Understanding Therapists' Work With Suicidal Patients: An Examination of Qualitative Data.

The collaborative assessment and management of suicidality (CAMS) serves as a framework for maintaining a collaborative relationship between the therapist and patient. This study used an original coding manual to examine responses to open-ended questions to better understand the ways in which therapists use CAMS collaboratively as well as their reasons for adhering (or not adhering) to certain aspects of the framework. Results suggest differences in treatment application based on therapist characteristics including amount of experience, intensity of training received, and experience of a patient suicide attempt. Implications of this research include informing therapists interested in using the CAMS framework about the specific ways in which implementation can be made collaborative. Further, this research helps to shed light on how experiencing a client's death by suicide can impact therapists' future work with suicidal clients.

Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial.

BACKGROUND: Mindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources. OBJECTIVE: This pilot study examined the feasibility of a text messaging program (iQuit Mindfully) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation. METHODS: A total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants' ratings), participants' feedback regarding the text messaging intervention, and smoking cessation (assessed in person). RESULTS: Strong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment (P=.03) but not among those receiving iQuit Mindfully. CONCLUSIONS: Text messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting. TRIAL REGISTRATION: ClinicalTrials.gov NCT03029819; https://clinicaltrials.gov/ct2/show/NCT03029819.

Collegiate Athletes' Expectations and Experiences with Mindful Sport Performance Enhancement.

Although mindfulness training for athletes is an area of increasing interest, few studies have focused on the qualitative experiences of athletes in such programs. Prior to beginning six sessions of mindful sport performance enhancement (MSPE) training, 45 mixed-sport collegiate athletes reported what they hoped and expected to get from the training, and responded afterward to open-ended questions about their experiences. Participants' responses were coded for themes with high inter-rater reliability. Athletes initially hoped to gain psychological benefits in both sport and everyday life, such as relaxation and less stress or anxiety, better emotion regulation, mental toughness, and self-awareness, as well as sport performance improvement. Overall, they found MSPE to be a positive experience and reported many of the same benefits that they expected. Participants also provided constructive feedback and recommendations for future MSPE training. Finally, there was evidence to suggest that athletes' expectations predicted similar improvements in outcome measures.

Avoidant coping in panic disorder: a yohimbine biological challenge study.

Few studies have addressed whether the use of avoidance-oriented coping strategies is related to the development of panic in patients with panic disorder(PD). Self-report, clinician-rated, and physiological data were collected from 42 individuals who participated in a yohimbine biological challenge study, performed under double-blind, placebo-controlled conditions. Participants included 20 healthy controls and 22 currently symptomatic patients who met DSM-IV-TR diagnostic criteria for PD. Consistent with prediction, patients with PD who had higher perceived efficacy of avoidance-oriented strategies in reducing anxiety-related thoughts reported increased severity in panic symptoms during the yohimbine challenge condition as compared to the placebo. Further, patients with PD who had more fear of cognitive dyscontrol, cardiovascular symptoms, and publicly observable anxiety also reported increased severity in panic symptoms during the challenge. Healthy controls who had more fear of cardiovascular symptoms similarly reported increased severity in panic symptoms during the challenge. No effects were found for heart rate response to the challenge agent. These results provide support for the role of avoidance-oriented coping strategies and fear of anxiety-related symptoms as risk and maintenance factors in the development of panic symptoms, particularly within a biological challenge model.

Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma.

Mindfulness- and acceptance-based conceptualizations of PTSD implicate experiential avoidance and non-mindful behavior in the etiology and maintenance of the disorder. If experiential avoidance is associated with vulnerability to PTSD, then a mindful and accepting orientation toward experience may confer psychological resilience following exposure to trauma. This article examines how mindfulness- and acceptance-based theories of psychopathology relate to risk of and resilience to PTSD. Research is reviewed dealing with the impact of experiential avoidance, avoidant coping, dissociation, acceptance, and mindfulness on PTSD symptom severity and posttraumatic functioning. This review suggests that trait mindfulness and acceptance are associated with greater psychological adjustment following exposure to trauma, while experiential avoidance, persistent dissociation, and coping strategies involving emotional disengagement are associated with greater PTSD symptom severity and related psychopathology. Methodological challenges are explored and suggestions for future research and PTSD prevention programs are discussed.

Predictors of the impact of the September 11th terrorist attacks on victims of intimate partner violence.

This study examined the role of several hypothesized predictors of the impact of a potentially traumatic event, the terrorist attacks of September 11, 2001 (9/11), on a sample of women experiencing intimate partner violence (IPV) and related posttraumatic stress symptoms (PTSS). We found that IPV-related PTSS mediated the relationship between IPV and 9/11-related PTSS, confirming the hypothesis that severity of symptoms related to prior trauma plays a role in the development and severity of PTSS related to subsequent potentially traumatic events. Media exposure and threat appraisal were significantly positively associated with 9/11-related PTSS, whereas social support was significantly negatively associated with 9/11-related PTSS, with none of these variables serving as moderators of the relationship between IPV-related and 9/11-related PTSS. Our results suggest that trauma-related psychiatric history is an important factor in the development of PTSS subsequent to an additional potentially traumatic event, even after adjusting for relevant variables occurring at the time of that event.

Expectations.

Patients' expectations have long been considered a contributory factor to successful psychotherapy. Expectations come in different guises, with outcome expectations centered on prognostic beliefs about the consequences of engaging in treatment. In this article, we define outcome expectations and present assessment methods and clinical examples of outcome expectations. Our research review includes a comprehensive meta-analysis (N =8,016 patients across 46 independent samples) of the association between pretherapy or early-therapy outcome expectations and posttreatment outcomes. The overall weighted effect size was d=.24, p<.001, indicating a small but significant positive effect of outcome expectations on adaptive treatment outcomes. We also provide a narrative review of mediators of the expectation-outcome link and patient factors that relate to their outcome expectations. Finally, we discuss limitations of the research base and offer therapeutic practices based on our findings.

The impact of the September 11th terrorist attacks on psychiatric patients: a review.

Studies of the general population have shown that the terrorist attacks of September 11, 2001 had a well-documented psychological effect, regardless of whether or not individuals were directly exposed to the events. In light of findings that pre-existing mental illness and prior exposure to trauma are associated with vulnerability to PTSD following a subsequent traumatic event, this article reviews research on the impact of the September 11th terrorist attacks on psychiatric patients. Findings suggest that, in general, psychiatric patients experienced immediate and long-term posttraumatic symptoms at levels greater than normal controls, although there were differential effects by diagnostic group and symptoms as observed did not always match complaints of subjective impairment. Studies sampling inpatients and outpatients, as well as research regarding service utilization, are evaluated. Assessment and treatment implications for clinicians responsible for the care of psychiatric patients following a national trauma are discussed, and recommendations for future research are presented.

Psychotherapy integration as practiced by experts.

Twenty-four psychotherapists who were experts in psychotherapy integration and had a mean of 32 years of clinical experience completed a questionnaire assessing their practice history and fidelity to various psychodynamic, cognitive-behavioral, humanistic, and family systems theories. They then completed the 100-item Psychotherapy Process Q set (Jones, Hall, & Parke, 1991) modified to be a self-report questionnaire, based on a client they had treated using integrative therapy. Most therapists reported some influence of all 4 orientations, but almost three-quarters indicated that only 1 was a salient influence. Principal components factor analysis revealed 4 factors representing 4 integrative practice styles, which were then correlated with prior prototypes of cognitive-behavioral, psychodynamic, and interpersonal therapies. The first factor, accounting for just over half the variance, most resembled cognitive-behavioral therapy. The second factor shared elements of several orientations, whereas the third factor most resembled psychodynamic therapy. The responses of more than half the therapists loaded on more than 1 factor. Findings demonstrate a diversity of theoretical influences and practices among these experts. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations.

Post-traumatic stress disorder (PTSD) represents a frequent consequence of a variety of extreme psychological stressors. Lists of empirically supported treatments for PTSD usually include cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR), but nonresponse and dropout rates in these treatments often are high. We review the treatment dropout and nonresponse rates in 55 studies of empirically supported treatments for PTSD, review the literature for predictors of dropout and nonresponse, discuss methodological inconsistencies in the literature that make comparisons across studies difficult, and outline future directions for research. Dropout rates ranged widely and may have depended, at least in part, on the nature of the study population. It was not uncommon to find nonresponse rates as high as 50%. Standard methods of reporting dropout and nonresponse rates are needed for reporting outcomes. We suggest guidelines for collecting data to help identify characteristics and predictors of dropouts and nonresponders.

Contributions of psychodynamic approaches to treatment of PTSD and trauma: a review of the empirical treatment and psychopathology literature.

Reviews of currently empirically supported treatments for post-traumatic stress disorder (PTSD) show that despite their efficacy for many patients, these treatments have high nonresponse and dropout rates. This article develops arguments for the value of psychodynamic approaches for PTSD, based on a review of the empirical psychopathology and treatment literature. Psychodynamic approaches may help address crucial areas in the clinical presentation of PTSD and the sequelae of trauma that are not targeted by currently empirically supported treatments. They may be particularly helpful when treating complex PTSD. Empirical and clinical evidence suggests that psychodynamic approaches may result in improved self-esteem, increased ability to resolve reactions to trauma through improved reflective functioning, increased reliance on mature defenses with concomitant decreased reliance on immature defenses, the internalization of more secure working models of relationships, and improved social functioning. Additionally, psychodynamic psychotherapy tends to result in continued improvement after treatment ends. Additional empirical studies of psychodynamic psychotherapy for PTSD are needed, including randomized controlled outcome studies.

The structure of worry: relations between positive/negative personality characteristics and the Penn State Worry Questionnaire.

The present studies investigated the structure, correlates, and predictors of worry, as assessed by the Penn State Worry Questionnaire (PSWQ), in a large nonclinical sample (N=1439). Exploratory factor analysis of the PSWQ in Study 1 revealed a two-factor solution (Worry Engagement and Absence of Worry). Confirmatory factor analysis in Study 2 indicated that the two-factor solution provided a better fit to the data than a one-factor model. The PSWQ and its factors evidenced good internal consistency, and correlations with measures of positive and negative state-trait variables provided evidence for good convergent and discriminant validity in both studies. Evidence for the specificity of the two-factor solution was also found such that the Worry Engagement factor demonstrated higher correlations with negative state-trait variables than the Absence of Worry factor. However, path analyses in Study 3 examining predictors of worry provided support for a one-factor solution to the PSWQ. Furthermore, path analyses showed that trait anxiety significantly mediated the relationship between negative characteristics and worry, whereas trait anxiety inversely mediated the relationship between positive characteristics and worry. These findings support the use of the PSWQ in research examining the nature of worry and highlight how positive and negative characteristics may have unique relations with worry in the context of trait anxiety.

Religious coping research and contemporary personality theory: an exploration of Endler's (1997) integrative personality theory.

Notable weaknesses in the literature on religion and mental health include theoretical inconsistencies and lack of integration with contemporary personality theory. The current study explored a potential solution to these theoretical limitations. A modified form of Endler's (1997) interactive model of personality was applied to the prediction of religious coping and tested using structural equation modelling. As predicted by the model, personality dispositions predicted coping directly, as well as indirectly through perception of the situation and situational anxiety. These patterns were, as expected, found to interact with the type of situation. Results indicated that having a positive disposition appears to buffer one's negative perceptions of situations over which one has little control. Participants tended to use more religious coping in low-control situations; in high-control situations, participants tended not to use negative religious coping techniques such as pleading for miracles.

The hoarding dimension of OCD: psychological comorbidity and the five-factor personality model.

Although hoarding has been associated with several psychological disorders, it is most frequently linked to obsessive-compulsive disorder (OCD). The present study assessed hoarding obsessions and compulsions in 204 individuals with OCD, and evaluated how hoarding was related to obsessive-compulsive symptom severity, psychological comorbidity, and personality as measured by the five-factor model. Results indicated that hoarding in OCD is a dimensional variable that is positively associated with dysphoria, total number of lifetime Axis I disorders, and lifetime histories of bipolar I, PTSD, and body dysmorphic disorder. Hoarding was negatively correlated with the NEO-Personality Inventory-Revised (NEO-PI-R) factor of Conscientiousness and positively associated with the NEO-PI-R factor of Neuroticism. When all personality and psychopathology variables were entered into a regression equation, dysphoria, bipolar II disorder, Conscientiousness, age, and Extraversion emerged as significant predictors of hoarding severity. Recommendations are made for clinicians and for future research.