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.

Cognitive-behavioral treatments are the most well-documented, and apparently most effective, treatments for childhood depression. Efforts to translate these findings to clinical practice are thwarted by the large number of strategies (and sessions) included in empirically supported treatment packages and a lack of guidance regarding differential selection of strategies. The aim of this study was to determine the impact of case formulation on the selection of individual treatments for childhood depression. Two hundred thirty-seven Ph.D.-level mental health professionals with knowledge of behavioral and/or cognitive behavioral theory and practice were recruited via e-mail to participate in this study. Candidates were asked to indicate the likelihood that they would select each of 9 cognitive-behavioral treatments based on one of twelve fictional vignettes. The vignettes were designed to represent children of ages 6, 10, and 14, and presenting with depression based on Cognitive Distortion, Social Skills Deficit, or Environmental Deficit etiologies. Three "Control" vignettes, in which the age of the child was varied but no case formulation was provided, were also included. Our results provide confirmation that case formulation is an important step in the treatment of childhood disorder. Participants successfully matched cognitive treatments to cognitive etiologies, social skills treatments to social skills deficit etiologies, and environmental treatments to environmental deficit etiologies of childhood depression. Differences in treatment selection were also noted with regard to age of the child being treated, in a manner consistent with developmental theory. Here, we have confirmed that the case formulation approach is useful in the differential selection of empirically supported cognitive-behavioral treatments for childhood depression. / Ph. D.

Youth with inflammatory bowel disease (IBD) have higher rates of depression than healthy youth. A cognitive-behavioral treatment, primary and secondary control enhancement training-physical illness (PASCET-PI), for depressed adolescents with IBD was associated with reductions in depressive symptoms. The purpose of this study was to examine the salience of nonspecific processes (factors inherent in any human relationship) and specific processes (factors related to therapy content) during PASCET-PI sessions and their association with improvements in psychological functioning. Participants included 10 adolescent patients with IBD with mean illness duration of 31.9 months. At intake, eight participants qualified for a diagnosis of major depressive disorder and two for a diagnosis of minor depression. Participants completed measures of depressive symptomatology and clinicians completed the Children's Global Assessment Scale (CGAS). Measures were completed at posttreatment, 6 months posttreatment, and 1 year posttreatment. Independent judges used the Psychotherapy Process Q-sort (PQS) to rate the salience of therapeutic processes for PASCET-PI sessions #2 and #8 for each subject. PQS ratings of PASCET-PI sessions were con-elated with ideal prototypes of cognitive-behavioral treatment (CBT), inteqnrsonal therapy (IPT), and psychodynamic (PD) orientations that were previously developed based on PQS ratings of an ideal session, according to expert therapists. Findings indicate that PASCET-PI sessions most closely resembled the CBT prototype (r = .51, p < .05). Change scores on outcome measures were correlated with PQS-prototype correlates to determine which processes were associated with improved psychological functioning. Findings suggest that reductions in depressive symptomatology were associated with processes characteristic of various orientations. Thus, CBT processes were not exclusive in promoting change. There were strong positive relationships between change scores of the PCS and prototypes of all orientations (CBT, IPT, and PD) at posttreatment and between the CDI and ASQ and all orientations at 6-months follow-up (r = .62 -.72, p < .05). Comparisons of specific process-outcome correlates and nonspecific process-outcome correlates did not reveal significant differences.

The current study examined whether variables that have been found to influence treatment outcome serve as mediators of a child and adolescent cognitive behavioral treatment (CBT) anxiety program at multiple time points throughout the intervention. The study also examined mediating variables measured at multiple time points during treatment to determine the time lags necessary for changes in the mediator variable to translate into changes on treatment gains. Participants were 168 youth (ages 6 to 16 years; 54% males) and their mothers who presented to the Child Anxiety and Phobia Program (CAPP) at Florida International University (FIU). Overall, results indicate that the mediators at multiple time points influenced youth anxiety in a fluctuating manner, such that a decrease in skills at one given session caused changes in youth anxiety at a later session. This dynamic between the mediator and outcome may be reflective of the process of therapeutic change and suggests that skills gained from session to session took time to exert their effect on youth anxiety. The methodology employed helps to elucidate how variables mediate treatment outcome in youth anxiety disorders.

No description available.

Brief, easy to use, psychometrically strong (i.e., pragmatic) instruments are needed to support implementation research; the current study assessed whether it was possible to develop a pragmatic observational treatment integrity instrument and reduce the amount of time coders spend making treatment integrity ratings (while maintaining score validity) of therapists delivering two protocols of individual cognitive-behavioral treatment (ICBT) for youth anxiety in research and practice settings. The 12-item instrument was derived from four observational treatment integrity instruments with promising score reliability and validity that assess adherence, competence, differentiation, and alliance. A sample of 106 youths (M age = 10.12, SD = 1.81, ages 7-14; 42.50% Female; 69.80% Caucasian) received one of three treatments to address anxiety: standard ICBT in a research setting (n = 51) or standard ICBT (n = 22), modular ICBT (n = 16), or usual care (UC; n = 17) in practice settings. Four coders independently coded five- and 15- minute segments sampled from four sessions from each client (N = 756 sessions). Ten percent of sessions were double-coded for reliability purposes. Reliability, sensitivity to change, construct validity, and predictive validity from the two segments were compared to full session treatment integrity scores independently archived in a study assessing the same clients. Across five- and 15-minute segments, the instrument produced promising score reliability and convergent validity evidence for adherence, competence, and alliance items (items intended for inclusion in ICBT for youth anxiety; M ICCs = .62, SD = .17; M rs = .58, SD = .12) and poor score reliability and validity evidence for differentiation items (items intended for inclusion in other treatment domains; M ICCs = .21, SD = .28; M rs = .27, SD = .25). This study met its primary aim, to develop an instrument that can be coded in less than 20 minutes while maintaining evidence of score validity. Researchers interested in developing such instruments can use this study design as a roadmap. Future research should investigate whether psychometric findings replicate across samples, why certain items (e.g., client-centered interventions) did not evidence score validity, and how this type of instrument can inform EBT training.

Problemas no momento de dormir e frequentes despertares noturnos são comuns em crianças, afetando 20% a 30% da população infantil. Tais dificuldades com o sono podem afetar aspectos comportamentais da criança, além de prejudicar o sono, o humor e a funcionalidade diurna de seus cuidadores. Apesar da importância do sono para a saúde infantil, há uma carência de estudos sobre o tema no cenário nacional. Esta pesquisa teve como objetivo avaliar a eficácia de uma intervenção comportamental para insônia infantil por meio de um programa dirigido aos pais. Participaram 62 pais de crianças de um a cinco anos de idade que apresentavam problemas de ordem comportamental relacionados ao sono. Os participantes foram randomizados em bloco de oito para os grupos de intervenção e controle. O programa de intervenção foi composto por cinco sessões nas quais os pais receberam educação sobre o sono da criança, orientações sobre o estabelecimento de horários e rotina para dormir e quanto ao uso de técnicas (extinção e reforço positivo) para a melhoria do momento de dormir e redução de despertares noturnos. Os participantes foram avaliados em quatro etapas pré-­intervenção, pós-­intervenção, seguimento de um e seis meses por meio dos instrumentos Escala UNESP de Hábitos e Higiene do Sono -­ Versão Crianças, Escala de Distúrbios do Sono para Crianças e Adolescentes, Inventário de Comportamentos para Crianças entre 1½ a 5 anos (CBCL), Inventário de Autoavaliação para adultos de 18 a 59 anos (ASR), Diário de Sono, Diário de Comportamento e Actigrafia. Os resultados deste estudo demonstraram que depois da intervenção houve melhora (p<0,05) nas variáveis do sono, tais como horário para dormir, latência para início do sono, despertares, duração total, bem como nos comportamentos das crianças no momento de dormir, avaliados por medidas subjetivas, como dormir com os pais e resistência a ir para a cama. Também houve melhora na latência para início do sono das crianças e na latência, eficiência e despertares de suas mães por actigrafia. Além da melhora na qualidade do sono, foi observada melhora detectável nos problemas de comportamento externalizante, internalizante e total de problemas de comportamento das crianças avaliados pelo CBCL, e um menor número de mães com pontuações clínicas no ASR. Conclui-­se que a intervenção comportamental para insônia infantil, por meio de orientação para pais, é eficaz na melhora da qualidade de sono e nos comportamentos diurnos das crianças, além de trazer benefícios no sono e nos comportamentos de suas mães. Tais resultados apontam para a necessidade de disseminação desse conhecimento no Brasil, a partir da possibilidade de aplicação desse protocolo em clínicas-­escolas de psicologia / Problems when they sleep and frequent awakenings are common in children. They affect approximately 20 % to 30 % of the child population. These problems, classified as behavioral childhood insomnia, can affect behavioral, emotional and educational aspects of the child, in addition to affecting sleep, mood and daytime functionality of their caregivers. Despite the importance of sleep for and on children\'s health, there is a lack of studies on this topic on the national scene. The present study aimed to evaluate the efficacy of a behavioral intervention for childhood insomnia through a program aimed at parents. Sixty-­two parents of children 1-­5 years of age who have behavioral problems related to sleep participated order. Participants were randomized into eight block for the intervention and control group. The intervention program consisted of five sessions in which parents received training on child sleep, guidelines on establishing schedules and bedtime routines and how the use of techniques (extinction and positive reinforcement) to improve the time to sleep and reduced nighttime awakenings. Participants were evaluated in four stages pre-­intervention, post-­intervention, follow-­ up at one and six month intervals through the instruments Escala UNESP de Hábitos e Higiene do Sono Versão Crianças, Escala de Distúrbios do Sono para Crianças e Adolescentes, Child Behavior Checklist 1½ to 5 years (CBCL), Adult Self Report (ASR), sleep and behavior diaries and actigraphy. The results of this study demonstrated that post intervention, there are improvement (p<0.05) of sleep variables, such as bedtime schedule, sleep latency, awakenings, time sleep total, and in behaviors at bedtime, like co-­sleeping and resistance to go to bed, in children, evaluated by subjective measures and improvement in latency to sleep in children and latency, efficiency and awakenings of their mothers for actigraphy. Besides the improvement in sleep quality, we also noted a detectable improvement at behavior problems externalizing, internalizing and total behavior problems of children evaluated by CBCL and smaller number of mothers with clinical scores by ASR. Behavioral interventions for insomnia to childhood, through parental guidance, is effective in improving the quality of sleep and daytime behavior in children and brings benefits to sleep and behavior in our female caregivers. These results indicate the need to dissemination this knowledge in Brazil from the opportunity to apply this protocol in schools of clinical psychology

Subjects for this study were 40 women (N= 40) with subclinical bulimia nervosa who were randomly assigned to either a Cognitive Behavioral Treatment group (CBT) or to a waiting list control group. Treatment was provided for 8 weeks in an individual, self-administered format, using an audio-taped treatment package for Body Image Dissatisfaction (BID). Cognitive behavioral treatment focused on changing negative thoughts and feelings about one's body. No specific treatment focused on changing eating symptomatology or concomitant symptoms, although these were assessed. The waiting list control condition received assessment, followed by 8 weeks of no treatment. Treatment outcome measures were three self-report scales that assessed BID and two measures that assessed eating symptomatology and concomitant symptoms. At posttest, treated subjects showed improvement on two of three measures of BID, with a trend towards improvement on the third measure, when compared to waiting list control subjects. Treated subjects also showed a trend towards improved eating symptomatology and concomitant symptoms such as depression and anxiety, relative to waiting list control subjects. The results indicated that CBT is effective for decreasing BID in women with subclinical bulimia nervosa when administered in a self-directed manner.

Anxiety and depressive disorders are prevalent among youth and are often experienced concurrently or sequentially during development (Kroes et al., 2001; Costello, Erklani, & Angold, 2006). These disorders are also associated with weaker cognitive behavioral treatment (CBT) outcomes when experienced simultaneously in youth (e.g. Berman, Weems, Silverman, & Kurtines, 2000). Treatment research has begun to investigate the feasibility and efficacy of treating comorbid emotional disorders using transdiagnostic treatment approaches (Barlow et al., 2010; Ehrenreich et al., 2008). Evidence from adult and adolescent populations indicates that these more broadly focused treatment programs may offer benefits above and beyond disorder- and domain-specific protocols, leading to improvements in diagnostic severity and emotion regulation across a range of disorders and emotions (Ellard, Fairholme, Boisseau, Farchione, & Barlow, 2010; Ehrenreich-May & Remmes, 2010). The current study extends transdiagnostic treatment research to school-age children, ages 7-12, in a mental health clinic setting by investigating preliminary post-treatment outcomes and treatment acceptability in a recent open trial (N enrolled= 16; N completed treatment=13) of the Emotion Detectives Treatment Protocol (EDTP; Ehrenreich-May & Laird, 2009). Results revealed that participants experienced significant improvements in clinical severity ratings of principal and all related diagnoses, as well as in parent reported anxious and parent and child reported depressive symptoms at the post-treatment assessment. Additionally, parents reported gains in child coping and improvements in dysregulation across emotional domains (including worry, sadness, and anger). The EDTP had good retention rates, moderately good attendance, and parents and children reported high levels of treatment satisfaction. The results of this open trial provide preliminary evidence for the utility and acceptability of a transdiagnostic group protocol to treat both clinical anxiety disorders, as well as self- and parent-reported anxious and depressive symptoms for youth within a mental health setting. These results suggest that children may uniquely benefit from a more generalized, emotion-focused treatment modality, such as the EDTP, that can offer flexibility in its treatment targets to families as well as mental health clinicians.

Problemas no momento de dormir e frequentes despertares noturnos são comuns em crianças, afetando 20% a 30% da população infantil. Tais dificuldades com o sono podem afetar aspectos comportamentais da criança, além de prejudicar o sono, o humor e a funcionalidade diurna de seus cuidadores. Apesar da importância do sono para a saúde infantil, há uma carência de estudos sobre o tema no cenário nacional. Esta pesquisa teve como objetivo avaliar a eficácia de uma intervenção comportamental para insônia infantil por meio de um programa dirigido aos pais. Participaram 62 pais de crianças de um a cinco anos de idade que apresentavam problemas de ordem comportamental relacionados ao sono. Os participantes foram randomizados em bloco de oito para os grupos de intervenção e controle. O programa de intervenção foi composto por cinco sessões nas quais os pais receberam educação sobre o sono da criança, orientações sobre o estabelecimento de horários e rotina para dormir e quanto ao uso de técnicas (extinção e reforço positivo) para a melhoria do momento de dormir e redução de despertares noturnos. Os participantes foram avaliados em quatro etapas pré-­intervenção, pós-­intervenção, seguimento de um e seis meses por meio dos instrumentos Escala UNESP de Hábitos e Higiene do Sono -­ Versão Crianças, Escala de Distúrbios do Sono para Crianças e Adolescentes, Inventário de Comportamentos para Crianças entre 1½ a 5 anos (CBCL), Inventário de Autoavaliação para adultos de 18 a 59 anos (ASR), Diário de Sono, Diário de Comportamento e Actigrafia. Os resultados deste estudo demonstraram que depois da intervenção houve melhora (p<0,05) nas variáveis do sono, tais como horário para dormir, latência para início do sono, despertares, duração total, bem como nos comportamentos das crianças no momento de dormir, avaliados por medidas subjetivas, como dormir com os pais e resistência a ir para a cama. Também houve melhora na latência para início do sono das crianças e na latência, eficiência e despertares de suas mães por actigrafia. Além da melhora na qualidade do sono, foi observada melhora detectável nos problemas de comportamento externalizante, internalizante e total de problemas de comportamento das crianças avaliados pelo CBCL, e um menor número de mães com pontuações clínicas no ASR. Conclui-­se que a intervenção comportamental para insônia infantil, por meio de orientação para pais, é eficaz na melhora da qualidade de sono e nos comportamentos diurnos das crianças, além de trazer benefícios no sono e nos comportamentos de suas mães. Tais resultados apontam para a necessidade de disseminação desse conhecimento no Brasil, a partir da possibilidade de aplicação desse protocolo em clínicas-­escolas de psicologia / Problems when they sleep and frequent awakenings are common in children. They affect approximately 20 % to 30 % of the child population. These problems, classified as behavioral childhood insomnia, can affect behavioral, emotional and educational aspects of the child, in addition to affecting sleep, mood and daytime functionality of their caregivers. Despite the importance of sleep for and on children\'s health, there is a lack of studies on this topic on the national scene. The present study aimed to evaluate the efficacy of a behavioral intervention for childhood insomnia through a program aimed at parents. Sixty-­two parents of children 1-­5 years of age who have behavioral problems related to sleep participated order. Participants were randomized into eight block for the intervention and control group. The intervention program consisted of five sessions in which parents received training on child sleep, guidelines on establishing schedules and bedtime routines and how the use of techniques (extinction and positive reinforcement) to improve the time to sleep and reduced nighttime awakenings. Participants were evaluated in four stages pre-­intervention, post-­intervention, follow-­ up at one and six month intervals through the instruments Escala UNESP de Hábitos e Higiene do Sono Versão Crianças, Escala de Distúrbios do Sono para Crianças e Adolescentes, Child Behavior Checklist 1½ to 5 years (CBCL), Adult Self Report (ASR), sleep and behavior diaries and actigraphy. The results of this study demonstrated that post intervention, there are improvement (p<0.05) of sleep variables, such as bedtime schedule, sleep latency, awakenings, time sleep total, and in behaviors at bedtime, like co-­sleeping and resistance to go to bed, in children, evaluated by subjective measures and improvement in latency to sleep in children and latency, efficiency and awakenings of their mothers for actigraphy. Besides the improvement in sleep quality, we also noted a detectable improvement at behavior problems externalizing, internalizing and total behavior problems of children evaluated by CBCL and smaller number of mothers with clinical scores by ASR. Behavioral interventions for insomnia to childhood, through parental guidance, is effective in improving the quality of sleep and daytime behavior in children and brings benefits to sleep and behavior in our female caregivers. These results indicate the need to dissemination this knowledge in Brazil from the opportunity to apply this protocol in schools of clinical psychology