment modality for these youth, and the behavioral components of CBT protocols, in particular, are thought to be one of the active mechanisms through which positive symptom changes are produced. However, few procedures are available to measure the behavioral changes taking place in adolescents’ daily lives as they make therapeutic progress. This study examined adolescents’ “behavioral engagement” throughout treatment, a construct defined as time spent in social, athletic and academic activities. Behavioral engagement was measured using the Daily Phone Diary (DPD), a validated measure of daily activities utilized in the child health literature, which employs the principles of Ecological Momentary Assessment (EMA). Twenty-four adolescents reported each activity they engaged in throughout the day, in chronological order, over the past 24 hours. Participants were diverse in their ages, ethnicities, socioeconomic statuses and internalizing disorder diagnoses. Activities were reported during phone calls scheduled before, during, and after treatment using a transdiagnostic formulation of CBT and, for a randomized subset of the sample (N=8), both before and following a Waitlist comparison condition. Results indicated that “behavioral engagement” is a construct that is measurable and that daily phone diaries are an acceptable method of data collection for this population. Based on theoretical and empirical literature, three key categories of activities on the DPD comprised behavioral engagement: 1) Time spent socially engaged with others; 2) Time spent on any physical or athletic activity; and 3) Time doing homework. Results supported good inter-rater reliability and potentially reasonable test-retest reliability; data collection via the DPD was feasible and acceptable in this context. Tests of convergent validity with other measures of anxiety and depressive symptoms suggested that prior to treatment, more time spent in some activity categories was associated with more internalizing symptoms for those with anxiety disorders only, but fewer internalizing symptoms for those with depression as well as anxiety. Tests of convergent validity with other measures of weekly mood were promising. Future studies will explore alternate definitions of behavioral engagement, examine this construct in a larger sample that has completed a full course of CBT, and explore this construct’s potential role as a mediator of clinical improvement.

Behavioral and cognitive-behavioral psychotherapies utilizing exposure are considered the gold standard in anxiety disorder treatments. Despite their success, relapse remains problematic, especially over long-term follow up periods. Basic researchers traditionally conceptualize the mechanism of exposure as Pavlovian extinction, but this may overlook the important role of operant processes in the treatment and relapse of anxiety. Resurgence, in which a previously extinguished behavior returns following the extinction of another behavior that has replaced it, is a promising model of operant relapse. Nonhuman research on resurgence has shown that, while higher rates of alternative reinforcement result in faster and more comprehensive extinction of target behavior, they also result in greater resurgence. This somewhat paradoxical finding could have important implications for clinicians treating anxiety, as higher rates of alternative reinforcement may have the unintended side effect of producing greater relapse of avoidance if access to positive reinforcement later becomes unavailable. The current study took a translational approach to investigating the effects of rich and lean rates of alternative reinforcement on extinction and magnitude of resurgence in typically developing humans using a computerized task. Three groups (Rich, n = 18; Lean, n = 18; Control, n = 10) underwent acquisition of a target response. Target responding was then placed on extinction while varying rates of reinforcement for an alternative behavior were delivered. Resurgence was assessed under extinction conditions for all groups. Results indicated that the rich rate of alternative reinforcement facilitated extinction while the lean rate ultimately had a detrimental effect on extinction. Within groups, Rich and Lean experienced significant resurgence, while Control did not. Effect sizes were large. Between groups, Rich resurged more than Lean and Control. Effect sizes were again large. There was no significant difference in resurgence between Lean and Control. Implications for the treatment of anxiety disorders and future research directions are discussed.

Presentation in J. Cohen's Successful Strategies for Treating Traumatized Children in Challenging Circumstances.