<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)

BACKGROUND: There is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER). METHODS: Sixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation. RESULTS: Over the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system. CONCLUSIONS: The results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011

Objective: Diabetes mellitus is a known epidemic that is increasing throughout the United States and if current trends continue, it is estimated that as many as one in three U.S. adults could have diabetes by 2050. Considerable evidence has been found to link the presence of depression and or Diabetes Distress Syndrome with type two diabetes mellitus. Current studies demonstrate that lack of treatment of Diabetes Distress Syndrome may result in a decrease in medication adherence, participation in diabetic group meetings, and quality of life. The purpose of this study was to examine nurse practitioners (NPs') knowledge, perceptions and attitudes in utilizing behavioral therapy in TTDM management. Research Design and Methods: A total of 20 NPs completed the survey using Qualtrics. Results: suggest that there is a lack of knowledge in regards to Diabetes Distress Syndrome. Current practice for behavioral services in TTDM treatment is also deficient, however, NPs' are willing to learn more and use it as a treatment modality in their practice.

Depression is an increasingly common health problem among youth. There is growing empirical evidence that CBT is a promising treatment for childhood depression. It remains unclear what treatment-specific effects of CBT contribute to therapeutic gains. Cognitive theories propose that a primary mechanism of change in CBT are cognitive interventions that target depressogenic cognitions regarding the self, world, and future (cognitive triad), which are thought to mediate depression. The effects of cognitive interventions on depressive symptoms are thus hypothesized to be mediated by changes in the cognitive triad. No studies have investigated whether CBT for depressed youth works by treating the cognitive triad through the implementation of cognitive techniques. As part of a larger study analyzing the mechanisms of change in CBT for depressed youth, the purpose of this study was to investigate: (1) whether specific cognitive techniques are related to depressive symptom reduction in youth, and (2) if improvements in depressive symptoms are mediated through the cognitive triad of depressed youth. Participants were 42 girls, aged 8 to 14, who completed a manualized CBT protocol for depression in group format. Girls completed a diagnostic interview for depression and self-report measures assessing the cognitive triad. Group therapy sessions were coded for cognitive interventions. Results indicated a non-significant relation between levels of cognitive interventions and post-treatment depression scores, after controlling for pre-treatment depression. Therefore, tests of mediation were discontinued. Relevant control variables were added to the model to reduce error variance. After controlling for pre-treatment depression, age, presence of learning disorder, mastery of therapeutic skills, and behavioral interventions, cognitive interventions were significantly and positively associated with post-treatment depression. The relation between cognitive interventions and the cognitive triad was non-significant and meditational analyses were discontinued. Exploratory factor analysis revealed four cognitive interventions factors that were consistent with CBT theory. Further analyses revealed that all factors were not significantly related to post-treatment depression. Tests of interactions between cognitive interventions and behavioral interventions, age, and mastery level of therapeutic skills were also non-significant. Implications, limitations, and recommendations for further areas of research are presented. / text

Objective: Understanding the pathways through which treatments work to change symptom and diagnostic outcomes is important to the development and delivery of evidence-based treatments. This study assessed the extent to which adherence (therapist’s delivery of prescribed therapeutic interventions) and differentiation (therapist’s delivery of non-prescribed therapeutic interventions) to Coping Cat, a CBT program, affected client symptom and diagnostic outcomes. Method: The Therapy Process Observational Coding System for Child Psychotherapy – Revised Strategies Scale (McLeod et al., 2015) was used to characterize therapeutic interventions delivered within and outside of the Coping Cat program with youths aged 7-15 receiving treatment in one efficacy (n = 51; 41% female; 84% Caucasian, M age = 10.37) and one effectiveness (n = 17; 56% female, 39% Caucasian, M age = 10.90) trial. Youth- and parent-report symptom checklists and diagnostic interviews were used to assess symptom and diagnostic remission. Multiple hierarchical regression analyses and hierarchical binomial logistic regression were used to investigate the relation between adherence and differentiation and symptom change and remission of principal diagnosis. Results: Neither adherence nor differentiation were significantly related to symptom or diagnostic outcomes. No clear trend emerged, and results were inconsistent across parent and youth report, outcome type, and setting. Conclusion: These results are consistent with past literature. Two interpretations exist: (1) that there is no relation between treatment delivery and outcomes, and (2) that methodological and analytic flaws undercut the ability of the analyses to identify a relation.

The present study used a basic behavioral paradigm derived from Relational Frame Theory (RFT), a contemporary behavioral account of language and cognition, to validate principle-based definitions of the cognitive interventions of defusion and reappraisal. Ninety-one participants first underwent an RFT learning paradigm that established symbolically generalized avoidance. Participants were then randomized to a defusion, reappraisal, or control condition. The main outcomes were equivalence responding—indicative of the trained relational network and analogous to the content of cognition—and avoidance—analogous to the behavioral impact of cognition. Defusion and reappraisal significantly reduced avoidance responding, providing support for the hypothesis that these interventions target the behavior of relational framing. Mediation analyses, conducted on an exploratory basis, revealed differences between the mechanisms of defusion and reappraisal and provided preliminary support for the classification of these interventions as a functional context intervention and a relational context intervention, respectively.

The child-therapist alliance is believed to be a critical ingredient of successful psychotherapy for youth depression. However, only a few studies have examined the association between the alliance and clinical outcomes in the treatment of youth depression. The present thesis examined the alliance-outcome association in two treatments for youth depression: cognitive-behavioral therapy (CBT) and usual clinical care (UC). Data were from an effectiveness trial conducted in six community clinics (see Weisz et al., 2009). Forty-one youth were randomly assigned to receive CBT or UC from community clinicians. The observed early alliance, alliance shifts, and self-reported alliance did not significantly predict child- or parent-reported depression outcome. However, the direction and strength of the alliance-outcome associations differed across alliance methodology (self- and observer-report) and condition (CBT and UC). Early child alliance did significantly predict treatment satisfaction. Implications and limitations of the results are discussed.

Combat and war zone veterans are particularly vulnerable to developing Posttraumatic Stress Disorder (PTSD) due to the increased risk of experiencing trauma inherent in military service. Insomnia and nightmares are core symptoms of PTSD and can be factors in the development, maintenance, and exacerbation of PTSD. However, sleep disturbance has received relatively little attention from a treatment point of view until recently. Recent research has demonstrated that cognitive behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares are effective stand alone and combination treatments for sleep disturbance in civilian and veteran populations. Although group interventions are lower in cost and more efficient to deliver in a VA setting, studies have yet to test the feasibility and efficacy of group CBT-I/IRT combination treatment for veterans with PTSD. The current pilot study investigated the feasibility and efficacy of a combined CBT-I and IRT protocol intervention for insomnia and nightmares delivered in a group format to a sample of mixed theater veterans with PTSD. Participants (n = 34) were randomly assigned to either a treatment (n = 17) or waitlist control condition (n = 17). After baseline assessment, participants assigned to the treatment condition participated in six weekly group sessions of combined CBT-I and IRT and completed posttreatment and two month follow-up assessments. Those in the waitlist condition completed a six week waiting period. After completing post-waitlist assessment, they were given the opportunity to receive the treatment. Authors hypothesized that those in the treatment condition would experience significant improvement on self-report measures of sleep, nightmare frequency, PTSD-related sleep disturbance, beliefs about sleep, and overall PTSD and depression severity compared to the waitlist condition at posttreatment and two-month follow-up. These hypotheses were largely supported by the study results with some notable exceptions. Significant condition by time interactions were found on measures of sleep and nightmares, beliefs about sleep, and depression at posttreatment. Treatment gains were maintained at two month follow-up for sleep variables but not nightmare frequency or depression. There were no condition by time interactions for measures of PTSD or PTSD-related sleep disturbance at posttreatment. In sum, the findings of this study indicate that a combined CBT-I and IRT delivered in a group format was effective in reducing insomnia symptoms, nightmare frequency, and depression in a sample of mixed theater veterans with PTSD. The study also demonstrated the feasibility of this treatment approach with this population suggesting that a larger randomized controlled study is warranted.

The field has developed many evidence-based treatments (EBTs); the integrity of EBTs being delivered, however, has been studied less than rigorously. Because many treatment manuals are developed to be delivered session-by-session, one way to assess treatment adherence, specifically, is across the course of the case: do therapists deliver treatment components in the order prescribed? The goals of this study were to characterize how therapists deviate from prescribed order and how adherence to order relates to child characteristics. Therapy process data were collected from a subsample of children (N = 33, aged 7-15) that received cognitive behavioral therapy (CBT) to address primary symptoms of anxiety. Adherence to CBT was measured by the CBT Adherence Scale for Youth Anxiety (Southam-Gerow & McLeod, 2011). Four methods to assess order were developed. Analyses include descriptive and correlative statistics that characterize the delivery of CBT and the relation between adherence to order and pretreatment characteristics.

Insomnia is defined as difficulty initiating or maintaining sleep, or nonrestorative sleep that lasts for at least one month and is accompanied by significant impairment in daytime functioning including fatigue, irritability, and/or difficulty concentrating. It is one of the most common complaints reported by individuals with cancer, especially around the time of cancer diagnosis and treatment. Yet it is often unrecognized and untreated, leading to adverse health consequences and increased healthcare costs. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been recommended as the gold standard for treating insomnia among individuals with cancer. Multiple studies have tested and proven the efficacy and effectiveness of CBT-I among individuals with cancer. However, only one study has investigated the efficacy of CBT-I in individuals newly diagnosed with cancer who are undergoing cancer treatment. Moreover, previous studies have been limited by their focus on largely homogenous samples of White, well-educated women with breast cancer. The dissemination of CBT-I among individuals with cancer is greatly limited by the lack of available providers and resources needed to implement the standard face-to-face treatment. One strategy to address this shortage has been to abbreviate standard CBT-I into low-intensity modalities that require fewer resources and can be self-administered on the Internet. The current study sought to examine the feasibility and acceptability, as well as the efficacy of one such program, an online low-intensity CBT-I intervention, Sleeping Healthy Using the Internet (SHUTi), supplemented with clinician support, in a sample of individuals newly diagnosed with heterogeneous malignancies who were undergoing chemotherapy and/or radiation. Results yielded support for the feasibility and acceptability of addressing individuals’ insomnia with a low-intensity CBT-I intervention while they are undergoing cancer treatment. With regard to sleep, there were significant treatment effects observed on a global measure of insomnia severity and on subjective sleep consolidation. There were also significant treatment effects for depressive symptoms. Findings are discussed in the context of study limitations and for the purpose of expanding the literature on disseminating CBT-I early in the cancer care trajectory.