Journal of Consulting and Clinical Psychology

Nota, Jacob A.; Chu, Carol; Beard, Courtney; Björgvinsson, Thröstur

doi: 10.1037/ccp0000610pmid: 33136421

Objective: Bidirectional relations between sleep disturbances, depression symptoms, and anxiety symptoms have been frequently observed in empirical studies; however, little is known about the temporal relations between these variables in the context of treatment. Method: The current study examines the temporal relations between sleep parameters, depression symptoms, and anxiety symptoms in a large sample of individuals undergoing intensive cognitive–behavioral partial hospital treatment (N = 1,184). Random-intercept cross-lagged panel models were fit to these data to determine whether (1) sleep parameters uniquely predicted subsequent depression and anxiety symptoms and (2) depression and anxiety symptoms uniquely predicted subsequent sleep parameters. Results: Results revealed relations in both directions: later than usual bedtimes predicted higher than usual anxiety and depression the next day, shorter than usual sleep duration predicted higher than usual depression the next day, shorter than usual nighttime sleep onset latency predicted higher than usual anxiety the next day, and higher than usual anxiety predicted shorter than usual sleep duration on the next night. Conclusions: These finding suggest the potential value of examining sleep behaviors associated with sleep timing and circadian rhythms as important transdiagnostic factors during treatment for anxiety and depression. We discuss the implications for future studies of the relations between sleep and psychopathology symptoms and understanding individuals’ experiences in the context of cognitive–behavioral treatment.

Wasil, Akash R.; Gillespie, Sarah; Patel, Raveena; Petre, Annemarie; Venturo-Conerly, Katherine E.; Shingleton, Rebecca M.; Weisz, John R.; DeRubeis, Robert J.

doi: 10.1037/ccp0000604pmid: 32881542

Objective: To assess the dissemination of evidence-based content within smartphone apps for depression and anxiety by developing and applying user-adjusted analysis—a method for weighting app content based on each app’s number of active users. Method: We searched the Apple App Store and Google Play Store and identified 27 apps within the top search hits, which real-world users are most likely to encounter. We developed a codebook of evidence-based treatment elements by reviewing past research on empirically supported treatments. We coded the apps to develop an initial tally of the frequency of treatment elements within the mental health (MH) apps. We then developed and applied user-adjusted analysis to refine the tallies based on each app’s number of monthly active users. Results: The 2 most popular apps were responsible for 90% of monthly active users, and user-adjusted analysis markedly altered conclusions of prior reports based on tallies alone. For example, mindfulness was present in 37% of apps but reached 96% of monthly active users, cognitive restructuring was present in 22% but reached only 2%, and exposure was present in 7% but reached only 0.0004%. Conclusions: The potential impact of MH apps on mental health may be best evaluated via assessment that combines tallies of evidence-based content with data on the content users are actually accessing. Given wide variation in the popularity of MH apps, findings weighted by usage data may differ markedly from findings based on raw tallies alone.

Linardon, Jake; Shatte, Adrian; Messer, Mariel; Firth, Joseph; Fuller-Tyszkiewicz, Matthew

doi: 10.1037/ccp0000575pmid: 32852971

Objectives: E-mental health (digital) interventions can help overcome existing barriers that stand in the way of people receiving help for an eating disorder (ED). Although e-mental health interventions for treating and preventing EDs have been met with enthusiasm, earlier reviews brought attention to poor quality of evidence, and offered solutions to enhance their evidence base. To assess developments in the field, we conducted an updated meta-analysis on the efficacy of e-mental health interventions for treating and preventing EDs, paying attention to whether trial quality and outcomes have improved in recent trials. We also assessed whether user-centered design principles have been implemented in existing digital interventions. Method: Four databases were searched for RCTs of digital interventions for treating and preventing EDs. Thirty-six RCTs (28 prevention- and 8 treatment-focused) were included. Results: Some evidence that study quality improved in recent prevention-focused trials was found. Few trials involved the end-user in the design or development stage of the intervention. Issues with intervention engagement were noted, and 1 in 4 participants dropped out from prevention- and treatment-focused trials. Digital interventions were more effective than control conditions in reducing established risk factors and symptoms in prevention- (g’s = 0.19 to 0.43) and treatment-focused trials (g’s = 0.29 to 0.69), respectively. Effect sizes have not increased in recent trials. Few trials compared a digital intervention with a face-to-face intervention. Whether digital interventions can prevent ED onset is unclear. Conclusion: Digital interventions are a promising approach to ED treatment and prevention, but improvements are still needed. Three key recommendations are provided.

Burns, John W.; Van Dyke, Benjamin P.; Newman, Andrea K.; Morais, Calia A.; Thorn, Beverly E.

doi: 10.1037/ccp0000612pmid: 33136422

Objectives: The goals of the study were to determine to what degree changes in pain-related cognition during cognitive behavioral treatment (CBT) and pain education (EDU) represented treatment mechanisms and whether these cognitive changes worked to a larger extent to produce favorable outcomes in CBT than in EDU. Method: Reported here are secondary analyses of a randomized control trial (N = 290) comparing CBT, EDU, and treatment as usual for low-literacy, low-socioeconomic-status people with chronic pain. We excluded the treatment as usual condition from these analyses and included measures collected at a midtreatment epoch. Treatment was 10 weekly group sessions. Results: Linear mixed models revealed nonsignificant differences in pre- to mid- to posttreatment changes in pain catastrophizing and pain self-efficacy between CBT and EDU. The same was true for outcome measures. Cross-lagged analyses revealed significant relationships between pre- to midtreatment changes in catastrophizing and self-efficacy and mid- to posttreatment changes in outcomes. However, relationships between pre- to midtreatment changes in outcomes and mid- to posttreatment changes in catastrophizing and self-efficacy were also significant. Conclusions: Results suggest a complex set of mechanistic relationships. Instead of a unidirectional path from designated mechanism to designated outcome, our results suggest reciprocal influences whereby cognitive changes may beget outcome improvements and vice versa. Results also suggest that cognitive changes do not occur solely in a treatment that uses cognitive restructuring to foster such changes but may occur as a function of providing people with detailed information regarding the biopsychosocial nature of chronic pain.

Weissberg-Benchell, Jill; Shapiro, Jenna B.; Bryant, Fred B.; Hood, Korey K.

doi: 10.1037/ccp0000608pmid: 33136423

Objective: This article reports the 3-year outcomes for the Supporting Teen Problem-Solving (STePS) multisite Randomized Control Trial (RCT); reporting the overall impact of the STePS trial, and the differential impact of each arm of the trial (a resilience promoting intervention [PRP T1D] vs. a diabetes education intervention [EI]) on diabetes-specific emotional distress and depressive symptoms. Method: Participants included 264 adolescents with Type 1 diabetes (T1D), ages 14–18, in Chicago and San Francisco. Both intervention arms lasted 4.5 months and assessments were conducted at baseline, postintervention (4.5 months), and 5 follow-up visits (8, 12, 16, 28, and 40 months from baseline). Intervention efficacy was investigated using latent growth curve modeling (LGCM) to analyze the rate and shape of change of outcomes from preintervention across postintervention and follow-up time points. Results: Mean age of participants was 15.7 years, mean T1D duration was 6.9 years, mean HbA1c at baseline was 9.1%. The sample was diverse with nearly 35% identifying as racial or ethnic minorities, and 60% were female. PRP T1D participants reported significantly lower diabetes distress compared with EI participants, and the effect size increased over time. For the pooled sample, while 40% of youth reported elevated distress at baseline, only 23% reported elevated distress 3 years postintervention. Moreover, PRP T1D participants experienced a significant decline in depressive symptoms from 16 to 40 months postbaseline, while participants in the education arm did not. Conclusions: Results from the 3-year outcomes assessment demonstrate the robust effects of PRP T1D in adolescents with declines in distress and depressive symptoms.

Andover, Margaret S.; Schatten, Heather T.; Holman, Caroline S.; Miller, Ivan W.

doi: 10.1037/ccp0000603pmid: 32816504

Objective: Despite the prevalence and impact of nonsuicidal self-injury (NSSI), there are few treatments developed to treat the behavior specifically, and little is known about moderators of treatment response. The Treatment for Self-Injurious Behaviors (T-SIB), a brief, behavioral intervention, was developed to treat NSSI in young adults; a previous pilot randomized controlled trial (RCT) comparing T-SIB with treatment as usual (TAU) provided support for the intervention. This study examined demographic, clinical, and NSSI-related predictors of treatment outcome in the pilot RCT for T-SIB. Method: Young adults (N = 33) were randomized to receive T-SIB or treatment as usual; all participants were included in intent-to-treat analyses. The primary outcome of NSSI behaviors was assessed at baseline, posttreatment (9 weeks), and 3-month follow up, and potential moderators were assessed at baseline. Results: Greater lifetime and last year NSSI frequency was associated with fewer NSSI behaviors at posttreatment and follow up among participants in T-SIB. Anxious symptoms also moderated treatment outcomes, but other demographic and clinical variables did not. Conclusion: Previous research has shown that T-SIB is more effective than TAU overall; the current study suggests that T-SIB may be effective for individuals with more frequent NSSI and those with elevated anxiety. A larger evaluation of T-SIB is supported.

Simpson, Tracy L.; Hawrilenko, Matt; Goldberg, Simon; Browne, Kendall; Lehavot, Keren; Borowitz, Michelle

doi: 10.1037/ccp0000600pmid: 32790452

Objective: To determine latent classes of treatment receipt among people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) and describe each class by demographics, disease characteristics, and psychiatric diagnoses. Method: Participants were National Epidemiologic Survey on Alcohol and Related Conditions–III respondents with lifetime PTSD and SUD (n = 1,349; mean age 40.3; 62.5% female; 30.9% non-White or Hispanic-White). Cross-sectional data were collected using the DSM–5 Alcohol Use Disorder and Associated Disabilities Interview Schedule. Latent class analysis was used to identify subgroups of participants with different patterns of treatment receipt. Results: Of the patients, 36% received at least 1 SUD treatment while 84% received at least 1 mental health (MH) treatment. Six latent classes were identified: no treatment (17.3%), outpatient MH (34.0%), outpatient + inpatient MH (17.9%), SUD (7.3%), SUD + outpatient MH (15.7%), and SUD + outpatient MH + inpatient MH (7.7%). The SUD treatment classes evidenced greater social instability, had higher alcohol use disorder symptom severity, and used more drug types than the non-SUD classes. Classes receiving inpatient MH treatment had a greater incidence of additional comorbid conditions and suicidal behaviors. Across all 6 classes, most respondents met diagnostic criteria for chronic PTSD (overall: 68.9%) while fewer met diagnostic criteria for chronic SUD (overall: 38.7%). Conclusions: Most people with lifetime PTSD and SUD have sought either SUD or MH treatment or both, with substantially greater receipt of MH treatment. This comorbid group has complex clinical presentations that differ depending upon treatment subgroup, and for most, their PTSD persisted despite high rates of treatment engagement.