Objective: Resistance is a therapeutic process variable that can play an important role in treatment. The present study examined whether observer-rated parental resistance during parent-only sessions of cognitive-behavioral therapy (CBT) for anxious youth predicted the number of parent-reported between-session exposures completed, posttreatment outcome, and 36-week follow-up. Method: Participants (N = 272) were parents or adult caregivers of youth (age 7 to 17 years old) who received CBT for an anxiety disorder as participants in the Child/Adolescent Anxiety Multimodal study (CAMS). Parent-only therapy sessions were rated for resistance by observers. Measures of anxiety and overall symptom severity were completed at posttreatment and 36-week follow-up. Mediation analyses examined the indirect effect of the number of parent-reported exposures completed on the relationship between parent in-session resistance and therapy outcomes at posttreatment and 36-week follow-up. Additionally, resistance levels in participants in the CBT-only condition of CAMS were compared with resistance levels for participants in the CBT plus sertraline condition. Results: Analyses demonstrated that there was no significant difference in mean resistance scores between the CBT-only group and the CBT plus sertraline group. None of the 12 mediation tests found statistically significant indirect effects of the number of parent-reported exposures completed on the relationship between parent in-session resistance and therapy outcomes at posttreatment and 36-week follow-up. A significant relationship was found, however, between number of exposures completed and posttreatment Pediatric Anxiety Rating Scale (PARS) total scores, indicating a significant relationship between number of parent-reported exposures and posttreatment therapy outcomes. Conclusions: Parental resistance is not associated with outcomes for youth receiving CBT for anxiety. Number of exposures was significantly associated with one measure of posttreatment therapy outcomes. / Psychology

Establishing evidence-based training for therapists is of paramount importance for effective dissemination of evidence-based interventions. Using cognitive-behavioral therapy (CBT) for child anxiety, this study compared three therapist training conditions: (1) routine training: a workshop that covered a specific manual, (2) computer training: computer-based training via an interactive DVD, and (3) augmented training: a workshop that included a focus on core CBT competencies and active learning with behavioral rehearsal. Training success was operationalized as: (1) adherence to CBT for child anxiety, (2) therapeutic skillfulness, (3) a knowledge test, (4) and training satisfaction. The study also investigated the degree to which consultation following training impacted therapist outcomes. Participants (115 therapists) were randomly assigned to training condition and, following training, were invited to participate in weekly consultation. The results indicate that all three training conditions were effective in improving therapist adherence, skill, and knowledge. Participants were most satisfied with the in-person conditions. With regard to consultation, the number of consultation hours attended significantly predicted therapist training outcomes. This finding underscores the importance of consultation when training therapists. / Psychology

Objective: Therapeutic processes that occur within session have been identified as a factor that may influence youth anxiety outcomes. The present study examined the relationships between positive and negative youth involvement, therapist therapeutic and nontherapeutic behaviors, and anxiety outcomes. Method: Sixty youth (aged 7-17) received cognitive-behavioral therapy for an anxiety disorder. Weekly session videos were rated by observers. Measures of anxiety severity were completed weekly and at posttreatment. Regression analyses examined the association between therapeutic processes and post-treatment outcomes. Univariate and bivariate latent difference score (LDS) models evaluated whether changes in one factor were prospectively associated with later changes in the same factor and in other factors. Results: Positive youth involvement significantly predicted reduced anxiety severity, greater improvement, and remission of principal anxiety disorder at posttreatment. Youth negative involvement during psychoeducation sessions predicted a reduced likelihood of remission. Therapist therapeutic behaviors during psychoeducation sessions predicted lower anxiety severity, greater improvement, and treatment response. Nontherapeutic behaviors in psychoeducation sessions were associated with increased anxiety severity, less improvement, and a reduced likelihood of treatment response and remission of principal anxiety disorder. When entered simultaneously, only nontherapeutic behaviors were significantly associated with increased anxiety severity. LDS models resulted in poor model fit, thus, the temporal sequence among involvement, therapist behaviors, and anxiety severity was not established. Conclusions: Youth involvement and therapist behaviors are associated with beneficial outcomes. Therapist nontherapeutic behaviors are strongly associated with poorer outcomes. Findings are discussed in relation to previous findings and future directions are proposed. / Psychology

Parental accommodation refers to the ways in which a parent modifies his/her behavior to avoid or reduce the distress their child experiences. Parental accommodation of youth anxiety is common, and reduction in accommodation is associated with reduced anxiety after treatment. The current study evaluated the efficacy of an adapted cognitive-behavioral therapy program (CBT) designed to address parental accommodation (Accommodation Reduction Intervention; ARI). Sixty children and adolescents (age 7-17) and their parents were evaluated for youth anxiety and parental accommodation before and after 16 weeks of treatment. Thirty youth received ARI and 30 received Coping Cat (CC). Both youth anxiety and parental accommodation were significantly reduced from pre to posttreatment in youth who received ARI as well as those who received CC. No significant difference was found between the two treatment conditions on any measure of anxiety or accommodation. Findings indicate that an adapted CBT that focuses on parent accommodation (ARI) produced favorable outcomes comparable to Coping Cat. Clinical implications and future directions are discussed. / Psychology

Clinicians are increasingly incorporating cognitive behavioral therapy (CBT)-based approaches into fluency treatment for children and adolescents who stutter. However, minimal research examines the efficacy of such programs. The present study assesses the efficacy of a CBT-based, intensive, five-day summer camp that promotes self-acceptance and aims to improve the quality of life of adolescents who stutter. Specifically, this study examines whether the camp is effective in reducing state and trait anxiety, decreasing the negative impact of stuttering on daily life, and increasing fluency. A single-subject design on a 14-year old, male adolescent who stutters, LM, and personal interview data with LM’s mother, MM, are utilized. Post-treatment, LM’s scores reflect improvements in self-efficacy surrounding communication situations, as measured by the Self-Efficacy for Adolescents Scale (SEA-Scale), and improvements in overall speaking-related quality of life, as measured by the Overall Assessment of the Speaker’s Experience of Stuttering – Teen (OASES-T). These improvements were maintained at one and three months follow-up. Nonetheless, a large degree of variation in percent syllables stuttered (%SS) and LM’s consistently low rates of state and trait anxiety, as measured by the State-Trait Anxiety Inventory for Children (STAIC), suggest that additional study is warranted before conclusions can be drawn about the efficacy of the summer camp program on reducing stuttering severity and anxiety. / Communication Sciences

Previous research has suggested that depressive disorders are common in youth and are associated with many negative outcomes. As a result, understanding how to treat depression effectively is very important. It is unclear; however, what factors predict treatment success or failure for depressed youth. Researchers are starting to investigate whether comorbid anxiety is a possible moderator of treatment outcome for youth with depression. Studies of the relation between comorbid anxiety and treatment outcome have produced mixed findings and have almost exclusively focused on older depressed adolescents. There is also limited research exploring whether parent intervention moderates the effect of comorbid anxiety on treatment outcome in depressed youth. This study focused on investigating the relation between comorbid anxiety and treatment outcome in a sample of 84 depressed female early adolescents who received either group cognitive behavioral therapy (CBT) or group CBT plus a parent intervention. The addition of parent intervention was explored as a moderator of the relation between anxiety and treatment outcome. Treatment outcome was measured by changes in depression severity and global functioning during treatment. The depression severity and global functioning scores of depressed girls with comorbid anxiety were also compared to depressed girls without comorbid anxiety prior to treatment to determine whether the first group of girls entered treatment with a different level of psychopathology. Participants and their primary caregivers were administered a semi-structured diagnostic interview which was used as a measure of depression severity, global functioning, anxiety severity, and to determine whether participants met diagnostic criteria for depressive and anxiety diagnoses. The results of this study suggested that depressed youth with comorbid anxiety or higher anxiety severity started out treatment with higher depression severity and lower functioning. Results also suggested that comorbid anxiety was not related to negative treatment outcome and that youth with comorbid anxiety actually experienced larger reductions in depression severity over the course of treatment than youth without comorbid anxiety. Parent intervention did not significantly moderate the effect of comorbid anxiety on treatment outcome. The study’s limitations, implications of the results, and recommendations for future research were discussed. / text

Trigeminal neuralgia is a painful neuralgia with a complicated pathology that is not clearly understood. Due to the ambiguity of the condition, patients often have to search for medical providers that specialize in trigeminal neuralgia, and even with the guidance of a specialist, some patients do not respond well to treatment.1 Despite the uncertainty surrounding the specifics of the disease, there are treatments available that can provide some level of pain relief for patients suffering from this disorder. When a patient does not respond well to medical therapy, surgery can be the next appropriate step in patient care management.2 However, while surgery can provide significant pain relief for patients who qualify, non-surgical treatments are needed during the interim, in the event of relapse, or for individuals who do not qualify for surgery. Cognitive behavioral therapy (CBT) is a well-researched treatment for chronic pain resulting from various diseases and disabilities.3 A systematic literature review was performed to identify if CBT decreases pain and improves the quality of life for patients diagnosed with classical, secondary, or idiopathic trigeminal neuralgia. More research is needed, but there is promising evidence in the literature that cognitive behavioral therapy can be useful for patients with trigeminal neuralgia to help them cope with their pain. In addition, there may be evidence that, while somewhat effective alone, cognitive behavioral therapy may be more effective in conjunction with another treatment such as medication. These results are encouraging for patients suffering with the chronic pain of trigeminal neuralgia, and future studies should further investigate the benefits of cognitive behavioral therapy for patients with trigeminal neuralgia.

No description available.

Objective: To determine the feasibility of an online cognitive behavioral therapy for insomnia (CBT-I) in bereaved older adults. Participants: The study participants include adults aged 55 and older (N = 30) that lost a loved one within the past five years and are currently experiencing symptoms of insomnia. Methods: This study used an experimental design and was guided by the Transitions Theory developed by Meleis. Descriptive statistics and t-tests were used to measure changes within and between groups. Experimental arm had the CBT-I online treatment and the control arm had attention controlled online tasks. Intervention fidelity was measured. Results: The online CBT-I intervention is a feasible intervention for bereaved older adults with insomnia. High retention rates were shown in both groups, and both groups’ insomnia and mood symptoms improved at post- study measurement. There were no statistically significant differences seen in any measure between groups. Conclusions: Transitions in older adult life includes loss of friends and family as well as development of sleep issues. The Transitions Theory is useful for informing the design of behavioral interventions in this older population. Further research is needed to understand how sleep can be improved by cost effective online interventions that might not include solely CBT-I.

<p>The term ‘stigma’ is formally defined as the assignment of negative perceptions to an individual because of perceived difference from the population at large (The Free Online Dictionary by Farlex). Stigma, pervasive on a micro, mezzo and macro level serves to devalue individuals who have been diagnosed with mental illness and the support systems that are designed to assist them. Although efforts have been made in public awareness campaigns to reduce the stigma associated with mental illness, stigma continues to limit opportunities and restrain individuals from living full and enriching lives. Many individuals “suffer in silence” often resorting to maladaptive coping mechanisms to manage symptoms.</p> <p>The purpose of this study was to uncover the short term and long term impact of stigma from the perspective of those who are labelled with mental illness in order to gain a deeper and more accurate understanding of the effects of such on life satisfaction. Existing literature suggests that the result of anticipated and experienced stigma can affect individuals in multiple ways: diminished self-esteem, self-efficacy, and self-worth; social withdrawal; identity ambivalence; secrecy and reduced opportunities (employment, housing, income).</p> <p>This research utilized qualitative semi-structured interviews and photo elicitation to gain an understanding of experienced and anticipated stigma as perceived by those with mental illness. Theoretically, the study was influenced by the modified labelling theory which posits that social and internalized stigma associated with mental illness is a societal creation in that its’ development exists as a result of disapproving social attitudes about mental illness. Eight individuals with various diagnosed mental disorders participated in the study. The findings suggest that for each of the participants in this study, initial dealings with the mental health care system and its’ components are likely to impact individuals negatively but once effective treatment, medication stabilization and a good practitioner are found, the experience becomes positive and empowering to individuals. Regardless of the level to which internalized stigma exists, all participants engaged in acts of secrecy, withdrawal, passing and selective disclosure adversely affecting life satisfaction. The implications for practice include recognizing the structural factors that influence clients’ internalization of stigma which likely contributes to feelings of empowerment and control over ones’ life. Revealing mental health status to others may be beneficial in contributing to an improved quality of life satisfaction.</p> / Master of Social Work (MSW)