Effectiveness of a Self Help Cognitive Behavioural Treatment Program for Problem Gamblers: A Randomised Controlled Trial.

The study aimed to strengthen the scarce literature on self-help treatments for Problem Gambling (PG) by comparing the effectiveness of a Self-Help Cognitive Behavioral Treatment (SHCBT) program (n = 23) with a 6-week Waitlist condition (n = 32) in problem gamblers. Participants were community volunteers with gambling problems and were randomly allocated to the Waitlist and treatment conditions. Results showed significant improvements at post-treatment in gambling behaviors including frequency of gambling, average amount gambled per day and PG symptoms as well as a number of gambling correlates including psychological states (e.g., depression, anxiety and stress), gambling cognitions, gambling urges, gambling related self-efficacy, satisfaction with life, and quality of life among those who completed the SHCBT program, when compared with the waitlist condition. The effect size (partial η 2) ranged from .25 to .57 for all assessed outcomes that showed significant improvement from pre- to post-treatment. It was concluded that a self-help CBT program can be beneficial for treating community problem gamblers.

Positive effects of Individual Cognitive Behavior Therapy for patients with unipolar mood disorders with suicidal ideation in Malaysia: A randomised controlled trial.

The aim of this study was to investigate the effectiveness of Individual Cognitive Behavior Therapy (ICBT) in treating patients with mood disorders with suicidal ideation. A total of 69 patients (48 females, 21 males) with the diagnoses above were randomly allocated to either the group of Treatment As Usual (TAU)+ICBT (n=33) or the TAU group (n=36). All participants completed the Beck Depression Inventory (BDI), Beck Scale for Suicide Ideation (BSS), Positive and Negative Suicide Ideation Inventory (PANSI), Beck Hopelessness Scale (BHS), and Depression Anxiety Stress Scale-21 (DASS-21). These questionnaires were administered at pre-treatment, midway through treatment (week 4), post-treatment (week 8), and at follow-ups after three months (week 20) and six months (week 32). Factorial ANOVA results showed that the TAU+ICBT patients improved significantly and at faster rate as compared to the TAU group, which showed improvement only from pre to mid treatment on DASS-D and BHS-T measures. The effect size (Cohen's d), for the TAU+ICBT group showed large effect (1.47) for depressive symptoms and suicidal ideation (1.00). These findings suggest that ICBT used in addition to the TAU, was effective in enhancing treatment outcome of patients with unipolar mood disorders as well as, reducing risk for suicide behavior.

Psychometric properties and validation of the Reasons for Living Inventory in an outpatient clinical population in Malaysia.

The Reasons For Living Inventory has been shown to have good psychometric properties in Western populations for the past three decades. The present study examined the psychometric properties and factor structure of English and Malay version of the Reasons For Living (RFL) Inventory in a sample of clinical outpatients in Malaysia. The RFL is designed to assess an individual's various reasons for not committing suicide. A total of 483 participants (283 with psychiatric illnesses and 200 with non-psychiatric medical illnesses) completed the RFL and other self-report instruments. Results of the EFA (exploratory factor analysis) and CFA (confirmatory factor analysis) supported the fit for the six-factor oblique model as the best-fitting model. The internal consistency of the RFL was α=.94 and it was found to be high with good concurrent, criterion and discriminative validities. Thus, the RFL is a reliable and valid instrument to measure the various reasons for not committing suicide among psychiatry and medical outpatients in Malaysia.

Suicide ideation and intent in Malaysia: a review of the literature.

The aim of this paper was to review the literature on suicide ideation and intent in Malaysia. PsyINFO, PubMed, Medline databases from 1845 to 2012 and detailed manual search of local official reports from Ministry of Health, Malaysian Psychiatric Association and unpublished dissertations from 3 local universities providing postgraduate psychiatric training, were included in the current review. A total of 13 studies on suicide ideation and intent in Malaysia were found and reviewed. The review showed that research on suicide ideation and intent in Malaysia was fragmented and limited, at best. Approximately 50% of existing research on suicide ideation and intent simply focused on sociodemographic data. Fifty-four percent of the data were obtained from hospitals. No study has been conducted on treatment and interventions for suicide ideation and intent. None of the studies used validated suicide scales. The impact of culture was rarely considered. It was clear from the review that for researchers, clinicians and public health policy makers to gain a better understanding of suicide behavior especially suicide ideation and intent in Malaysia, more systematic and empirically stringent methodologies and research frameworks need to be used.

Binge drinking in university students: A test of the cognitive model.

The aim of this study was to test the cognitive model [Addict. Behav. 29 (2004) 159] of binge drinking in university students. In Study 1, 202 participants completed the Drinking Expectancy Questionnaire (DEQ), the Drinking Refusal Self-Efficacy Questionnaire (DRSEQ), and the Khavari Alcohol Test (KAT). The results showed that both alcohol expectancies (AEs) and drinking refusal self-efficacy (DRSE) are needed to discriminate between binge, social, and heavy drinkers. In general, binge drinkers tend to have higher AEs than social drinkers, and have slightly lower DRSE. However, young social and binge drinkers can only be discriminated on the basis of their AEs. One hundred and fourteen students were recruited for the second study, to predict which individuals would engage in binge drinking during a 4-week self-monitoring period. Over 80% of predicted binge drinkers binged at least once during the monitoring period. These two studies confirmed the cognitive model of binge drinking, and thus, hold implications for the prevention of binge drinking among adolescents and young adults.

Confirmatory factor analysis of the COPE questionnaire on community drinkers and an alcohol-dependent sample.

OBJECTIVE: The COPE questionnaire has often been used as an efficient method of assessing a range of coping dimensions in many areas, including alcohol research. To date, however, this questionnaire has not been validated for use in community drinkers or alcohol-dependent samples. This study aimed to rectify this shortcoming in the literature. METHOD: Confirmatory factor analyses (CFA) were performed for 600 Australians (315 men, 285 women; 300 community drinkers and 300 individuals dependent on alcohol), in an attempt to confirm the 14 primary factors and the higher-order factor structure of the COPE. RESULTS: The results of the CFA showed that, whereas a 14-factor primary structure and the popular 3-factor higher-order structure were confirmed in the sample of community drinkers, the 4-factor model (COPE) was not confirmed. No support for any factor solution was found in the alcohol-dependent sample. CONCLUSIONS: It was concluded that the COPE has good psychometric properties when assessing community drinkers, but it is not an adequate tool for assessing dimensions of coping in an alcohol-dependent sample and should be used with extreme caution.

Cognitive and biochemical processes in depressed adult outpatients: a test of the circular process model.

The circular process model is a psychobiological model of depression, in which it is postulated that catecholamines and negative cognitions interact to influence depression. Since its publication, there have been no empirical tests to support or refute the model. This study tested the model in 92 depressed adult outpatients with non-bipolar non-psychotic depression. There were no significant bivariate correlations among the biochemical and cognitive measures. However, the interactive model was supported by results of two out of three hierarchical regression analyses, in which the biochemical-by-cognitive interactive terms significantly predicted depression after the main effects of each variable were accounted for. These findings show sufficient evidence in support of the Circular Process Model to warrant further testing over the treatment period.

Alcohol expectancy and drinking refusal self-efficacy: a test of specificity theory.

Although alcohol expectancy (expectations about the effects of drinking alcohol on one's behavior and mood) and drinking refusal self-efficacy (one's perceived ability to resist drinking in high-risk situations) have consistently been demonstrated to be useful to our understanding of alcohol use and abuse, the specificity of these constructs to alcohol consumption has not been previously demonstrated. Using 161 first-year psychology students and multiple regression analyses this study indicated that alcohol expectancies and drinking refusal self-efficacy were specifically related to quantity of alcohol consumption, but not to caffeine or nicotine intake. These results provide empirical evidence to confirm the theoretical and practical utility of these two cognitive constructs to alcohol research and serve to strengthen the theoretical foundations of alcohol expectancy theory.

The predictive utility of drinking refusal self-efficacy and alcohol expectancy: a diary-based study of tension reduction.

The potential tension reduction effects of alcohol may be most appropriately tested by examining the role of alcohol related beliefs regarding alcohol's anxiolytic properties. The relationship between affective change drinking refusal self-efficacy, tension reduction alcohol expectancies, and ongoing drinking behavior was examined amongst 57 regular drinkers. Alcohol consumption, antecedent, and consequent mood states were monitored prospectively by diary, Social learning theory hypothesizes that low drinking refusal self-efficacy when experiencing a negative mood state should be associated with more frequent drinking when tense. Strong alcohol expectancies of tension reduction were hypothesized to predict subsequent tension reduction. Contrary to this hypothesis, the present study found that alcohol expectancies were more strongly related to antecedent mood states. Only a weak relationship between drinking refusal self-efficacy and predrinking tension, and between alcohol expectancy and subsequent tension reduction, was evident.

Development of a Satisfaction with Therapy and Therapist Scale.

OBJECTIVE: While much work has gone into developing measures of specific factors in psychotherapy for depression, measures for non-specific factors have been lacking. This paper aims to develop a scale for a non-specific factor called 'Satisfaction with Therapy and Therapist Scale'. METHOD: Sixty-seven patients with major depression completed the questionnaires during the fourth session of cognitive therapy. The patients went through an assessment clinical interview using a SCID. They also completed the ATQ, BDI and DAS questionnaires during the fourth session. RESULTS: Principal component factor analysis with varimax rotation showed that the scale possesses two factors, 'Satisfaction with Therapy' and 'Client Evaluation of Therapist', accounting for 64.7% of the total variance. The alpha Cronbach for the two factors is 0.91 and 0.80 with the total scale alpha at 0.90. The scale also possesses good concurrent and discriminant validity. CONCLUSION: The Satisfaction with Therapy and Therapist Scale is an adequate measure for measuring a non-specific factor in psychotherapy.

Cognitive changes following recovery from depression in a group cognitive-behaviour therapy program.

OBJECTIVE: We report on the changes in cognitions as a result of cognitive-behaviour therapy (CBT), in 35 recovered and 32 non-recovered mood disordered patients who had undergone a 12-week group CBT program for depression. METHOD: An end-of-therapy cut-off score of 10 on the BDI was used to define recovered and non-recovered patients. ANOVA analyses were conducted to explore possible main effects of recovery status and time on various clinical measures, including cognitions and activity levels. RESULTS: Mean mood and activity self-rating measures were significantly higher for the recovered as compared to the non-recovered patients over the course of the program. Similarly, scores on the Automatic Thoughts Questionnaire (ATQ) for recovered patients were within the non-clinical range, in contrast to their non-recovered counterparts. In addition, recovered patients improved significantly in their Hopelessness scores, and there was a change in the expected direction in their Dysfunctional Attitudes Scale scores, although this was not significant. CONCLUSION: These results are consistent with the proposition of cognitive theory (i.e. the remediation of negative cognition plays a significant role in recovery from depression during CBT).

The relationship of positive and negative alcohol expectancies to patterns of consumption of alcohol in social drinkers.

Negative alcohol expectancies have recently come to occupy a more important position in the expectancy literature, but recent claims that positive expectancies are unimportant in the consumption of alcohol when compared with negative expectancies are based on potentially flawed methodology. This study investigated the relative contribution of positive and negative expectancies to the consumption of alcohol using an instrument designed to measure both positive and negative expectancies. One hundred ninety-three men and women from the general community participated in the study. Findings showed while negative expectancies accounted for the greater proportion of variance of frequency of consumption, positive expectancies remained an important predictor of consumption, accounting for the greater proportion of variance of quantity consumed per session. The interesting but sometimes counterintuitive directions of these relationships can be explained in terms of social learning principles. The relatively neglected concept of negative expectancies is worthy of further use and investigation.

Psychometric properties of a quitting time for alcohol questionnaire: factor structure, reliability, and validity.

Research into the dynamics of alcohol use has traditionally focused on etiological factors, particularly on the reasons an individual engages in drinking behaviours. Although reasons for the permanent cessation of drinking have also been well documented, little is known about the reasons for the episodic cessation of alcohol use that is characteristic of nonproblematic drinking patterns. The purpose of the present study was to develop and validate a questionnaire designed to monitor the reasons an individual temporarily stops drinking at the end of a drinking episode. A 23-item Quitting Time for Alcohol Questionnaire (QTAQ) was developed and distributed to a community based sample of 252 participants. Factor analysis revealed three conceptually distinct factors, QTAQ-IS (Internal Status) QTAQ-AA (Avoidance Adherence) and QTAQ-IC (Immediate Context), which accounted for 36.3% of the variance. Cross-validation on a large sample of undergraduate students (N = 479) confirmed the three-factor solution (accounting for 33% of the variance). Cronbach's alpha coefficients for the factors ranged from .74 to .81 for the community sample and from .62 to .78 for the student sample. The validity of the emergent factors was demonstrated by their ability to classify participants according to self-reported alcohol consumption and alcohol dependence criteria, and also by their significant predictive relationship with these criteria. The present findings suggest that the QTAQ is a useful instrument both for research and for use in clinical practice.

Is there evidence to show that fetal alcohol syndrome can be prevented?

Fetal Alcohol Syndrome (FAS) is currently the major cause of mental retardation in the Western world. Since FAS is not a natural phenomenon and is created by mixing alcohol and pregnancy, the solution to decreasing the incidence of all alcohol-related birth defects is therefore entirely preventable. To date, little is known about the effectiveness of prevention programs in reducing the incidence of FAS. Therefore, it is the intention of this article to review the effectiveness of prevention programs in lowering the incidence of FAS. The present review revealed that prevention programs, to date, have been successful in raising awareness of FAS levels across the groups examined. However, this awareness has not been translated into behavioral changes in "high risk" drinkers as consumption levels in this group have decreased only marginally, indicating prevention programs have had minimal or no impact in lowering the incidence of FAS. Urgent steps must now be taken to fully test prevention programs, and find new strategies involving both sexes, to reduce and ultimately eliminate the incidence of FAS.

Pre-existing antidepressant medication and the outcome of group cognitive-behavioural therapy.

OBJECTIVE: This study aimed to investigate the impact of pre-existing medication on the outcome of group cognitive-behavioural therapy (CBT) in the treatment of patients with depression. METHOD: Of the 71 patients diagnosed with major depression who participated in group CBT, 25 were on medication (CBT-M) and 46 were unmedicated (CBT). The patients received 12 sessions of group CBT over a 3-month period. The dependent measures used were the Beck Depression Inventory, Zung Self-Rating Depression Scale, Automatic Thoughts Questionnaire, Hopelessness Scale, Dysfunctional Attitude Scale, Daily Activity Rating Scale and Daily Mood Rating Scale. RESULTS: Both the CBT and CBT-M groups showed statistically significant improvement in depression scores and cognitive process measures. However, the rate of improvement for both groups on these measures did not differ. CONCLUSION: The study indicated that pre-existing antidepressant medication did not enhance or detract from the positive treatment outcome of depressed patients receiving a group CBT treatment.

Predictors of career commitment and employment level of tertiary-educated Indonesian women.

This study investigated the relationships among education, liberal sex-role values, gender-role orientation (masculinity/femininity), career commitment, and employment level for a sample of 302 married Indonesian women. All participants were tertiary educated and currently employed either as teachers in tertiary institutions or as managers in government or private enterprise. Multiple regression analysis revealed that liberal sex-role values and masculinity were significant predictors of career commitment, whereas education was the only variable to significantly predict employment level. Results are compared with previous research on predictors of career commitment and employment level in both Asian and Western cultures. Directions for further research are discussed.

Biological and psychological processes in recovery from depression during cognitive therapy.

This study investigated the relationship between biological and psychological processes in the recovery phase of depression during treatment with cognitive therapy. In particular, we tested the hypothesis that biological and psychological processes are independent; the hypothesis that they are related in a linear or sequential process; and the hypothesis that there is a circular relationship between them. 35 depressed patients completed a 12 week program of cognitive therapy. Changes in measures of negative thinking and amine dysfunction over the course of therapy were compared for those who improved and those who did not. There was a significant relationship between improvement in symptoms and change for ATQ scores, DAS scores, and epinephrine levels. There was significant change in metanephrine levels during therapy which was not related to improvement. The changes were not consistent across indices. Although the results did not provide definite support for any of the four models of the relationship between biological and psychological variables during recovery from depression, the finding that there was some change in some of the indices of amine dysfunction during cognitive therapy indicates that the interface between biological and psychological processes in depression should continue to be studied.

The differential role of alcohol expectancies and drinking refusal self-efficacy in problem and nonproblem drinkers.

OBJECTIVE: The present study aimed to examine the discriminatory ability of alcohol expectancies and drinking refusal self-efficacy and to identify the differential role of these constructs in social and problem drinkers. METHOD: Drinkers (N = 276) were self-selected from general (n = 185) and clinical (n = 91) populations to complete a 40-minute questionnaire that asked about alcohol expectancies, drinking refusal self-efficacy, consumption, degree of dependence and demographics. RESULTS: The results showed that in social drinkers both the expectancy and self-efficacy constructs were reliably able to discriminate between types of drinker. Expectancy was related to consumption in social drinkers, but did not appear to account for a significant proportion of the variance in problem drinkers. CONCLUSIONS: The findings are discussed in terms of a two-process model of drinking behavior that suggests that expectancies operate differently in social and problem drinkers.

Depression after traumatic brain injury: conceptualization and treatment considerations.

The understanding and treatment of depression that develops following traumatic brain injury (TBI) is still unclear and likely to be the result of a complex variety of interacting factors. Past researchers have developed ways to classify important variables related to patients' depression into broad domains such as: Pre-injury assets and liabilities, the nature and severity of brain injury; and reaction to difficulties. However, a better conceptualization of the problem is required in order to guide the assessment and treatment considerations for depressed patients with TBI. This review provides this conceptualization by postulating six theoretical relationships between depression and TBI. The degree of empirical support provided in the literature for these links is indicated. Research findings suggested that an individual with TBI is the most susceptible to depression when any of the following conditions exist: a pre-existing psychiatric disturbance is exacerbated; the injury sustained involved the left anterior region of the brain; and when her individual has poor insight into her deficits, attempts to resume her pre-injury roles and experiences significant failure. For each relationship, a likely outcome is predicted if the recommended treatment plan is not conducted. The present conceptualization and treatment considerations will be of substantial benefit to clinicians working in the area.

Effects of maternal cigarette smoking during pregnancy on long-term physical and cognitive parameters of child development.

The negative impact of maternal cigarette smoking during pregnancy on the growth and development of the foetus has been well documented. However, the long-term effects of the subsequent cognitive and physical development of the child are less clearly understood. This article presents a critical review of the literature on this topic. The review shows that the effects of prenatal exposure to smoking on children's physical development are mediated by a dose-response relationship. Although the observed effects are long term, they are small and may have no major functional importance. The evidence on the long-term consequences of intellectual function is still unclear. One reason is that very few studies have looked at the long-term consequences of maternal smoking on both physical and cognitive development. More effort is needed to investigate this important issue.