The Clinical Psychology Training Program at the University of Nebraska–Lincoln

The Clinical Psychology Training Program (CPTP) at the University of Nebraska–Lincoln (UNL) has been continuously accredited by the American Psychological Association (APA) since 1948, the first year any programs were accredited. The CPTP’s history and approach to training through the years have been described in numerous articles (DiLillo & McChargue, 2007; Hargrove, 1991; Hargrove & Howe, 1981; Hargrove & Spaulding, 1988; Hope, Hansen, & Cole, 1994; Howe, 1974; Howe & Neimeyer, 1979; Jones & Levine, 1963; Rivers & Cole, 1976). Our program was historically described as a “Community-Clinical” psychology training program, and this focus on understanding and enhancing well-being at the individual, family, and community levels continues to be valued in our program today across a variety of clinical and research activities. The CPTP has followed the scientistpractitioner, Boulder-model of clinical training since its inception. Our Director of Clinical Training in 1949, Marshall Jones, was a participant in the Boulder Conference on Graduate Education in Clinical Psychology. Both clinical and research training are continuous, integrated processes in the CPTP, continuously supervised and monitored by the clinical faculty. The CPTP subscribes to the APA evidence- based practice model (APA, 2006) across all of our clinical training. Integration of EBP into our scientist-practitioner curriculum was highlighted in a special issue of Journal of Clinical Psychology that focused on EBP training (DiLillo & McChargue, 2007). Students in the CPTP are trained to be both consumers and producers of research, applying best research evidence in clinical practice and generating new knowledge to improve treatment. Within this EBP framework our emphasis is on behavioral and cognitive behavioral therapies. The department made an active decision, beginning in 1990, to hire scientist- practitioner faculty members with a behavioral or cognitive-behavioral orientation. The core clinical faculty provide clinical and research training in behavioral and cognitive-behavioral therapies, third-generation cognitive-behavioral approaches (e.g., mindfulness and acceptance-based), motivational enhancement approaches, and, to a lesser degree, family systems. The CPTP was honored to receive the 2013 ABCT Outstanding Training Program Award. The award is given for “significant contribution to training behavior therapists and/or promoting behavior therapy.

The role of the individual in the coming era of process-based therapy

For decades the development of evidence-based therapy has been based on experimental tests of protocols designed to impact psychiatric syndromes. As this paradigm weakens, a more process-based therapy approach is rising in its place, focused on how to best target and change core biopsychosocial processes in specific situations for given goals with given clients. This is an inherently more idiographic question than has normally been at issue in evidence-based therapy over the last few decades. In this article we explore methods of assessment and analysis that can integrate idiographic and nomothetic approaches in a process-based era.Accepted manuscrip

Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions.

Schizophrenia can be a chronic and debilitating psychiatric disorder. Though advancements have been made in the psychosocial treatment of some symptoms of schizophrenia, people with schizophrenia often continue to experience some level of symptoms, particularly negative symptoms, throughout their lives. Because negative symptoms are associated with poor functioning and quality of life, the treatment of negative symptoms is a high priority for intervention development. However, current psychosocial treatments primarily focus on the reduction of positive symptoms with comparatively few studies investigating the efficacy of psychosocial treatments for negative symptoms. In this article, we review and evaluate the existing literature on three categories of psychosocial treatments--cognitive behavioral therapy (CBT), social skills training (SST), and combined treatment interventions--and their impact on the negative symptoms of schizophrenia. Of the interventions reviewed, CBT and SST appear to have the most empirical support, with some evidence suggesting that CBT is associated with maintenance of negative symptom improvement beyond six months after treatment. It remains unclear if a combined treatment approach provides improvements above and beyond those associated with each individual treatment modality. Although psychosocial treatments show promise for the treatment of negative symptoms, there are many unanswered questions about how best to intervene. We conclude with a general discussion of these unanswered questions, future directions and methodological considerations, and suggestions for the further development of negative symptom interventions

From Promise to Practice: Mental Health Models That Work for Children and Youth

Identifies potential programs for the Mental Health Services Act, enacted in November 2004. Outlines three types of family and community based treatment models and provides recommendations for implementing each strategy

Safer Streets: Cutting Repeat Crimes by Juvenile Offenders.

FIGHT CRIME: INVEST IN KIDS is an anti-crime organization led by more than 3,500 law enforcement leaders -- chiefs, sheriffs and prosecutors -- and survivors of crime. Most of the survivors are parents of murdered children. Crime requires punishment. Punishment may be placing a young offender in custody, or, depending on the crime, imposing a range of other tough sanctions. The bottom line is that residents must be safe walking the streets. Research shows, however, that punishment alone will often not be enough; troubled teens will need help to stop their aggression, substance abuse, or other anti-social behaviors. It is usually not too late to change anti-social patterns of behavior. Sanctions that include strict and effective interventions can direct anti-social and dangerous juveniles onto a different path that will make Americans safer

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

Reducing parental anxiety using a family based intervention for youth mental health : a randomized controlled trial

This paper presents findings on parent anxiety and attachment relationship style from the Deakin Family Options (DFO) pilot study, a randomized controlled pilot study comparing a family-based treatment (BEST Plus), versus a youth only treatment (CBT) versus a group who received both of these treatments (COMBINED). Eligible participants were families with a young person (aged 12 - 25 years) with a high prevalence mental health problem. Youth from participating families scored in the clinical or subclinical range for depression, anxiety and/or substance misuse symptoms on standardized measures during the initial assessment. The collected sample was drawn from regional and urban centers in Victoria, Australia and allocated to treatment condition using a simple randomization procedure (parallel design). It was hypothesized that families receiving the BEST Plus would experience greater reductions in youth and parent mental health symptoms, and improved parent-child relationships, compared with those in the CBT condition. This paper describes and discusses changes in parent anxiety and parent attachment, according to whether the parent participated in a treatment (BEST Plus) or did not (NONBEST Plus). Participants were blind to the study hypotheses. In total 71 parent participants returned pre data and were allocated to a treatment group. In this paper, data from parent participants who completed pre and post measures (n = 48) and pre, post, and 6-month follow-up measures (n = 28) on anxiety and attachment were analyzed by group (BEST Plus versus NONBEST Plus). The results of this study suggest that parent anxiety decreased significantly more following parent involvement in a group treatment, than for parents that did not receive treatment. Unexpectedly, avoidant attachment increased in the no treatment group, but remained relatively stable following the BEST Plus group. There were no significant findings in relation to compulsive traits and anxious attachment. These findings are discussed in light of the study limitations.<br /

Family-focused treatment for childhood depression: model and case illustrations

Although the evidence base for treatment of depressive disorders in adolescents has strengthened in recent years, less is known about the treatment of depression in middle to late childhood. A family-based treatment may be optimal in addressing the interpersonal problems and symptoms frequently evident among depressed children during this developmental phase, particularly given data indicating that attributes of the family environment predict recovery versus continuing depression among depressed children. Family-Focused Treatment for Childhood Depression (FFT-CD) is designed as a 15-session family treatment with both the youth and parents targeting two putative mechanisms involved in recovery: (a) enhancing family support, specifically decreasing criticism and increasing supportive interactions; and (b) strengthening specific cognitive-behavioral skills within a family context that have been central to CBT for depression, specifically behavioral activation, communication, and problem solving. This article describes in detail the FFT-CD protocol and illustrates its implementation with three depressed children and their families. Common themes/challenges in treatment included family stressors, comorbidity, parental mental health challenges, and inclusion/integration of siblings into sessions. These three children experienced positive changes from pre- to posttreatment on assessor-rated depressive symptoms, parent- and child-rated depressive symptoms, and parent-rated internalizing and externalizing symptoms. These changes were maintained at follow-up evaluations 4 and 9 months following treatment completion.K23 MH101238 - NIMH NIH HHS; R01 MH082856 - NIMH NIH HHS; R01 MH082861 - NIMH NIH HH

Home-Based Parent Child Therapy for Young Traumatized Children Living In Poverty: A Randomized Controlled Trial

A randomized control trial was used to evaluate the effectiveness of a home-based, parent-and-child therapy program specifically developed for toddlers and preschoolers living in poverty with trauma symptoms. Sixty-four children 5-years of age and younger were referred to a community-based clinic for behavior problems and emotional difficulties. All children had experienced one or more potentially traumatic events and met the DSM-5’s criteria for Post-Traumatic Stress Disorder in Children Six Years of Age and Younger. All families received government assistance indicating that their income met the federal definition for poverty. Participants were randomly assigned to either immediate treatment or wait list control groups. Significant between-group differences on all post-treatment measures were found. After the waitlist group completed treatment, significant improvements for both groups were found on all measures at six-weeks follow-up. Outcomes included reductions in challenging behaviors and emotional symptoms of trauma, improved caregiver-child relationships, and increased caregiver adherence to treatment strategies. This study offers support for early intervention of children with trauma symptoms and identifies the clinical challenges and advantages of providing therapy services in a home setting for very young children in poverty

Improving the Health Care of Foster Children Throughout the US: Texas, a Case Example

Children who have been exposed to the foster care system comprise a high-risk, vulnerable, and potentially medically complex population that has both poor health and poor access to health care. This review with Texas as a case example aims to describe the health and health care issues impacting children in foster care (CFCs), the state and federal level mechanisms to ensure appropriate funding for the health care of CFCs, and recent legislative efforts to improve the health and health care access for CFCs. The review discusses potential solutions in regards to improving the health of CFCs through four main domains: facilitating integration of care through delivery mechanisms such as the medical home; understanding the role of trauma and toxic stress and consequently the impact of trauma-informed care on the health of CFCs; improving mental health screening efforts and tools; and enhancing access to appropriate mental health care services