Combined MI + CBT for Depressive Symptoms and Binge Drinking Among Young Adults: Two Case Studies.

There are high rates of comorbidity between heavy drinking and depressive symptoms among college students, often resulting in severe alcohol-related consequences. No empirically supported treatment exists that concurrently addresses both of these problems in this population. Research with college students has demonstrated that brief motivational interventions (BMIs) reduce heavy drinking and alcohol-related consequences, and that cognitive behavioral therapy for depression (CBT-D) is effective in reducing depressive symptoms. Thus, a program combining BMI and CBT-D appears ideal for college students with co-occurring binge drinking and depressive symptoms. This manuscript presents the rationale and format of a BMI + CBT-D treatment protocol for this population, and provides a case example of a female college student who received the protocol and experienced improvement in depressive symptoms, a reduction in alcohol use and alcohol-related negative consequences, and an increase in readiness to change alcohol consumption. We discuss theoretical and clinical implications of these findings, and suggest directions for future research.

Does acceptance and relationship focused behavior therapy contribute to bupropion outcomes? A randomized controlled trial of functional analytic psychotherapy and acceptance and commitment therapy for smoking cessation.

This study evaluated a treatment combining bupropion with a novel acceptance and relationship focused behavioral intervention based on the acceptance and relationship context (ARC) model. Three hundred and three smokers from a community sample were randomly assigned to bupropion, a widely used smoking cessation medication, or bupropion plus functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT). Objective measures of smoking outcomes and self-report measures of acceptance and relationship processes were taken at pretreatment, posttreatment, 6-month, and 1-year follow-up. The combined treatment was significantly better than bupropion alone at 1-year follow-up with 7-day point prevalence quit rates of 31.6% in the combined condition versus 17.5% in the medication-alone condition. Acceptance and the therapeutic relationship at posttreatment statistically mediated 12-month outcomes. Bupropion outcomes were enhanced with an acceptance and relationship focused behavioral treatment.

A randomized controlled trial of cognitive-behavioral treatment for depression versus relaxation training for alcohol-dependent individuals with elevated depressive symptoms.

OBJECTIVE: A previous pilot study found positive outcomes among alcohol-dependent individuals with elevated depressive symptoms who received cognitive-behavioral treatment for depression (CBT-D; n = 19) compared with a relaxation training control (RTC; n = 16). The current study represents a replication of this pilot study using a larger sample size and a longer follow-up assessment period. METHOD: Patients entering a partial hospital drug and alcohol treatment program who met criteria for alcohol dependence and elevated depressive symptoms (Beck Depression Inventory score ≥ 15) were recruited and randomly assigned to receive eight individual sessions of CBT-D (n = 81) or RTC (n = 84). RESULTS: There were significant improvements in depressive and alcohol use outcomes over time for all participants.Compared with RTC, the CBT-D condition had significantly lower levels of depressive symptoms, as measured by the Beck Depression Inventory, at the 6-week follow-up. However, this effect was inconsistent because there were no differences in the Modified Hamilton Rating Scale for Depression between conditions at that time point and there were no significant differences at any other follow-up. No significant between-group differences on alcohol use outcomes were found. CONCLUSIONS: The current findings did not replicate the positive outcomes observed in the CBT-D condition in our previous pilot study. Possible explanations for why these findings were not replicated are discussed, as are theoretical and clinical implications of using CBT-D in alcohol treatment.

Reaction to stressful life events: what predicts symptom severity?

This study examined the effect of Criterion A and non-Criterion A (as defined by the DSM-IV-TR) events on symptomatology related to Posttraumatic Stress Disorder (PTSD). Two hundred and forty-one college students completed a series of questionnaires related to symptoms of Posttraumatic Stress Disorder, psychological processes and psychopathology. Participants were divided into two groups: those that experienced a Criterion A traumatic life event as defined by the DSM-IV-TR, and those that experienced a non-Criterion A event. A chi-square analysis revealed a higher percentage of those with a Criterion A event meeting criteria for PTSD, although results indicated no differences on the overall severity of PTSD symptoms, or the re-experiencing, hyperarousal or avoidance subscales of PTSD symptoms between these two groups when time since event and distress were held constant. In a logistic regression analysis, the tendency to engage in thought suppression and level of distress were related to a diagnosis of PTSD, while type of event (Criterion A or non-Criterion A) was marginally related. Results are discussed in relation to ongoing discussion examining the description, classification and impact of a Criterion A event on PTSD symptoms, and the possible impact for treatment.

Evaluating symptom expression as a function of a posttraumatic stress disorder severity.

Little is known about the relative severity or typical sequence of Diagnostic and Statistical Manual (DSM-IV) symptoms of posttraumatic stress disorder (PTSD). Using data from the National Comorbidity Study-Replication (NCS-R) [Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa, S., & Hiripi, E., et al. (2004). The US National Comorbidity Survey-Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research, 13(2), 69-92], the current study used a logistic item response model to assess the degree to which DSM-IV symptoms combine to define a primary construct underlying PTSD, to identify which symptoms are associated with greater severity of PTSD, and to determine whether the symptoms and symptom patterns are influenced by gender. Results suggested that PTSD symptoms can be combined to assess a single dimension of PTSD severity, providing support for a continuum of symptom severity. However, several DSM-IV symptoms provided overlapping information, potentially reducing the effectiveness of these symptoms in describing a broad range of PTSD. More precise assessment of PTSD severity may help improve the descriptive value of PTSD measures relationship to continuous measures of treatment outcomes, and ultimately inform more effective treatments.

Sexual victimization and physical health: an examination of explanatory mechanisms.

There is a growing body of research illustrating a significant relationship between a history of sexual victimization and the development of physical health problems; however, few researchers have examined variables that mediate this relationship. The present study examined two potential mediating variables: experiential avoidance and current stress. Results indicated that current stress significantly mediated the relationship between adult sexual assault and physical health complaints, and experiential avoidance may be a partial mediator. Implications of the findings and future directions are discussed.

Distress tolerance treatment for early-lapse smokers: rationale, program description, and preliminary findings.

A significant percentage of individuals attempting smoking cessation lapse within a matter of days, and very few are able to recover to achieve long-term abstinence. This observation suggests that many smokers may have quit-attempt histories characterized exclusively by early lapses to smoking following quit attempts. Recent negative-reinforcement conceptualizations of early lapse to smoking suggest that individuals' reactions to withdrawal and inability to tolerate the experience of these symptoms, rather than withdrawal severity itself, may represent an important treatment target in the development of new behavioral interventions for this subpopulation of smokers. This article presents the theoretical rationale and describes a novel, multicomponent distress-tolerance treatment for early-lapse smokers that incorporates behavioral and pharmacological elements of standard smoking-cessation treatment, whereas drawing distress-tolerance elements from exposure-based and Acceptance and Commitment Therapy-based treatment approaches. Preliminary data from a pilot study (N = 16) are presented, and clinical implications are discussed.

Chronic avoidance helps explain the relationship between severity of childhood sexual abuse and psychological distress in adulthood.

Recent studies have found that chronic avoidance of unpleasant internal experiences (e.g., thoughts, emotions, memories) is a maladaptive means of affect regulation often adopted by women with a history of sexual victimization in childhood. The primary aim of this study was to replicate and extend previous findings suggesting that higher levels of experiential avoidance may account for the relationship between childhood sexual abuse (CSA) and psychological distress in adulthood. It was hypothesized that, in a sample of undergraduate females (n = 151), the relationship between severity of CSA (e.g., frequency, nature of victimization) and trauma-related psychological distress would be mediated by avoidance. Results supported this hypothesis. Findings are consistent with previous studies, and further suggest that the general tendency to avoid or escape from unpleasant internal experiences may be a specific factor that exacerbates psychological distress among women with a history of sexual victimization in childhood.

Vicarious traumatization: potential hazards and interventions for disaster and trauma workers.

Disaster and trauma workers often disregard their own reactions and needs when focusing on caring for those directly exposed to traumatic events. This article discusses the concept of vicarious traumatization, a form of post-traumatic stress response sometimes experienced by those who indirectly are exposed to traumatic events. It includes an examination of how vicarious trauma reactions are experienced across different professions, and suggestions on how to limit or prevent vicarious traumatization. The authors review self-care strategies as well as training and organizational considerations that may be beneficial for individuals and organizations to address.