Telephone-administered psychotherapy for depression in MS patients: moderating role of social support

Depression is common in individuals with multiple sclerosis (MS). While psychotherapy is an effective treatment for depression, not all individuals benefit. We examined whether baseline social support might differentially affect treatment outcome in 127 participants with MS and depression randomized to either Telephone-administered Cognitive-Behavioral Therapy (T-CBT) or Telephone-administered Emotion-Focused Therapy (T-EFT). We predicted that those with low social support would improve more in T-EFT, since this approach emphasizes the therapeutic relationship, while participants with strong social networks and presumably more emotional resources might fare better in the more structured and demanding T-CBT. We found that both level of received support and satisfaction with that support at baseline did moderate treatment outcome. Individuals with high social support showed a greater reduction in depressive symptoms in the T-CBT as predicted, but participants with low social support showed a similar reduction in both treatments. This suggests that for participants with high social support, CBT may be a more beneficial treatment for depression compared with EFT

The effects of stress on different stages of memory

textResearch suggests that memory is influenced by stress and the associated rise of glucocorticoids, such as cortisol. While human studies have generally found a negative effect of stress and elevated cortisol on memory, animal studies have demonstrated a dose-dependent facilitative effect. These discrepant findings may be a result of methodological limitations in the human literature, which often confound the different stages of memory by elevating cortisol levels prior to encoding, consolidation and retrieval. The purpose of the current study was to parse the effects of an acute psychosocial stressor on these separate memory processes by varying the timing of the stressor. Based on recent evidence, we predicted that stress would enhance encoding and consolidation, but impair retrieval. 208 college students (63 male, 138 female, mean age = 18.9) were randomly assigned to a no-stress control group (n = 51) or one of three groups stressed at different time points: prior to stimulus presentation (encoding/ consolidation, n = 51), immediately after stimuli presentation (consolidation, n = 56), or just before memory testing 48 hours later (retrieval, n = 50). Salivary cortisol was measured at baseline and 20 minutes after the stressor. Both verbal and visual memory was measured at the 48-hr delay using a film stimulus developed by the investigator and with the WMS-III narrative. Results demonstrated that the group stressed prior to consolidation significantly outperformed controls on the film recognition at delay for verbal and total scores. This effect may have been related to cortisol response, as this was the only stress group to exhibit a significant increase in cortisol (40%) following the stressor. No significant differences in memory were found between the other stress conditions and controls. Within-group correlations between change in cortisol and memory were not significant, but exploratory analyses revealed a small but significant positive correlation for cortisol and verbal scores on the film recognition test across all groups (rxy = .18). Results support the hypothesis that stress enhances consolidation of new information, and provides the first evidence of this for verbal memory. Findings did not support a detrimental effect of stress on retrieval.Psycholog

Congruence of Patient Takeaways and Homework Assignment Content Predicts Homework Compliance in Psychotherapy

Homework is generally considered an essential part of psychotherapy. The present study tested the hypothesis that patients were more likely to complete homework assignments when the content of the assignments was more congruent with content the patient reported wanting to remember from the session (patient takeaways). The study relied on data collected in 541 sessions of individual naturalistic cognitive-behavioral therapy provided to 41 patients in a private practice setting and who completed a feedback form in each session that recorded the content of the homework assignments for the session, patient takeaways from the session, and homework completion. Congruence was determined by raters who evaluated the match between homework content and patient takeaways. Results of generalized linear mixed modeling showed, as predicted, that congruence between homework assignment content and takeaways was statistically significantly associated with homework compliance. This finding suggests that therapists may be able to improve homework compliance by soliciting feedback about what the client found important about the session and then assigning homework consistent with that information

The selection and design of control conditions for randomized controlled trials of psychological interventions

The randomized controlled trial (RCT) provides critical support for evidence-based practice using psychological interventions. The control condition is the principal method of removing the influence of unwanted variables in RCTs. There is little agreement or consistency in the design and construction of control conditions. Because control conditions have variable effects, the results of RCTs can depend as much on control condition selection as on the experimental intervention. The aim of this paper is to present a framework for the selection and design of control conditions for these trials. Threats to internal validity arising from modern RCT methodology are reviewed and reconsidered. The strengths and weaknesses of several categories of control conditions are examined, including the ones that are under experimental control, the ones that are under the control of clinical service providers, and no-treatment controls. Considerations in the selection of control conditions are discussed and several recommendations are proposed. The aim of this paper is to begin to define principles by which control conditions can be selected or developed in a manner that can assist both investigators and grant reviewers