Mindfulness-based therapy and behavioral activation: A randomized controlled trial with depressed college students.

Major Depressive Disorder (MDD) manifests in 20-30% of college students, with increased incidence in recent decades. Very limited research has assessed the efficacy of evidence-based interventions for MDD in college students. Mindfulness-Based Therapy (MBT) and Behavioral Activation (BA) are two interventions with significant potential to meet demands of college counseling clinics and effectively treat college students with MDD. This study utilized a randomized controlled research design (n = 50) to examine the efficacy of four-sessions of abbreviated MBT and BA relative to a wait-list control condition with depressed college students. Intent-to-treat data analyses on depression outcome measures suggested both treatments were superior to the control group. There were significant pre-post treatment improvements across measures of depression, rumination, stress, and mindfulness, gains largely maintained at 1-month follow-up. Neither active treatment effectively reduced somatic anxiety. Both treatments generally had moderate-strong effect sizes relative to the control group, and based on depression response and remission criteria, 56-79% of patients exhibited clinically significant improvement. Based on reliable change indices, 75-85% experienced clinically significant reductions in depression. There was strong therapist competence and adherence to treatment protocols and high patient satisfaction with both interventions. Study limitations and implications for the assessment and treatment of depressed college students are discussed.

Behavioral activation and problem-solving therapy for depressed breast cancer patients: preliminary support for decreased suicidal ideation.

Major depressive disorder (MDD) is the most common psychiatric disorder in breast cancer patients. The prevalence of suicidal ideation in breast cancer patients is considerable, and relative to the general population, the prevalence of completed suicide is elevated, particularly in cancer patients with MDD. A major component of suicide prevention is effective treatment of MDD. Although some research has explored the utility of psychotherapy with breast cancer patients, only three trials have explored the benefits of behavior therapy in patients with well-diagnosed MDD and there has been no systematic investigation of the potential benefits of psychotherapy toward reducing suicidal ideation in breast cancer patients. As a follow-up to a recently completed randomized trial, this study examined the efficacy of 8 weeks of behavioral activation treatment for depression (BATD) and problem-solving therapy (PST) in reducing depression and suicidal ideation, as well as increasing hopefulness in breast cancer patients with MDD (n = 80). Across both treatments, GEE analyses revealed decreased depression and suicidal ideation and increased hopefulness at posttreatment, results that were maintained at 12-month follow-up. Moreover, follow-up patient contact at approximately 2 years posttreatment yielded no indication of completed suicide. Although these data are preliminary, BATD and PST may represent practical approaches to decrease suicidal ideation in depressed breast cancer patients.

COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects 14 to 20 million Americans and is associated with increased prevalence of affective disorders, contributing significantly to disability. This study compared cognitive behavioral therapy (CBT) group treatment for anxiety and depression with COPD education for COPD patients with moderate-to-severe anxiety and/or depressive symptoms. METHOD: A randomized controlled trial (RCT) was conducted between 11 July 2002 and 30 April 2005 at the Michael E. DeBakey VA Medical Center, Houston, TX. Participants were 238 patients treated for COPD the year before, with forced expiratory value in 1 second (FEV)1/forced vital capacity (FVC)<70% and FEV1<70% predicted, and symptoms of moderate anxiety and/or moderate depression, who were being treated by a primary care provider or pulmonologist. Participants attended eight sessions of CBT or COPD education. Assessments were at baseline, at 4 and 8 weeks, and 4, 8 and 12 months. Primary outcomes were disease-specific and generic quality of life (QoL) [Chronic Respiratory Questionnaire (CRQ) and Medical Outcomes Survey Short Form-36 (SF-36) respectively]. Secondary outcomes were anxiety [Beck Anxiety Inventory (BAI)], depressive symptoms [Beck Depression Inventory-II (BDI-II)], 6-minute walk distance (6MWD) and use of health services. RESULTS: Both treatments significantly improved QoL, anxiety and depression (p<0.005) over 8 weeks; the rate of change did not differ between groups. Improvements were maintained with no significant change during follow-up. Ratios of post- to pretreatment use of health services were equal to 1 for both groups. CONCLUSIONS: CBT group treatment and COPD education can achieve sustainable improvements in QoL for COPD patients experiencing moderate-to-severe symptoms of depression or anxiety.

Assessing predictive factors for extended hospitalization at acute psychiatric admission.

OBJECTIVE: This study examined whether information obtained early in the hospitalization process can be used to assess a patient's need for extended care. METHODS: A sample of 2,430 inpatients who were admitted to a state psychiatric facility during a one-year index period (January through December 1997) were randomly assigned to a primary sample or a replication sample. Data were collected on demographic characteristics and history of previous hospitalization. The Brief Psychiatric Rating Scale-Anchored Version (BPRS-A) was administered to patients within 48 hours of admission, and four new subscales derived from ratings of newly admitted patients were calculated. Univariate and multivariate analyses were conducted to identify factors associated with whether a patient was discharged to the community or transported to another hospital for extended care. RESULTS: A discriminant analysis of the data correctly identified 70 percent of the patients who were referred for continued hospitalization and 80 percent of the patients who were discharged to the community. The main correlates of the need for extended inpatient services were, in descending order, scores on the BPRS-A resistance subscale, the number of previous referrals for extended hospitalizations, and scores on the BPRS-A positive symptoms and psychological discomfort scales. CONCLUSIONS: BPRS-A subscale scores should be considered to be at least as good as more traditional measures in predicting length of hospitalization.

The role of psychometric data in predicting inpatient mental health service utilization.

Inpatient mental health readmission rates have increased dramatically in recent years, with a subset of consumers referred to as revolving-door patients. In an effort to reduce the financial burden associated with these patients and increase treatment efficacy, researchers have begun to explore factors associated with increased service utilization. To date, predictors of increased service usage are remarkably discrepant across studies. Further exploration, therefore, is needed to better explicate the relevance of "traditional" predictors and also to identify alternate strategies that may assist in predicting rehospitalization. One method that may be helpful in identifying patients at high risk is the development of a psychometric screening procedure. As a means to this end, the present study was designed to assess the potential usefulness of psychometric data in predicting mental health service utilization. The sample consisted of 131 patients hospitalized during an index period of 8 months at an acute-care psychiatric hospital. Number of readmissions was recorded in a 9 month post-index period. Measures completed during the index admission included the Brief Psychiatric Rating Scale-Anchored (BPRS-A), Symptom Checklist-90-Revised (SCL-90-R), Kaufman Brief Intelligence Test (K-BIT), and the Beck Depression Inventory (BDI). Results indicated that psychometric data accounted for significant variance in predicting past, present and future mental health service utilization. The BPRS-A, SCL-90-R, and BDI show particular promise as time efficient psychometric screening instruments that may better enable practitioners to identify patients proactively who are at increased risk for rehospitalization. Implications are discussed with regard to patient-treatment matching and discharge planning.

Use of the Brief Psychiatric Rating Scale to facilitate differential diagnosis at acute inpatient admission.

BACKGROUND: The advent of managed care has necessitated strategies for quickly and accurately diagnosing psychiatric disorders. The aim of the present study was to ascertain whether the Brief Psychiatric Rating Scale-Anchored (BPRS-A) would be a useful adjunct to more traditional diagnostic strategies at acute inpatient admission. METHOD: Using a sample of 207 inpatients admitted during an 8-month index period, we examined the utility of the BPRS-A in predicting whether patients were more likely to be diagnosed with schizophrenia, bipolar disorder, or major depression (DSM-IV). RESULTS: Discriminant function analyses were used to correctly predict 68%, 60%, and 74% of patients diagnosed with schizophrenia, bipolar disorder, and major depression, respectively. The main predictors of diagnostic category, in descending order. were BPRS-A depressed mood item, BPRS-A positive symptoms scale, BPRS-A excitement item, BPRS-A guilt feelings item, BPRS-A mannerisms and posturing item, and number of previous episodes. CONCLUSION: As efforts are directed toward continuous quality improvement within mental health settings, an emphasis must be placed on improving the efficiency and accuracy of diagnostic procedures. The BPRS-A shows promise as a time-efficient assessment instrument that may be useful in facilitating differential diagnosis at inpatient admission and may increase the likelihood that efficacious prerelease interventions and appropriate aftercare services are implemented.

A brief behavioral activation treatment for depression. Treatment manual.

The brief behavioral activation treatment for depression is a simple, cost-effective method for treating depression. Based on basic behavioral theory and recent evidence that the behavioral component may be the active mechanism of change in cognitive-behavioral treatments of clinical depression, the authors designed a treatment to systematically increase exposure to positive activities, and thereby improve affect and corresponding cognitions. This article describes the rationale for the treatment and provides the treatment in manual form to be utilized by patients in therapy.

Generalized anxiety disorder in older adults: examining the relation between clinician severity ratings and patient self-report measures.

Generalized anxiety disorder (GAD) is the most prevalent of the chronic anxiety disorders for older adults. Although a variety of self-report measures are beginning to be utilized to assess anxiety and related symptoms in older adults, there is a paucity of data regarding the convergence of self-report measures with clinician ratings of symptom severity. This situation is problematic in that interpretability of assessment data is limited, as is our broader understanding of the construct of GAD in an older adult population. To address these issues, we examined convergence across assessment modalities among 64 older adults who met diagnostic criteria for GAD. In addition to two Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) interviews conducted by independent raters, participants completed four self-report measures (Penn State Worry Questionnaire [PSWQ], Worry Scale [WS], State-Trait Anxiety Inventory [STAI], Beck Depression Inventory [BDI]) as part of a more extensive pretreatment assessment battery. Results revealed significant correlations between clinician-rated GAD severity and the BDI, STAI, and PSWQ. Regression analyses indicated that the BDI (r2 = .15) and the PSWQ (r2 = .07) were particularly useful predictors of clinician-rated GAD severity. A comorbid mood disorder, however, was identified as an important mediator of these relations. Specifically, presence of coexistent depression accounted for 17% of the variance in clinician severity ratings (CSR; P < .01), with individuals diagnosed with a comorbid mood disorder receiving higher clinician severity ratings. The only self-report measure that accounted for additional significant variance was the PSWQ (7%). The study highlights the need to address coexistent psychological conditions when examining convergence between assessment modalities, and expands upon the relatively neglected area of anxiety assessment in older individuals. Specifically, the BDI and the PSWQ are identified as particularly useful screening instruments that may be helpful in conceptualizing GAD severity within an older adult population.

Assessing the perceived predictability of anxiety-related events: a report on the perceived predictability index.

Predictability, or lack thereof, is believed to play a critical role in the development and maintenance of anxiety, with unpredictability being associated with heightened levels of anxious and fearful responding. Despite the potential importance of predictability in theoretical accounts of emotional dysregulation, currently no standardized assessment instrument exists to assess predictability perceptions for anxiety-related events. The present series of four investigations report on an initial attempt to develop a self-report instrument (i.e., Perceived Predictability Index, PPI) that can measure predictability perceptions for the occurrence, duration, and termination of anxiety-related events. Initial item selection and factor structure of the instrument was based on a large sample of participants and yielded a two-factor solution: (1) prediction of anxiety-related environmental events and (2) prediction of internal events. Our subsequent studies show that the PPI possesses adequate levels of internal consistency and temporal stability over time. Additionally, the PPI demonstrated adequate divergent and convergent validity relative to other standard anxiety and fear measures. The internal dimension of the scale also demonstrated predictive validity for emotional responding during a biological challenge test. We discuss these findings in relation to the role of perceived predictability in the study of anxious and fearful responding, and offer directions for future research.

The effects of time pressure on arithmetic performance.

It has recently been demonstrated that highly math-anxious individuals may be less proficient on arithmetic tasks, particularly those that involve complex problems. The processing efficiency theory postulates that in highly anxious individuals, working memory resources are consumed by "worry," thereby leaving fewer resources available for task completion. Although there is some empirical support for this theory, the precise nature of this worry has yet to be identified. We tested the hypothesis that time pressure may be one component contributing to worry, and subsequent performance deficits characteristic of high math-anxious individuals. Thirty participants completed arithmetic problems of varying complexity in both a timed and untimed condition. Although the timing manipulation negatively affected arithmetic performance in both high and low anxious participants, anxiety groups were not differentially affected. Researchers may therefore have to look to other variables to explain the nature of worrisome thoughts that are theorized to disrupt the performance of anxious individuals.

Mathematics anxiety and working memory: support for the existence of a deficient inhibition mechanism.

A current theory of anxiety effects in cognition claims that anxiety disrupts normal processing within the working memory system. We examined this theory in the context of a reading task, for participants who were high or low in assessed mathematics anxiety. The task was designed to measure the ability to inhibit attention to distracting information and the effects of this ability on explicit memory performance. The results suggested that math-anxious individuals have a deficient inhibition mechanism whereby working memory resources are consumed by task-irrelevant distracters. A consequence of this deficiency was that explicit memory performance was poorer for high-anxious individuals. Based on these results, the recommendation is made that Eysenck and Calvo's (1992) processing efficiency theory be integrated with Connelly, Hasher, and Zack's (1991) inhibition theory to portray more comprehensively the relation between anxiety and performance.