Journal of Consulting and Clinical Psychology

Ruggero, Camilo J.; Kotov, Roman; Hopwood, Christopher J.; First, Michael; Clark, Lee Anna; Skodol, Andrew E.; Mullins-Sweatt, Stephanie N.; Patrick, Christopher J.; Bach, Bo; Cicero, David C.; Docherty, Anna; Simms, Leonard J.; Bagby, R. Michael; Krueger, Robert F.; Callahan, Jennifer L.; Chmielewski, Michael; Conway, Christopher C.; De Clercq, Barbara; Dornbach-Bender, Allison; Eaton, Nicholas R.; Forbes, Miriam K.; Forbush, Kelsie T.; Haltigan, John D.; Miller, Joshua D.; Morey, Leslie C.; Patalay, Praveetha; Regier, Darrel A.; Reininghaus, Ulrich; Shackman, Alexander J.; Waszczuk, Monika A.; Watson, David; Wright, Aidan G. C.; Zimmermann, Johannes

doi: 10.1037/ccp0000452pmid: 31724426

Objective: Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. Method: The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. Results: Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed. Conclusions: HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility.

Kogan, Steven M.; Bae, Dayoung; Lei, Man-Kit; Brody, Gene H.

doi: 10.1037/ccp0000448pmid: 31613129

Objective: The efficacy of the Strong African American Families (SAAF) alcohol use prevention program was tested. SAAF is a 7-session family skills training program offered in community settings. To overcome limitations of a past trial that used intent-to-treat (ITT) analyses, a Complier Average Causal Effect (CACE) analysis was used to estimate intervention effects and to determine the precise dosage of the intervention needed to achieve alcohol deterrence. Method: A sample of 472 African American youth and their caregivers were recruited randomly from public schools in 7 rural Georgia counties. Families were assigned randomly to receive SAAF or a no-treatment control. Youth provided data on their alcohol use during the past 3 months at 4 home visits, the final occurring 34 months after baseline and 28 months after the intervention. Results: Efficacy was tested with Poisson latent growth curve models. SAAF deterred growth in alcohol use in models using both ITT and CACE estimation. CACE analyses revealed that, among participants who received a full dose of the intervention (7 sessions), a large treatment effect on slowed growth in alcohol use emerged (β = −.83, p < .001). Dose-response analyses in CACE models revealed a medium-sized effect (d [95% CI] = 1.51 [1.25, 1.75]) when participants attended at least 5 of the 7 sessions offered. Conclusions: Replication of SAAF in a second randomized prevention trial supports the robustness of program effects. It is critical, however, that participant engagement protocols be designed to encourage participation in as at least 5 of the 7 sessions.

Magill, Molly; Ray, Lara; Kiluk, Brian; Hoadley, Ariel; Bernstein, Michael; Tonigan, J. Scott; Carroll, Kathleen

doi: 10.1037/ccp0000447pmid: 31599606

Objective: This meta-analysis examined 30 randomized controlled trials (32 study sites; 35 study arms) that tested the efficacy of cognitive-behavioral therapy (CBT) for alcohol or other drug use disorders. The study aim was to provide estimates of efficacy against three levels of experimental contrast (i.e., minimal [k = 5]; nonspecific therapy [k = 11]; specific therapy [k = 19]) for consumption frequency and quantity outcomes at early (1 to 6 months [kes = 41]) and late (8+ months [kes = 26]) follow-up time points. When pooled effect sizes were statistically heterogeneous, study-level moderators were examined. Method: The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Sensitivity analyses included tests of heterogeneity, study influence, and publication bias. Results: CBT in contrast to minimal treatment showed a moderate and significant effect size that was consistent across outcome type and follow-up. When CBT was contrasted with a nonspecific therapy or treatment as usual, treatment effect was statistically significant for consumption frequency and quantity at early, but not late, follow-up. CBT effects in contrast to a specific therapy were consistently nonsignificant across outcomes and follow-up time points. Of 10 pooled effect sizes examined, two showed moderate heterogeneity, but multivariate analyses revealed few systematic predictors of between-study variance. Conclusions: The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or nonspecific control. Consistent with findings on other evidence-based therapies, CBT did not show superior efficacy in contrast to another specific modality.

Kang, Dahyeon; Fairbairn, Catharine E.; Ariss, Talia A.

doi: 10.1037/ccp0000450pmid: 31724427

Objective: Emotional distress has been posited as a key underlying mechanism in the development and maintenance of substance use disorder (SUD), and patients seeking SUD treatment are often experiencing high levels of negative emotion and/or low levels of positive emotion. But the extent to which SUD interventions impact emotional outcomes among general SUD populations is yet unquantified. The current meta-analysis aims to fill this gap. Method: A total of 11,754 records were screened for randomized, controlled trials examining the effect of behavioral SUD interventions on emotion outcomes. Our search yielded a total of 138 effect sizes calculated based on data from 5,146 individuals enrolled in 30 independent clinical trials. Random-effects meta-analysis was used to calculate pooled effect sizes, and metaregression analyses examined study-level moderators (e.g., intervention type). Results: Findings indicated a small but significant effect of SUD interventions on emotion outcomes, d = 0.157, 95% CI [0.052, 0.262] (k = 30). The effect size for negative emotion was nominally bigger, d = 0.162, 95% CI [0.056, 0.269] (k = 30), whereas the effect for positive emotion did not reach statistical significance, d = 0.062, 95% CI [−0.089, 0.213] (k = 7). Studies featuring SUD interventions designed to specifically target emotions (i.e., affect-regulation, mindfulness-based treatments) produced larger reductions in negative emotion compared with studies featuring interventions that did not contain specific emotion modules (e.g., contingency management). Conclusions: Findings suggest that SUD interventions—especially mindfulness-based and affect-regulation treatments—indeed significantly reduce negative emotion, although relatively small effect sizes indicate potential room for improvement. Conclusions regarding positive emotion should be considered preliminary because of the limited numbers of samples assessing these outcomes.

Langhinrichsen-Rohling, Jennifer; Snarr, Jeffery D.; Slep, Amy M. Smith; Heyman, Richard E.

doi: 10.1037/ccp0000435pmid: 31556654

Objective: Differentiating suicide attempters from suicide ideators has been named a critical suicidology frontier (Klonsky & May, 2013). Per Bronfenbrenner’s (1977, 1994) ecological systems theory, risk/protective factors from four ecological levels (individual, family, workplace, and community) were used to predict last year suicide attempt status among active duty service members expressing suicide ideation. Method: Active duty U.S. Air Force members (N = 52,780, 79.3% male, 79.2% non-Hispanic White, M age = 31.8 years) anonymously completed an online community assessment administered biennially at 82 bases worldwide. Last year suicide ideation and attempts were concurrently measured, as were an array of co-occurring risk and protective factors. Results: Among the 1,927 (approximately 4%) service members self-reporting suicidal ideation, 152 also reported a last year suicide attempt (7.9% of the ideators, 8.7% of men vs. 6.1% of women). However, in multivariate models, military member sex was not a significant moderator. In bivariate models, numerous individual, family/spouse/parent, and community factors were associated with suicide attempt status. In the final multivariate model for the whole sample, risk for a last year attempt was associated with years in the military, social support, and alcohol use problems, but not depression. Among active duty military in relationships, attempt status risk was associated with years in the military, social support, and intimate partner violence victimization. However, the effect sizes for these models were small. Conclusions: Beyond a focus on depression, addressing alcohol misuse, facilitating resilient and nonviolent couple/family relationships, and increasing social support may enhance suicide attempt prevention efforts among military members.

Zisk, Abigail; Abbott, Caroline H.; Bounoua, Nadia; Diamond, Guy S.; Kobak, Roger

doi: 10.1037/ccp0000457pmid: 31647277

Objective: Although there are currently several efficacious treatments for depressed and suicidal adolescents, less is known about predictors and moderators of adolescents’ treatment response. A growing literature has identified family functioning as a prognostic indicator of adolescents’ likelihood of benefiting from treatment. The current study tested both observational and perceived measures of family functioning as indicators of adolescents’ response to 2 treatment conditions. Method: The sample consisted of 129 depressed and suicidal adolescents (Mage = 14.96, 82.9% female, 56% Black/African American) who were randomized to attachment-based family therapy or family-enhanced nondirective supportive therapy (Diamond et al., 2019). Baseline assessments of family functioning included ratings of parent–adolescent communication coded with the Goal-Corrected Partnership in Adolescence Coding System (Lyons-Ruth, Hennighausen, & Holmes, 2005) and adolescent and parent reports of Family Conflict and Cohesion from the Self-Report of Family Functioning (Bloom, 1985). Results: Adolescents who engaged in more uncooperative communication with their parents during a 10-min conflict discussion showed greater reductions in depressive symptoms in both treatments. Adolescents from traditionally underserved (non-White or lower income) families showed greater reductions in suicidal ideation in both treatments. Conclusions: Attachment-based family therapy and family-enhanced nondirective supportive therapy were most effective for adolescents from traditionally underserved families and adolescents who engaged in less cooperative communication with their caregivers. Observational ratings of parent–adolescent communication were better prognostic indicators of treatment response than were self-reported indicators of global family functioning. Implications for generalizing these results to other treatments for depressed and suicidal adolescents are discussed.

Owen, Jesse; Drinane, Joanna M.; Kivlighan, Martin; Miller, Scott; Kopta, Mark; Imel, Zac

doi: 10.1037/ccp0000437pmid: 31545628

Objective: Therapist effectiveness has primarily been defined as being the aggregate of the client therapy outcomes within a therapist’s caseload. It may seem intuitive that the most skilled therapists are both effective (in the way defined above) and consistent in facilitating positive outcomes across their clients; however, this premise has not been fully tested. The present study sought to empirically examine this question in a large, multisite, geographically diverse sample. We first computed a consistency variable and an aggregate outcome variable for each therapist among a subset of each individual therapist’s caseload (the first 30 clients per therapist within our data set). We then utilized this consistency score and aggregate outcome score to predict the therapy outcomes of their remaining clients. Clients’ pretreatment severity scores were also included as a moderator of the association between therapist consistency, therapist aggregate outcome, and client outcomes. Method: The sample included 27,778 clients who were treated by 275 therapists. At the start of each session, clients completed the Behavioral Health Measure–20 as a measure of psychological functioning. Results: Polynomial regression and response surface analysis indicated a discrepant effect, such that subsequent clients’ outcomes were highest when therapists’ aggregate outcome with their first 30 clients was high and the consistency in the outcomes of their first 30 clients was also high. This relationship was not moderated by clients’ pretreatment severity. Conclusion: Therapists’ expertise consists of both high performance and consistency. Therapists who achieved better outcomes consistently were top performers with their subsequent clients.