Treatment integrity: Implications for training

Perepletchikova and Kazdin (this issue) reviewed the extant literature on the relationship between treatment integrity and therapy outcomes. The empirical literature on this relationship is inconsistent, and the authors note existing limitations in current research strategies and provide recommendations for future research efforts. This commentary explores the implications that a focus on treatment integrity has for training. As such, comments are offered on a number of conceptual, methodological, and practical issues relating to treatment integrity, instruction in empirically supported treatments, competence, and the training of future clinical psychologists. © The Author 2005. Published by Oxford University Press on behalf of the Psychological Association D12. All rights reserved

Reducing Anxiety to Prevent Depression

Abstract: Depression is one of the most prevalent mental disorders. Accordingly, treatment research has flourished; however, prevention efforts have lagged behind. The extant literature is reviewed on the relationship between anxiety and depression and the potential for childhood anxiety interventions to reduce the risks of secondary depression. Additionally, methodologic issues and recommendations in the design of depression prevention programs are presented. Research appears to support the view that anxiety plays a role in the development of depression; yet, the nature of that role remains unclear. © 2006 American Journal of Preventive Medicine

Use of the herb gymnema sylvestre to illustrate the principles of gustatory sensation: An undergraduate neuroscience laboratory exercise

The Indian herb Gymnema sylvestre has been used in traditional Ayurvedic medicine for 2000 years, most recently for the treatment of diabetes. Loose leaf Gymnema sylvestre can be prepared as a tea and will impair the ability to taste sugar by blocking sweet receptors on the tongue. This report describes a laboratory exercise easily applied to an undergraduate neuroscience course that can be used to illustrate the principles of gustatory sensation. Combined with a preceding lecture on the primary taste sensations, students experience and appreciate how the primary tastes are combined to produce overall taste. In addition, the exercises outlined here expand upon previously published demonstrations employing Gymnema sylvestre to include illustrations of the different sensory transduction mechanisms associated with each of the four or five primary taste modalities. Students compare their qualitative primary taste experiences to salt, sugar, aspartame, chocolate, and sweet-sour candy prior to and following exposure to Gymnema sylvestre. The herb\u27s impairment of sweet sensation is profound and dramatically alters the perception of sweetness in sugar, chocolate, and candy without altering the perception of the other primary tastes. The exercise has an indelible effect on students because the herb\u27s intense effect compels students to rely on their unique personal experiences to highlight the principles of gustatory sensation. Copyright © 2005 Faculty for Undergraduate Neuroscience

Cognitive behavior therapy

Increasingly, attention is turning to the significance of children\u27s mental health. This attention results from a confluence of information sources col lectively emphasizing the prevalence of childhood problems. Epidemiologi-cal estimates for the prevalence rates of childhood emotional and behavioral disorders range between 15 and 22% (e.g., McCracken, 1992; Roberts, Att-kisson,&Rosenblatt, 1998; Rutter, 1989; Kazdin&Weisz, 2003a; WHO, 2001). These rates may be underestimates as epidemiological studies often do not include children exhibiting subclinical distress despite the fact that these subclinical conditions have been found to be associated with sig nificant functional impairments (e.g., Angold, Costello, Farmer, Burns,&Erkanli, 1999). Childhood difficulties have been associated with problems in adolescent and adult adjustment (e.g., Colman, Wadsworth, Croudace,&Jones, 2007). Evidence exists suggesting that childhood psychopathology has long-term social consequences including truncated educational attain ment, teen parenthood, early marriage, and marital instability (e.g., Kes-sler, Berglund, Foster, Saunders, Stang,&Walters, 1997; Kessler, Molnar, Feurer&Appelbaum, 2001; Kessler, Foster, Saunders,&Stang, 1995; Kes-sler, Walters,&Forthofer, 1998; Forthofer, Kessler, Story,&Gotlib, 1996). Despite the evidence that a large number of children are diagnosed or at risk for disorder, research has suggested that as few as 40% of chil dren experiencing mental health problems receive help and only about 20% receive specialty mental health services (Burns et al., 1995). Hence, there is a real need for easily accessed, client-acceptable, and effective interventions for childhood mental health issues. In recent years, the child therapy literature has grown with a profusion of empirical investigations of efficacy. Many of these investigative efforts have involved cognitive-behavioral treatments. © 2009 Springer New York

Posttraumatic Cognitions as Mediators Between Childhood Maltreatment and Poorer Mental Health Among Young Adults

Childhood maltreatment is a significant public health issue that has been linked to a myriad of negative health consequences. To further elucidate the mechanisms of this link, the present study examined maladaptive cognitions (i.e., posttraumatic cognitions related to the self and world) and mental health sequelae among a sample of young adults. Participants were 287 undergraduate students (ages 18-29 years) who completed self-report questionnaires assessing childhood maltreatment, posttraumatic cognitions, and current mental health functioning. Data were analyzed using structural equation modeling. Findings support childhood maltreatment as an important risk factor for long-term mental health difficulties. Importantly, posttraumatic cognitions were supported as mediators in this relationship and may be useful points of intervention to mitigate mental health concerns in adulthood. © 2014 Springer International Publishing

Childhood Emotional Maltreatment and Somatic Complaints: The Mediating Role of Alexithymia

The relationship between childhood emotional maltreatment (CEM) and adverse health-related outcomes is well-documented in the literature. However, mediators of such relationships are not fully understood. The present study examined alexithymia as a potential mediator of the relationship between CEM and somatic complaints in young adults. A sample of 270 undergraduates completed self-report questionnaires assessing CEM, alexithymia, and somatic complaints. All variables were moderately intercorrelated. Controlling for the effects of sex, path analyses supported a model in which alexithymia partially mediated the relationship between CEM and somatic complaints. This study provides further evidence for the occurrence and lasting sequelae of CEM in a sample of young adults. It also illuminates the role of emotions in the relationship between CEM and somatic complaints, suggesting that interventions emphasizing affective education may lessen somatic complaints. Individual differences in CEM and other mediators warrant further investigation. © 2013 Copyright Taylor and Francis Group, LLC

Trauma, Attentional Biases, and Revictimization Among Young Adults

Individuals with previous histories of trauma are at increased risk for subsequent victimization and the development of posttraumatic stress disorder, depression, and anxiety disorders. Attentional biases to threat-related stimuli are thought to impact one’s ability to recognize future risk in his or her environment and may explain high rates of revictimization. Although the literature has identified three possible types of attentional biases among victims of trauma (i.e., interference, facilitation, and avoidance), findings are mixed. The current study examined attentional biases to threats among a sample of men and women with no, some, and multiple incident interpersonal and non-interpersonal trauma histories. It was hypothesized that those with multiple incident interpersonal trauma histories would demonstrate an interference effect (i.e., slower response times to threat-related words). Participants (N = 309) were 18- to 29-year-old college students. Self-report measures assessed trauma history, posttraumatic stress, and other psychological sequelae. Attentional biases were assessed using a dot probe computer task. Contrary to hypotheses, no significant differences in response times in the presence of threat-related words or neutral words were found among groups. Results suggest that multiple traumatized individuals do not exhibit attentional bias to threats compared to individuals with some or no trauma

Children with co-morbid recurrent abdominal pain and anxiety disorders: Results from a multiple-baseline intervention study

Recurrent Abdominal Pain (RAP), one of the most common complaints of childhood, is associated with many adverse outcomes. However, few treatment studies have been conducted, especially for children with co-morbid RAP and anxiety disorders. The primary aim of the present study was to explore the utility of a cognitive-behavioral treatment (CBT) and a treatment that combined both CBT and family-based approaches in a community sample of children with co-morbid anxiety and RAP. A multiple-baseline across participants design utilizing repeated measures of anxiety and pain was implemented (n = 8 families). An examination of the clinical significance of both treatment approaches is suggestive of their utility in the treatment of anxiety and pain symptoms in children with RAP. More research is warranted in RAP treatment outcome research, particularly with family-based approaches to treatment. © The Author(s) 2011

Anxiety Assessment and Treatment in Typically Developing Children

Anxiety disorders are highly prevalent in youth and have been associated with difficulties in adolescence and adulthood. The field has responded with empirical investigations of assessment methods and therapeutic interventions. This chapter highlights some considerations in the assessment and treatment of childhood anxiety disorders as well as the strengths and limitations of commonly used intervention assessment tools. The need for easily accessible, consumer-friendly, and effective interventions for childhood anxiety disorders is paramount, and much of the intervention research has focused on the use of cognitive-behavioral therapy for the treatment of childhood anxiety disorders. While cognitive behavioral treatments vary in terms of emphases, therapy formats, and populations targeted, most cognitive-behavioral therapies share common elements including psychoeducation, exposure, cognitive restructuring, parent training, relaxation, modeling, and self-monitoring. These techniques have been packaged together to treat a variety of anxiety diagnoses, and empirical support for treatment of each disorder is reviewed within the chapter. Future research considerations are discussed

Anxiety disorders school-based cognitive- behavioral interventions

Although anxiety disorders are the most prevalent mental-health problem experienced by youth, it is often children with disruptive externalizing problems such as attention deficit hyperactivity disorder (ADHD) who come to the attention of school personnel . Children with anxiety disorders may be overlooked due to difficulty recognizing their internalizing symptoms, unfamiliarity with diagnostic criteria, and misconceptions regarding the negative consequences of these problems . Most school personnel are surprised to learn that approximately one in ten children suffers from an anxiety disorder, with epidemiological studies estimating prevalence rates between 12% to 20% in youth (Achenbach, Howell, McConaughy, & Stanger, 1995; Gurley, Cohen, Pin, & Brook, 1996; Shaffer et al ., 1996) . Left untreated, these disorders tend to have long-term effects on social and emotional development . Negative consequences associated with anxiety disorders in youth include academic underachievement, underemployment, substance use, lower levels of social support, and high comorbidity with other psychiatric disorders (Velting, Setzer, & Albano, 2004) . Moreover, evidence suggests that these disorders demonstrate a chronic course, often persisting into adulthood (Rapee & Barlow, 2001)