Believability of hallucinations as a potential mediator of their frequency and associated distress in psychotic inpatients

Behavioural and Cognitive Psychotherapy, 34(4): pp. 497-502.The aim of the current study was to examine how belief in the validity of hallucinations relates to the association between hallucination frequency and associated distress. In a sample of inpatients with psychotic symptoms, results demonstrated that hallucination believability predicted later distress after controlling for symptom frequency. In addition, results were consistent with the hypothesis that hallucination believability mediated the frequencydistress link. Recent randomized controlled trials have supported the efficacy of cognitive behavior therapy for schizophrenia and related psychotic disorders. Further evidence suggests that cognitive behavioral approaches that incorporate mindfulness and acceptance-based strategies may be effective in reducing the believability of positive symptoms. Future trials incorporating longitudinal designs and more detailed assessments of these variables are needed

Self-efficacy for social situations in adolescents with generalized social anxiety disorder

Behavioural and Cognitive Psychotherapy, 35(2): pp. 209-223.Self-efficacy is a potentially useful concept when applied to Social Anxiety Disorder (SAD). The aims of the current study were to examine the psychometric properties of the Self- Efficacy for Social Situations Scale (SESS; Gaudiano and Herbert, 2003) and to investigate the relationship between self-efficacy and anxiety in an adolescent sample with generalized SAD. Results replicated those found in a previous adult SAD sample. The SESS showed high internal consistency and good construct and criterion-related validity. The SESS also predicted subjective anxiety and perceived performance in social role play tests after controlling for social anxiety severity. Furthermore, self-efficacy more clearly predicted self-ratings in contrast to observer ratings of performance in social role play tests. Finally, changes in social selfefficacy were strongly associated with changes in social anxiety symptoms following treatment, even after controlling for changes in fear of negative evaluation. Treatment implications for adolescent SAD are discussed

Integrating Storytelling into the Theory and Practice of Contextual Behavioral Science

The practice of generating and interpreting stories can be examined through a behavioral lens and has many potential implications for clinical practice. However, storytelling has for the most part yet to be integrated into the field of contextual behavioral science (CBS). A bedrock of human culture, storytelling has influenced both individual behavior and intergroup cooperation for millennia. Basic principles of relational frame theory, such as those pertaining to coherence, perspective-taking, and the transformation of stimulus function, may help to reveal how stories derive their psychological impact. In turn, understanding storytelling from a CBS perspective can facilitate the broader integration of narrative methods into clinical interventions, which may help in expanding the reach and impact of individual, group, and self-help interventions. Suggestions for integrating storytelling into practice are provided as are future directions for studying the behavioral mechanisms of storytelling

Onset of illness and developmental factors in social anxiety disorder: Preliminary findings from a retrospective interview

Journal of Psychopathology and Behavioral Assessment, 29(2): pp. 101-110.Although many advances have been made in the treatment of Social Anxiety Disorder (SAD), less is known about its onset and factors related to its course and severity. The current study aimed to investigate developmental factors (e.g., onset of illness, behavioral inhibition, socially 12 traumatic experiences) that research has suggested are related to the course and severity of SAD in a sample of adults diagnosed with generalized SAD. Results showed behavioral inhibition to be the only consistent predictor of current severity. Results for age of onset were consistent with previous studies suggesting an early childhood and later adolescent pattern. In addition, an earlier age of onset negatively impacted improvement in cognitive behavior therapy for SAD, but no other developmental factors were related to treatment outcome. Future research using longitudinal designs and multiple informants is needed to confirm findings from retrospective reports

The treatment of psychotic major depression: is there a role for adjunctive psychotherapy?

Psychotherapy and Psychosomatics, 76(5): pp. 271-277.Background: Psychotic depression is a relatively prevalent mood disorder associated with greater symptom severity, a poorer course of illness and higher levels of functional impairment compared with nonpsychotic depression. Separate lines of investigation suggest that various forms of cognitive- behavioral therapy are efficacious for treating severe forms of nonpsychotic depression as well as primary psychotic disorders. However, there currently are no empirically supported psychotherapies specifically designed for treating psychotic depression. Method: We review the efficacy of current somatic treatments for the disorder and discuss the limited data to date on potentially useful psychotherapeutic approaches. In particular, we describe the clinical improvement observed in a subgroup of hospitalized patients with psychotic depression treated with Acceptance and Commitment Therapy as part of a larger clinical trial. Results: Pilot results demonstrated that Acceptance and Commitment Therapy was associated with clinically significant reductions in acute symptom severity and impairment compared with treatment as usual. Conclusion: The findings suggest that patients with psychotic depression can benefit from psychotherapy. Clinical and research recommendations in this area are presented

Acceptance-based Behavior Therapy for Depression With Psychosis: Results From a Pilot Feasibility Randomized Controlled Trial

Acceptance-based depression and psychosis therapy (ADAPT), a mindfulness/acceptance-based behavioral activation treatment, showed clinically significant effects in the treatment of depression with psychosis in a previous open trial. The goal of the current study was to further test the feasibility of ADAPT to determine the utility of testing it in a future clinical trial, following a stage model of treatment development. Feasibility was determined by randomizing a small number of patients (N = 13) with comorbid depression and psychosis to medication treatment as usual plus enhanced assessment and monitoring (EAM) versus ADAPT for 4 months of outpatient treatment. Both conditions were deemed acceptable by patients. Differences in between-subjects effect sizes favored ADAPT post-treatment and were in the medium to large range for depression, psychosocial functioning, and experiential avoidance (ie, the target mechanism). Thus ADAPT shows promise for improving outcomes compared to medications alone and requires testing in a fully powered randomized trial

Special Article Methodological Issues in Clinical Trials of Antidepressant Medications: Perspectives from Psychotherapy Outcome Research

Abstract Despite their widespread use, the specific efficacy of antidepressant medications has been a source of debate in recent years. Examination of the literature reveals that a significant proportion of the benefit produced in antidepressant trials is duplicated in pill placebo conditions. Furthermore, early trials utilizing active placebos, or medications that mimic the common side effects of antidepressants, showed even smaller differences as compared with active medications. We examine issues surrounding the use of placebo control conditions in antidepressant trials, including the pros and cons of active placebos. We conclude that similar challenges are faced by psychotherapy outcome researchers who have focused more on the separation of specific from nonspecific treatment factors and on the effects of researcher allegiance and patient expectancy on outcome. Within this context, recommendations for improving future antidepressant research are discussed