Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction.

There are few available culturally and linguistically adapted behavioral health interventions for substance use among Spanish-speaking adults. The authors describe the cultural adaptation of an innovative computer-based training for cognitive behavioral therapy program (CBT4CBT). Based in cognitive-behavioral skills training, CBT4CBT utilizes a telenovela to teach monolingual Spanish-speaking adults who have migrated to the United States to recognize triggers; avoid these situations; and cope more effectively with the consequences of substance use. Participants endorsed high levels of satisfaction with the program content and found the material to be easy to understand and relevant to their life experiences.

Religiosity and Spirituality in Latinx Individuals with Substance Use Disorders: Association with Treatment Outcomes in a Randomized Clinical Trial.

Although many studies have examined religiosity as a protective factor for substance use, few have considered its relationship to treatment outcomes among Latinx adults. Using data from 89 individuals participating in a randomized clinical trial evaluating a culturally adapted Spanish-language version of web-based cognitive behavioral therapy (CBT4CBT-Spanish) for substance use, we evaluated the relationship between religiosity, as measured by the Religious Background and Behavior questionnaire, and treatment outcomes. Overall, there were few significant correlations between religiosity scores and treatment outcomes. Past-year religiosity was positively correlated with one measure of abstinence for those randomized to CBT4CBT-Spanish, but this did not persist during a six-month follow-up period. Findings suggest that religiosity may be associated with short-term abstinence outcomes among Latinx adults receiving a culturally adapted cognitive behavioral therapy treatment. However, additional research is needed with larger and more heterogenous Latinx populations.

Using the Cultural Formulation Interview to Build Culturally Sensitive Services.

As part of the development of DSM-5, the Cultural Formulation Interview (CFI) was administered to 30 monolingual Spanish-speaking adults at one site of a 2012 feasibility study of the CFI. The authors identified salient themes in data collected through use of the CFI, with a focus on interventions that could lead to more culturally responsive mental health services. Findings suggest that establishing trust and focusing on the restoration of social ties while attending to the impact of stigma and patients' pressing psychosocial needs are elements of culturally responsive services for Hispanic persons. Routine use of the CFI can help clinicians identify unique needs and preferences by understanding an individual within his or her cultural context.

The convergence of personality disorder diagnoses across different methods among monolingual (Spanish-speaking only) Hispanic patients in substance use treatment.

Methods for diagnosing personality disorders (PDs) within clinical settings typically diverge from those used in treatment research. Treatment groups in research studies are routinely diagnosed using semistructured interviews or self-report questionnaires, yet these methods show poor agreement with clinical diagnoses recorded in medical charts or assigned by treating clinicians, reducing the potential for evidence-based practice. Furthermore, existing research has been limited by focusing on primarily White and English-speaking participants. Our study extended prior research by comparing 4 independent methods of PD diagnosis, including self-report questionnaire, semistructured interview, chart diagnoses, and ratings by treating clinicians, within a clinical series of 130 monolingual (Spanish only) Hispanic persons (69% male; M age 37.4), in treatment for substance use. The authors examined the convergence of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) PD diagnoses across these methods. PD diagnoses appeared infrequently within medical charts but were diagnosed at higher levels by independent treating clinicians, self-report questionnaires, and semistructured interviews. Nonetheless, diagnostic concordance between clinical diagnoses and the other methods were poor (κ < .20). Convergence of PD diagnoses across diagnostic methods for Spanish-speaking Hispanic persons are comparable to other groups allaying concerns about cross-cultural application of PD diagnoses. Additionally, the results of this study echo previous research in suggesting that clinicians' PD diagnoses overlap little with self-report questionnaires or semistructured diagnostic interviews and suggest that PDs are underdiagnosed using standard diagnostic approaches. Implications for the clinical application of empirically supported research are discussed.

Negative weight-based attitudes in treatment-seeking obese monolingual Hispanic patients with and without binge eating disorder.

OBJECTIVE: The aims of this study were to compare weight-based attitudes in obese Latino adults with and without binge eating disorder (BED) and to examine whether these attitudes are related to indices of eating disorder psychopathology and psychological functioning. METHOD: Participants were a consecutive series of 79 monolingual Spanish-speaking-only obese Latinos (65 female, 14 male) participating in a randomized placebo-controlled trial performed at a Hispanic community mental health center. Participants were categorized as meeting the criteria for BED (n = 40) or obese non-binge-eating controls (n = 39) based on diagnostic and semistructured interviews administered by fully bilingual research clinicians trained specifically for this study. RESULTS: Analyses revealed that negative attitudes toward obesity did not differ significantly between the BED and non-binge-eating groups nor were they correlated with the intensity of eating disorder psychopathology (eg, levels of weight and shape concerns). Overall, the levels of negative attitudes toward obesity in this Latino/Latina group are similar to those reported previously for samples of English-speaking primarily white obese persons. DISCUSSION: These findings suggest that it may be obesity per se-rather than eating disorder psychopathology or body image-that heightens vulnerability to negative weight-based attitudes.

Informal discussions in substance abuse treatment sessions with Spanish-speaking clients.

This study investigated the extent to which bilingual counselors initiated informal discussions about topics that were unrelated to the treatment of their monolingual Spanish-speaking Hispanic clients in a National Institute on Drug Abuse Clinical Trial Network protocol examining the effectiveness of motivational enhancement therapy (MET). Session audiotapes were independently rated to assess counselor treatment fidelity and the incidence of informal discussions. Eighty-three percent of the 23 counselors participating in the trial initiated informal discussions at least once in one or more of their sessions. Counselors delivering MET in the trial initiated informal discussion significantly less often than the counselors delivering standard treatment. Counselors delivering standard treatment were likely to talk informally the most when they were ethnically non-Latin. In addition, informal discussion was found to have significant inverse correlations with client motivation to reduce substance use and client retention in treatment. These results suggest that informal discussion may have adverse consequences on Hispanic clients' motivation for change and substance abuse treatment outcomes and that maintaining a more formal relationship in early treatment sessions may work best with Hispanic clients. Careful counselor training and supervision in MET may suppress the tendency of counselors to talk informally in sessions.

The prevalence and structure of obsessive-compulsive personality disorder in Hispanic psychiatric outpatients.

This study sought to confirm a multi-factor model of Obsessive-compulsive personality disorder (OCPD) in a Hispanic outpatient sample and to explore associations of the OCPD factors with aggression, depression, and suicidal thoughts. One hundred and thirty monolingual, Spanish-speaking participants were recruited from a community mental health center and were assessed by bilingual doctoral-level clinicians. OCPD was highly prevalent (26%) in this sample. Multi-factor models of OCPD were tested and the two factors - perfectionism and interpersonal rigidity - provided the best model fit. Interpersonal rigidity was associated with aggression and anger while perfectionism was associated with depression and suicidal thoughts.

A multisite randomized effectiveness trial of motivational enhancement therapy for Spanish-speaking substance users.

Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition x Time interactions nor Site x Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude.

Las múltiples caras de la hospitalización parcial / The many faces of partial hospitalization

Se revisa el papel de la hospitalización parcial dentro del marco de la continuidad asistencial de los servicios de salud mental. A partir del análisis de cuatro casos ejemplificadores de las diversas opciones terapéuticas de estos programas, se cuestionan algunos mitos en relación con esta modalidad y se subrayan las evidencias establecidas con respecto a ésta. Asimismo, se identifican sus principales funciones y los aspectos fundamentales e idiosincráticos que caracterizan a este tipo de recursos.

This paper reviews partial hospitalization in the context of the continuum of care of mental health services. This is accomplished through the analysis of four case examples that illustrate different modalities offered by these programs. Myths about this treatment modality are discussed in light of available evidence. The principal functions, in addition to the fundamental and unique features characteristic of partial hospitalization are identified and discussed.

Loss of control over eating is associated with eating disorder psychopathology in a community sample of Latinas.

This study examined the association between loss of control and eating disorder psychopathology in a community sample of women of Hispanic origin. Seventy-seven monolingual Spanish-speaking Latinas recruited from the community were administered the Spanish language version of the Eating Disorders Examination (S-EDE). Latinas who reported regular (at least once weekly) loss of control-through objective bulimic episodes (OBEs) and/or subjective bulimic episodes (SBEs)-were compared with Latinas who did not report regular loss of control. Latinas who reported LOC did not differ significantly from Latinas who denied LOC in age, current body mass index, or highest adult weight. Latinas who reported LOC had significantly more frequent weight cycling and significantly higher scores on all S-EDE subscales. The findings suggest that regular loss of control over eating-regardless of the amount of food consumed-may be a marker for the presence of eating disorder psychopathology.

Application of cultural constructs in the care of first generation Latino clients in a community mental health setting.

As the Latino population in the United States grows, it is imperative to attend to the appropriateness of the mental health care that is being provided to its members. Latinos experience many of the same behavioral health disorders as other ethnic and cultural groups in the United States, but underutilize services relative to many other groups. Such underutilization may be related to issues such as stigma, language, and acculturation level, all of which often create barriers to treatment. First generation Latinos (i.e., individuals born outside the United States) are especially vulnerable to adverse experiences when seeking and receiving treatment. This may be due in part to acculturation and language issues which may further contribute to future underutilization of services. A well established therapeutic alliance developed through the appropriate use of cultural constructs may help mitigate some of the barriers faced by some Latino groups, especially those who are first generation. This paper reviews several cultural constructs that have been highlighted in the Hispanic behavioral health literature and discusses their potential implications for clinical care. This paper offers a number of practical clinical guidelines for mental health professionals who work with Latino groups. These clinical recommendations are based on a synthesis of selected cultural constructs and the clinical experiences of the authors' work in a large community-based Hispanic mental health clinic.