Journal of Consulting and Clinical Psychology

Petry, Nancy M.; Alessi, Sheila M.; Rash, Carla J.; Barry, Danielle; Carroll, Kathleen M.

doi: 10.1037/ccp0000330pmid: 30265039

Objective: Contingency management (CM) interventions that reinforce attendance have rarely been evaluated in terms of reducing drug use. Using a sequential randomized design, this study examined the efficacy of three attendance CM conditions compared to usual care (UC) on drug use outcomes. It evaluated whether the duration (6 vs. 12 weeks) and timing (early vs. later treatment) of CM delivery impact treatment response. Method: Upon initiating outpatient treatment, patients with cocaine use disorders (N = 360) were randomized to UC or CM for attending treatment for 6 weeks. At week 6, patients (n = 308) were rerandomized to UC or CM for another 6 weeks, with assignment stratified on current functioning. Samples were screened for illicit drugs twice weekly for 12 weeks. Results: Patients randomized to CM at both time-points attended more sessions and achieved more abstinence than those never randomized to CM. Relative to UC, receiving attendance CM in weeks 1–6 only was not efficacious, but those receiving attendance CM in weeks 7–12 only evidenced some benefits compared to those who never received CM. Twelve weeks of attendance CM was more efficacious than 6 weeks. No between-groups differences in drug use were noted at follow-ups, but days attended treatment and proportion negative samples during treatment were associated with long-term cocaine abstinence. Conclusions: Attendance-based CM increases treatment participation and reduces drug use, with beneficial effects noted when CM is delivered over longer durations and during later phases of outpatient care.

Hien, Denise A.; Smith, Kathryn Z.; Owens, Max; López-Castro, Teresa; Ruglass, Lesia M.; Papini, Santiago

doi: 10.1037/ccp0000345pmid: 30265040

Objective: To advance understanding of the effectiveness of evidence-based treatments for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD), research must provide a more nuanced picture of how substance use affects change in PTSD symptoms over the course of treatments and whether prolonged exposure techniques can be efficacious during active substance use. A data set that included patients with PTSD/subthreshold-PTSD and SUD treated with an exposure-based intervention provided an opportunity to conduct a secondary analysis to test how patients’ substance use impacted PTSD change over treatment. Method: We applied growth models to week-to-week PTSD symptom and substance use changes during treatment and follow-up of a randomized controlled trial of two cognitive–behavioral treatments for PTSD and SUD: Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE) and Relapse Prevention Therapy (RPT). Cross-lagged analyses were used to determine whether prior week substance use impacted subsequent PTSD symptom severity. Results: Both treatments evidenced significant reductions in PTSD symptom severity. In the context of continued substance use, results suggest that individuals still benefit from exposure-based treatment. Conclusion: Results provide evidence that RPT and COPE both led to significant reductions in PTSD, providing further support that exposure-based techniques tailored for SUD can be conducted without jeopardizing PTSD or SUD outcomes. Implications for clinical decision making around treatment selection are discussed.

Stanton, Annette L.; Wiley, Joshua F.; Krull, Jennifer L.; Crespi, Catherine M.; Weihs, Karen L.

doi: 10.1037/ccp0000328pmid: 30265041

Objective: Although numerous studies address the relationships of depression with coping processes directed toward approaching or avoiding stressful experiences, the large majority are cross-sectional in design, assess coping processes at only one timepoint, or solely include prediction of the linear slope of depressive symptoms. In this research, coping processes were investigated as predictors of depressive symptoms, symptom trajectory classes (consistently high, recovery, consistently low), and major depressive episodes (MDEs) over 12 months in the cancer context. Method: Women (N = 460) within 4 months of breast cancer diagnosis completed assessments of cancer-related coping processes, depressive symptoms, and MDEs at 7 points across 1 year. Results: Beyond sociodemographic and medical variables, coping through cancer-related avoidance an average of 2 months after diagnosis was associated with likelihood of being in the high depressive symptom trajectory class and occurrence of a MDE during the year. Less decline in avoidant coping over time also predicted poor outcomes. In contrast, high initial engagement in approach-oriented coping, as well as increases in coping through emotional expression and acceptance, were associated with lower depressive symptoms across assessments and higher likelihood of being in the recovery or low trajectory class. Conclusions: Greater engagement in cancer-related avoidant coping was associated with all three indicators of depression, and greater approach-oriented coping was related to more favorable outcomes (except MDE). Sustained or increasing coping through emotional expression or acceptance predicted recovery from initially high depressive symptoms. Approach- and avoidance-oriented coping processes constitute malleable targets for preventive and ameliorative approaches.

Rodebaugh, Thomas L.; Tonge, Natasha A.; Piccirillo, Marilyn L.; Fried, Eiko; Horenstein, Arielle; Morrison, Amanda S.; Goldin, Philippe; Gross, James J.; Lim, Michelle H.; Fernandez, Katya C.; Blanco, Carlos; Schneier, Franklin R.; Bogdan, Ryan; Thompson, Renee J.;

Sandler, Irwin; Gunn, Heather; Mazza, Gina; Tein, Jenn-Yun; Wolchik, Sharlene; Kim, Hanjoe; Ayers, Tim; Porter, Michele

doi: 10.1037/ccp0000327pmid: 30265043

Objective: Effects are reported of the Family Bereavement Program (FBP) on the mental health of bereaved youth and their surviving parent 15 years following the program. Method: On-hundred and 56 families (244 children ages 8–16; 54% male; 67% Non-Hispanic White) were randomly assigned to receive either the FBP (N = 90) or a literature control condition (N = 66). At the 15-year follow-up 80% of the youth and 76% of the bereaved parents were reinterviewed. Mental health problems and service use were self-reported by young adults and their parents. Key informants reported on mental health problems of young adults. Results: Young adults in the FBP reported significantly less use of mental health services and of psychiatric medication than controls. Key informants reported significantly lower mental health problems for young adults who were in FBP as compared with controls and for those who were younger lower internalizing and externalizing problems for those in the FBP as compared with controls. Bereaved parents reported a significantly lower rate of alcoholism and less use of support groups than controls. Conclusions: The results provided evidence that FBP led to lower mental health problems and less service use by bereaved young adults and their parents as compared with controls.

Shelleby, Elizabeth C.; Shaw, Daniel S.; Dishion, Thomas J.; Wilson, Melvin N.; Gardner, Frances

doi: 10.1037/ccp0000337pmid: 30265044

Objective: The Family Check-Up (FCU) is a preventive intervention found to significantly reduce child conduct problems (CP). This study examined the extent to which parents reported that their child’s CP were a problem for them at baseline (baseline CP) as a moderator of FCU effects into middle childhood and moderated mediation models to explore positive parent-child dyadic interaction and maternal depressive symptoms as mediators. Method: Participants included 731 mother-child dyads followed from child ages 2 to 9.5 (49% female; 28% African American, 50% European American, 13% biracial, and 9% other; 13% self-reported as Hispanic), with half assigned to the FCU. Maternal depressive symptoms, observed parent and child behavior (positive dyadic interaction), and CP were assessed annually. Results: Support was found for baseline CP as a moderator of the FCU, with significant decreases in CP for children in the FCU demonstrating high baseline CP. The following associations did not differ between those with high versus low baseline CP. The FCU significantly increased positive dyadic interaction. Lower maternal depressive symptoms were associated with significantly lower CP. Conclusions: Findings add to existing evidence that preventive interventions are effective for high-risk families, and the FCU is especially beneficial for children whose parents report high levels of CP in early childhood. Further, the FCU significantly improved positive dyadic interaction for families of children with both high and low baseline CP.

Duberstein, Paul R.; Ward, Erin A.; Chaudron, Linda H.; He, Hue; Toth, Sheree L.; Wang, Wenjuan; Van Orden, Kimberly A.; Gamble, Stephanie A.; Talbot, Nancy L.

doi: 10.1037/ccp0000335pmid: 30265045