This study examined the level of satisfaction reported by participants of a technologically assisted intervention study (TAI). TAI is a type of teletherapy done through online, live video conferencing. Satisfaction was examined at three different time points, post therapy, 3-months post therapy, and 6-months post therapy. Analyses examined if there were any changes in reported satisfaction over the three time periods. Participants received cognitive behavioral therapy (CBT) targeted at reducing symptoms of mild to moderately severe depression. A satisfaction measure was developed for this study, and included quantitative and qualitative items which were analyzed to determine participants' level of satisfaction. Seventeen women residing in the Vernal and Roosevelt, Uintah Basin areas, volunteered to participate in the study that was funded by a CURI and AES grant. This study found that the women experienced a high level of satisfaction with TAI across the various dimension measured. This high level of satisfaction remained consistent across the three time periods examined. Qualitative data offered a depth of understanding regarding what particularly participants were and weren't satisfied with. (106 pages)

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.

The purpose of this study was to assess fear of cancer recurrence (FCR) in breast cancer survivors returning for regularly scheduled follow-up mammograms. FCR was hypothesized to increase prior to the mammogram, decrease from immediately pre- to immediately post-mammogram, and then increase following the mammogram. Based on the cognitive-behavioral model (CBM) of health anxiety, greater perceived risk of recurrence, worse perceived consequences of a recurrence, lower coping self-efficacy, and more engagement in reassurance-seeking behaviors were hypothesized to be associated with greater FCR in each time segment. Finally, exploratory analyses evaluated the various trajectories in FCR over time using growth mixture modeling and the CBM to predict class membership. The sample comprised 161 women who completed treatment for stage 0-IIIA breast cancer between 6 and 36 months previously. Participants completed the following measures at least 31 days prior to the scheduled mammogram: perceived risk and perceived consequences of breast cancer recurrence, treatment efficacy beliefs, coping self-efficacy, and reassurance seeking behaviors. Participants reported FCR at one month, one week, and immediately prior to the mammogram as well as one month, one week, and immediately after the mammogram using visual analogue scales (VAS) to rate anxiety and worry about cancer recurrence, the Cancer Worry Scale (CWS), and the Fear of Cancer Recurrence Inventory (FCRI). State anxiety and reassurance post-mammogram were also assessed. FCR significantly changed over time with increases in CWS scores prior to the mammogram, a significant decline on the VAS observed immediately following receipt of results, and a significant increase on the VAS, and decrease in reassurance during the month following the mammogram. The CBM did not significantly predict change in FCR over time, but certain variables did predict fluctuations including coping-self efficacy and perceived risk in the expected directions. Finally, growth mixture models revealed two classes, high-FCR and low-FCR, which were predicted by the CBM. These study findings support the use of the CBM in predicting which cancer survivors experience greater FCR and indicates that CBM-driven interventions may prove beneficial for reducing distressing FCR.

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.

Group delivered empirically supported therapies have been reported to have beneficial effects for cancer patients. However, little is known about the relationship between group cohesion and outcomes of these interventions. This study tested the hypothesis that group cohesion relates to the effects of a group intervention. Participants included 56 women with Stage I to II breast cancer who had completed a 10-week CBSM intervention 3 to 12 months after undergoing surgery and adjuvant therapy. Groups of 3 - 5 participants met weekly for sessions of approximately 1 hour and 45 minutes duration. All participants were assessed at baseline (2 weeks prior to beginning the intervention) and at follow-up (12 weeks after enrollment in the study). Cohesion was measured at the end of each intervention session by External Comfort (EC), a factor of the relatedness scale of the Stuttgarter Bogen instrument (1976). EC denotes an aspect of the sense of comfort of an individual within the group that is dependent on how the group participant relates to other members. EC score for session 9 (EC9), and change in EC from session 2 to session 9 (calculated as a change score, i.e., session 9 score minus session 2 score), were used for analyses as independent variables in simple linear regression models. Dependent variables were also calculated as a change score (i.e., follow-up minus baseline) and included benefit finding (Post Traumatic Growth Inventory PTGI, total score and its 5 factors), depression (CESD), urinary cortisol, and natural killer cell function (total percent, number and cytotoxicity). Results yielded a positive change in EC from session 2 to session 9 (M = 2.29, S.D. = 2.67). Regression analyses indicated a significant negative relationship between change in EC9 and change in total PTGI scores (beta= -.450, p= .011), and change in Factor 1 Relating to Others (beta=-.414, p=.021). A marginally significant negative relationship was observed between change in EC from session 2 to session 9 and the New Possibilities Factor of the PTGI (beta=-.323, p=.077). A median split, by change in EC, indicated that participants with high EC scores throughout the intervention showed an increase in total PTGI scores, and in two of the five PTGI factors at follow-up. In contrast, participants who initially scored lower values in EC showed no change in these variables. These results suggest that the longer it takes an individual to feel comfortable in the group, the less the individual would be able to find benefit from their cancer experience after the intervention.

Syftet med studien var att utvärdera vad tidigare klienter på Lenagården HVB, ett behandlingshem för vuxna med psykiska problem, upplevde som värdefullt, respektive vad de upplevde som negativt eller saknade i sin behandling. Utvärderingsfrågorna utgick från Lenagårdens programteori samt aspekter som tidigare forskning kring institutionsbehandling pekat ut som viktiga för framgångsrik behandling. Data samlades in via kvalitativa intervjuer med fyra tidigare klienter. Systemteorin har använts som utgångspunkt för resultaatanalysen. Utvärderingen visar bland annat att gott bemötande i termer av vänlighet och respekt samt personalens kompetens ansågs vara värdefulla faktorer i behandlingen. Själva terapin och behandlingsmetoden ansågs av samtliga intervjupersoner vara givande. Individanpassade lösningar, delaktighet och en förtroendefull relation till terapeuten eller behandlaren var i sin tur avgörande faktorer för en positiv upplevelse av terapin och behandlingen. Andra faktorer som värdesattes var meningsfulla aktiviteter, att bo med andra klienter samt fortsatt kontakt med Lenagården efter avslutad behandling. Några negativa aspekter i behandlingen beskrevs som för lite personaltid, för kort vistelse samt brist på gemensamma aktiviteter. / The aim of this evaluation was to find out what former clients at Lenagården HVB, an institution for treatment of adults with psychological problems, experienced as important in their treatment and what they experienced as negative or missing. The questions answered by the former clients were based on the program theory of Lenagården as well as earlier research about residential treatment. Data was gathered by qualitative interviews with 4 former clients.System theory was used as a theoretical framework for the analysis of the results. The evaluation points out that the experience of being treated in a friendly and respectful manner, the staffs level of professional training and the treatment method in itself were considered important. A trustful relation to the therapist and participation in the treatment were essential for a positive experience of the treatment. Other important aspects of treatment were activities, living with other clients and continued relations with Lenagården after completed treatment. Some negative aspects that were mentioned were not enough time with the staff, too short stay and lack of organized activities.

Social anxiety disorder (SAD) is the 3rd most common psychiatric diagnosis, and is associated with significant social, occupational, health, and educational impairment. Fortunately, both pharmacological and psychological treatments can reduce symptoms. Cognitive behavioral therapy is considered the gold standard treatment for SAD, and a robust literature supports its effectiveness. In contrast, process related factors, including the role of the working alliance, have received less attention in treatment of SAD. The current study examined development of the working alliance for a SAD sample. The working alliance is characterized as the collaborative relationship between a client and therapist, and includes shared goals, strategies, and an attachment bond. Within the context of SAD, the working alliance is particularly interesting, as the alliance itself is a social relationship that may elicit anxiety, which, in turn, may impact development of the alliance. The present study also investigated whether treatment type, that is, exposure group therapy (EGT) versus virtual reality exposure (VRE) therapy, or pre-treatment symptom severity influenced the working alliance trajectory. Data were provided by an adult sample presenting with a primary diagnosis of SAD. Participants were randomly assigned to one of two treatment conditions, both involved use of a manualized CBT treatment approach. Standardized measures of social anxiety were administered pre-treatment whereas working alliance ratings were obtained after each session. Results indicated high levels of working alliance and significant change in ratings over time. Treatment condition did not contribute to significant differences in the working alliance trajectory. Regarding the impact of SAD symptoms, initially high ratings of fear was associated with progressively increasing rates of growth in the working alliance whereas high initial ratings of avoidance signified steeper increase in the working alliance earlier in treatment followed by a declining rate of change over time. The current study contributes to the limited literature regarding the working alliance trajectory for clients with SAD, and is the first to consider the impact of VRE treatment on this trajectory. Findings also provide preliminary evidence for the differential impact of initial fear and avoidance as well as a potential curvature for the working alliance trajectory when using CBT.

Exposure therapy has received a great deal of support as an effective treatment for social anxiety. However, not all those who undergo exposure therapy improve, and some of those who do respond continue to report significant levels of symptoms. A theorized mechanism of change for exposure therapy is extinction learning. Extinction learning is believed to occur across exposure sessions during which new associations are formed and stored in memory. Individuals with social anxiety are prone to engage in post event processing (PEP), or rumination, after social experiences, which may interfere with extinction learning, and thus attenuate response to treatment. The current study examined whether PEP limits treatment response to two different exposure based treatments, a group based cognitive behavioral intervention and an individually based virtual reality exposure therapy among participants (n = 75) diagnosed with social anxiety disorder. The findings suggested that PEP decreased as a result of treatment and that social anxiety symptoms for those with greater amounts of PEP improved at a slower rate of change than those with lower levels of PEP. Implications for the role of PEP on treatment response are discussed.

This study is exploratory in nature and focuses on the relation between the individual and macrosystems by investigating the link between African Americans’ fear of confirming stereotypes and their experience with symptoms and treatments for social anxiety. This study hypothesizes that 1) among a sample of African Americans diagnosed with social anxiety, there will be a significant, positive relationship between African-Americans’ self-reported concerns over confirming stereotypes relevant to both social anxiety and their own self-reported levels of social anxiety, 2) significantly more African Americans will drop-out of therapy than Caucasians, 3) amongst African Americans, significantly more will drop out of group therapy than individual therapy, 4) the racial composition of the group will matter, such that more African Americans will drop out of groups where they are the only African American participant, compared to if there are other African Americans in the group, and 5) the presence of an African American co-therapist will impact attrition from group treatment, with higher attrition rates in groups without an African American co-therapist, compared to if there is one. Thirty-four participants, 23 females and 11 males, who self-identified as African Americans and forty-four participants, 23 females and 21 males, who self-identified as Caucasian took part in this study. Results did not show a relation between stereotype confirmation concern and social anxiety. Regarding attrition, results showed that significantly more African Americans dropped out of therapy than Caucasians. Additionally, more African Americans dropped out of group therapy than individual therapy. There was no impact of therapist ethnicity or the presence of other African Americans on attrition rates, though these tests were underpowered.

The aim of the present study was to assess the effectiveness of a cognitive-behavioral smoking cessation program combined with nicotine patches in a university student sample. Moreover, changes in self-efficacy judgments of both experimental and control group participants were examined. 37 students from various departments of Middle East Technical University participated in the study. Participants in the experimental group received a 6-week group based multicomponent smoking cessation program combined with nicotine patches, whereas those in the control group were provided with self-help booklets. Point prevalence abstinence was used as the main outcome measure, which was verified by CO-measurement in exhaled air both at post-treatment and follow-ups. Separate one-way ANOVAs and repeated measures ANOVAs were used in data analysis. Results showed that there were no significant differences between the experimental and control group in terms of their degree of motivation, readiness and decision to quit smoking, nicotine dependence, depression, self-efficacy, and perceived social support at pre-treatment. Results of the repeated measures ANOVA with CO-values showed that the CO-levels of experimental groups significantly declined from pre-treatment to post-treatment and to follow-ups. Abstinence rates for the experimental group were found to be 66.67%, 55.55% and 45.44% at post-treatment, 1-month follow-up and 2-months follow-up respectively. On the other hand, abstinence rates for the control group were found to be 11.76%, 5.88% and 5.88% at post-treatment, 1-month follow-up and 2-months follow-up respectively. Moreover, it was found that self-efficacy scores of experimental group participants significantly increased at post-treatment, whereas those of control group participants significantly decreased from pre-treatment to post-treatment. The findings were discussed in the light of the relevant literature. After discussing the limitations and implications of the study, directions for future studies were suggested.