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Depression is one of the leading causes of disability worldwide and its prevalence has increased further during the COVID-19 pandemic. There is a need for effective treatments that can be easily and cheaply disseminated worldwide. Behavioural activation is known to be an effective intervention for depression which can be disseminated by non-specialist practitioners. However, its exact mechanism of action is currently unknown, which impedes our understanding for how to deliver it most effectively. The aim of this thesis is to examine the efficacy of a 4-week course of non-specialist behavioural activation and to investigate its possible mechanisms of effect. To this end, two experiments were carried out with participants suffering from low mood. The first study examined the intervention in an online video format during the COVID-19 pandemic and compared it with a passive control group. We examined its effects on self-reported measures of mood and found significant improvements on measures of depression, activation, state anxiety and anhedonia. We also found that the intervention led to a more positive affective bias on accuracy and misclassification measures of the Facial Emotion Recognition Task. Moreover, early changes on emotional cognition correlated with later improvements in depressive symptoms. The results of this study indicate that this format of behavioural activation can not only be effective during a global pandemic, but its effects may be carried out through early changes in emotional cognitive processing, which could help us predict who it will be most suitable for. The second study compared the intervention to both an active control group, which only carried out activity monitoring, as well as a passive control group. We again found that behavioural activation had significant beneficial effects on self-reported measures of mood and activation in comparison to both of the groups. Activity monitoring on its own also led to significant decreases in depression symptoms, albeit to a lesser extent than behavioural activation. We did not replicate the emotionally cognitive effects from the first study, possibly due to reduced power as a result of technical and COVID-19 related disruptions to the data collection. We found that early increases in environmental reward predicted future decreases in depression symptoms, indicating another mechanistic factor that may be important for the success of behavioural activation. We found no significant effects of the two behavioural interventions on actigraphy parameters indicating participants' physical activity and circadian rhythm. Early changes on these parameters did not predict future depressive symptoms, suggesting that they may not be mechanistically involved. In conclusion, both of the experiments clearly showed that a 4-week format of non-specialist behavioural activation can provide significant benefits on self-reported mood measures. Moreover, activity monitoring on its own may be a useful intervention for depression. These findings can inform policy related to mental health provision during societal crisis periods and other times of unusual strain on mental health services. Reward processing and actigraphy factors did not appear to play a mechanistic role in behavioural activation. Further replication is needed to clarify the effects of the intervention on emotional cognition and environmental reinforcement, which may be promising mechanistic factors allowing for prediction of treatment success.

Applied behavior analysis (ABA) applies principles of learning to problems of social significance. As a therapy, ABA is a treatment of choice for autism spectrum disorders (ASD), with several decades of research demonstrating ABA's effectiveness. However, the effectiveness of ABA for another common neurodevelopmental disorder, attention-deficit/hyperactivity disorder (ADHD), is less well known. Understanding the effectiveness of ABA for ADHD would be important for practitioners, especially for those working with individuals who have a comorbid diagnosis of ASD and ADHD. Thus, the purpose of this paper is to examine the effectiveness of ABA to treat symptoms of ADHD for individuals who are 6-17 years of age using a structured literature review. Using specific keywords, several public databases were searched for articles describing the use of ABA interventions to treat symptoms of ADHD. In total, fourteen articles were found that described the use of ABA to treat symptoms of ADHD. In general, 12 of 14 articles found indicated ABA was effective for treating symptoms of ADHD in children who are 6-17 years of age. Results are discussed for practitioners and consumers looking to make treatment decisions.

Conduct problems (CP) are a class of disruptive and aggressive behaviors (e.g., aggression, vandalism) comprised of both oppositional defiant and conduct disorder. CP are highly heterogenous and one vital factor that parses out this heterogeneity is affect, specifically the affective traits of irritability (IRR) and limited prosocial emotions (LPE). The current study examined how IRR and LPE predict distinct aspects of treatment efficacy including (1) treatment response (i.e., magnitude of change from week 1 to week 5); (2) trajectories (i.e., shape of symptom change); and (3) time-out (i.e., behavioral and emotional reactions to time-out). Participants were 49 youth aged 7-12 years (71.4% male, 77.6% meeting CP criteria) who participated in an intensive behavioral summer treatment program. Outcomes were observational ratings of CP and parent-ratings of impairment. Pre-treatment IRR predicted reduced CP at week 5. Neither IRR nor LPE exerted any significant effect upon impairment treatment response, nor trajectories of change, nor behavioral or emotional reactions to time-out. IRR may be particularly important to consider in treating CP in youth. Future research should employ measurement of the distinct underlying treatment mechanisms (e.g., emotion dysregulation, empathy) to effectively target the mechanisms contributing to aggression and impairment in youth with different affective profiles.

Background Healthy lifestyle adherence is associated with lower chronic disease morbidity/mortality. The role of doctors, as counselors and role models, is essential. Among physicians participating in a prospective cohort, we investigated the behavioral counseling on diet and lifestyle provided to their patients in association with their own personal behaviors. Methods We assessed 890 doctors aged ≤65 years participating in the ‘Seguimiento Universidad de Navarra’ (SUN) cohort, who replied to an online questionnaire regarding their practices on behavioral counseling and drug prescription to their patients. Data were combined with previous baseline information on their personal healthy habits. Results Among doctors, 31% reported

INTRODUCTION: Community health workers are a growing and developing portion of the healthcare workforce. They have proven successes in decreasing healthcare inequities for many common chronic medical conditions, such as asthma, and have secured support at the Department of Health and Human Services. One common medical condition for which community health workers have not yet been explored as a resource is pediatric Attention Deficit Hyperactivity Disorder. We sought to investigate what the literature showed on community health workers' involvement in ADHD treatments thus far, and to specifically investigate which ADHD behavioral parent training program could best be adapted to a pilot study where community health workers were the intervention delivery agents. METHODS: We performed a systematic review of the literature on evidence based behavioral parent training programs for children with ADHD. Parent training interventions were compared for ease of application to a community health worker home-visit model. Program ability to successfully reduce child behavior problems and improve parenting practices was analyzed. RESULTS: 8 full text articles were analyzed in depth and grouped by intervention type. 1 article was a sports-based intervention for fathers, 1 was meant to improve attendance rates, 1 was a combined child-targeted and parent-targeted Behavioral Parent Training (BPT) therapy, 2 were based on the "New Forest Parenting Package", and 3 were based on Barkley's 1997 manualized BPT. DISCUSSION: Evidence exists for the ability of community health workers to deliver a behavioral therapy to families of children with ADHD, specifically behavioral parent training. Barkley's manualized BPT had the best combination in our study of positive outcomes for families and ease of adaptability to in-home delivery. We recommend a pilot study be conducted using a modified version of Barkley's BPT and have community health workers as the delivery agents to begin to see what role community health workers can play in the treatment of pediatric ADHD.

Major depressive disorder (MDD) is characterized by reduced activation of the dorsolateral prefrontal cortex (DLPFC), a brain region involved in both emotion regulation and basic cognitive control processes. Recent studies have indicated that computerized interventions designed to activate the DLPFC can reduce depressive symptoms. The current study was a randomized controlled trial which extends this research to test whether one such program, called Cognitive Control Training (CCT), enhances depression treatment outcomes when used in adjunct to brief behavioral activation therapy for depression (BATD), an empirically-supported outpatient intervention. This study also explored whether the effects of BATD + CCT treatment on depression were mediated by changes in rumination and cognitive control. In a sample of thirty-four adults diagnosed with MDD, participants were randomly assigned to complete four sessions of either computerized CCT or a non-active computerized control task, concurrently with four sessions of BATD. Completion of the assigned computerized task took place immediately before each of the four BATD therapy sessions. Depression symptoms and proposed treatment mediators were assessed at baseline, mid-treatment, post-treatment, and four-week follow-up visits. I hypothesized that compared to the control group, participants receiving adjunctive CCT would demonstrate significantly reduced depressive symptoms. I also hypothesized that these effects would be mediated by changes in inhibitory control and set-shifting performance in the context of negative emotional material, as well as by changes in ruminative brooding. Results did not support these hypotheses. Depressive symptoms were reduced over time in both treatment conditions, with no significant difference between treatment conditions. Assignment to CCT was not associated with changes in the proposed mediators. Furthermore, exploratory analyses found minimal evidence that performance on inhibitory control and set-shifting tasks were related to baseline clinical characteristics (such as depression severity, rumination, or anxiety symptoms) or treatment outcomes. The results of this study support the potential for BATD as a brief, low-cost, flexible intervention for the treatment of depression and further show that CCT administered in adjunct to a 4-session BATD program does not add clinical benefit in the treatment of depression. This study and other recent research suggest that the effects of CCT may not be as robust as previously indicated, highlighting the need for continued investigation of the conditions under which CCT may be effective.

Treatments for GAD are less efficacious than those for other anxiety disorders, and individuals in relationships characterized by distress are less likely to respond to standard GAD treatments, which suggest dyadic treatment of GAD may be beneficial to individuals in distressed relationships. This dissertation presents and conducts preliminary tests of an acceptance- and mindfulness-based dyadic treatment for GAD based on the principles of Integrative Behavioral Couple Therapy (IBCT). This dissertation first examined to what extent in-person and online IBCT reduced GAD symptoms; moderate effect sizes as compared to waitlist control were found for the online version of IBCT (the OurRelationship program). Because this program targeted relationship satisfaction in general, it would be useful for the GAD-focused modifications to specifically aim at altering aspects of couples' relationships that are associated with GAD. The next study examined associations between specific interpersonal behaviors in the dyadic context and GAD symptoms. Negative communication behaviors were found to be associated with GAD symptoms across four diverse samples, and in one sample, communication mediated the association between relationship satisfaction and GAD symptoms. Therefore, the third paper described an initial attempt at modifying the online OurRelationship program for couples to specifically address the needs of individuals with GAD and their partners. Two detailed case studies of couples who completed this IBCT-GAD intervention suggested that it was a credible treatment; both couples increased in relationship satisfaction, and one partner with GAD experienced clinically significant improvements in her symptoms. Quantitative and qualitative analysis suggested that improved GAD symptoms were associated with reductions in the partner's tendency to facilitate GAD-related behavior. Future data collection will provide additional information about the efficacy of the IBCT-GAD intervention and the mechanisms by which it operates.

The efficacy of multidisciplinary inpatient and outpatient treatment for transitioning children with severe pediatric feeding disorders from gastrostomy tube dependency to oral nutrition was investigated utilizing caloric and fluid intakes as an outcome measure. The study involved 29 children ages 12 months to 5 years of age with gastrostomy tube dependency. Treatments were provided by speech therapists, occupational therapist, dietician and psychologist for a 30 day period. Four treatment groups were evaluated and average intakes compared at 4 observation periods including pretreatment, initiation of treatment, completion of treatment at 30 days and 4 month follow-up. Children receiving inpatient treatment for feeding disorders evidenced significant differences in oral caloric intake from pretreatment to discharge than outpatient treatment (p < .01) and wait list control group (p = .04). Oral caloric intake from discharge to 4 month follow up yielded no significant differences indicating treatment gains were maintained. Change in environment and caretaker showed a significant effect for the inpatient group (d = 1.89). Effects of treatment by age and weight at 4 month follow up were also analyzed.

There is support in the literature for motivational enhancement therapy (MET) as an acceptable method for achieving abstinence and increasing retention in therapy for the treatment of marijuana and alcohol abuse, and for contingency management (CM) as a useful tool for enhancing both of these objectives when combined with empirically supported therapies such as MET. However, MET combined with CM had yet to be tested with substance using adolescents and young adults enrolled in a substance use program in a vocational and educational training facility. This study examined the effectiveness of an MET and CM program designed to provide opportunities to win prizes to reinforce therapy attendance and submission of urine samples that were negative for marijuana. Fourteen (N=14) individuals from a vocational training center who tested positive for marijuana on their initial drug screen were assigned to receive either standard treatment (ST), or CM plus MET in addition to ST. The retention rates of twenty-two (N=22) non-randomized participants who had tested positive for marijuana upon entry to the training center were also compared to the retention rates of the study participants. The MET+CM+ST group demonstrated significantly higher study drug screen pass rates at 1- and 3-month follow-ups, and significantly greater percent days abstinent (PDA) for marijuana at the 3-month follow-up compared to the ST group. In addition, the percentage of trainees who successfully passed their second official drug screen and were therefore retained and able to continue their training at the Job Corps was significantly higher for those who consented into the study than the non-randomized participant group; however, there were no statistical differences found between the study groups in retention, largely due to administrative leniency extended to the ST group by the training program. Originally, incoming trainees who were on probation for alcohol use were to be included in the study as well, however none of the incoming trainees were on probation due to alcohol use during the duration of this study. Also, there was very little alcohol use reported by the participants who were enrolled in the study, and there were no significant findings regarding alcohol use. The study results build upon prior research and offer an initial exploratory analysis of the efficacy of MET and CM with trainees from a vocational program who tested positive for marijuana, and highlights recommendations for developing interventions to facilitate abstinence in a real life, non-clinical setting.

Traditional behavioral techniques such as modeling, performance feedback, and reinforcement are the predominant methods used to teach social skills to adults with schizophrenia. Although they have been shown to be effective, these methods focus on the accuracy of skill acquisition, but do not focus on the speed with which an individual can perform the skill. In contrast, precision teaching, an alternative behaviorally based instructional technique, focuses on frequency training, which includes an emphasis on accuracy plus the speed of responding. The purpose of the present study was to compare components of the precision teaching methodology with accuracy training in order to determine which of these two methods is most useful for the teaching and maintenance of social skills in individuals with schizophrenia. The level of social skill ability for each participant was determined by recording the number of syllables spoken per minute. In this experiment each participant was able to increase his or her performance from that of baseline for number of syllables per minute and percent of correct responses. This experiment also supports the hypothesis that precision teaching produces an increased number of syllables per minute than did the accuracy training method during the retention and maintenance probes.

The purpose of this study is to determine the efficacy of anxiety-relief therapy when compared with three other treatment groups (group systematic desensitization; a pseudo-therapy, suggestion, group; and a no-treatment group).

An experiment was conducted to study the role of "positive expectancy" when utilizing anxiety-relief conditioning. Fourteen male and female undergraduate psychology students were selected as subjects (Ss), based on pre-test scores obtained on the "Snake Intimacy Test" (SIT). Ss were matched according to pre-SIT scores and randomly assigned to the "positive expectancy" or "no expectancy" groups. Anxiety relief conditioning was administered without variation. Only the rationale given each group describing what was transpiring was different. The statistical results revealed significant improvement by both groups. Also, the "positive expectancy" group improved significantly over the "no expectancy" group. Therefore, "positive expectancy" is apparently a sufficient, but not necessary, variable of anxiety-relief conditioning.

Cue-controlled relaxation is looked at to determine whether a component is efficacious as the entire procedure. Subjects were 40 male and 40 female undergraduates. Subjects were randomly assigned to one of four conditions: cue-controlled relaxation, progressive muscle relaxation, breathing exercises with a paired. cue word, on a presentation of the cue word without being paired. It was hypothesized that cue-controlled relaxation would be superior to a component of cue-controlled relaxation. It was determined that cue-controlled relaxation is not more efficacious than a particular component. Data suggests the majority of anxiety reduction takes place when the treatment focuses on the same modality from which the subject receives the most information about their anxiety. Implications and suggestions for further research are presented.

Assertive training was investigated to determine its usefulness in teaching mildly retarded women to become more assertive. The 10 subjects (ages 18-35, WAIS VIQ 50-75) were randomly assigned to either the assertive training or the control group. Experimental subjects received 5 weeks of daily assertive training sessions which employed modeling, behavior rehearsal, and focused instructions in a group setting. Specific components of assertive behavior were taught in the following order: (a) assertive refusals, (b) assertive requests, (c) posture, (d) eye contact, and (e) loudness, Results of a behavioral role-playing task administered to both groups before and after treatment revealed that assertaive training subjects made significantly greater improvement than controls in their assertive content, Additionally, these subjects manifested significantly more improvement than control subjects on a global assertiveness measure.

This research was a controlled group outcome study to determine the effectiveness of a multisystem therapeutic intervention for hyperarousal to stress. It was assumed that the hyperarousal syndrome is a generalized and undifferentiated response which involves multisystems of the organism, including physiological-autonomic aspects, cognitive appraisals and imagery, affective components, and an array of overt and covert behavioral responses. If the hyperarousal syndrome persists over a period of time, a psychophysiological disorder may occur in the response system that has been repeatedly stimulated. It was postulated that learning to maintain the arousal state within a normal range of functioning may prevent the occurrence of psychophysiological diseases. Verbal reports of the experimental group indicate a beginning ability to transfer the learned low-arousal response to real-life situations. The results of this study suggest that learning a low-arousal adaptation to stress may have important implications for prevention or attenuation of psychophysiological and psychiatric disorders.

An experiment was conducted to contrast the effectiveness of Behavior Therapy administered in self, individual, or group therapy versus a no-treatment control condition. The therapy conditions were administered to two subgroups, high and low self reinforcers, as defined by Rosensky and Bellack (1976). The general hypothesis was that high self reinforcers would engage in countercontrol and therefore do poorly in group and individual therapy, but would lose weight in self therapy. Individual behavior therapy showed the best long term results, but self and group therapies also showed significant weight loss. It was also found that low self reinforcers as a group lost more weight than did high self reinforcers.

The present study examined the efficacy of a cognitive-behavioral therapy package and a highly credible attention-placebo in the treatment of male heterosocial anxiety. Previous research provided evidence that cognitive factors are important in the etiology and maintenance of heterosocial anxiety, and suggested that a cognitive-behavioral approach should be effective in the treatment of this problem. Despite such evidence, relatively few therapy outcome studies have been conducted using cognitive-behavioral procedures.

The incidence of bulimia has been increasingly documented in recent years. Treatments have focused on one behavior in the Binge-Purge chain or have combined several treatment components. This study was designed to assess the effect of teaching bulimics alternative responses for dealing with stressful events.

The present research was designed to provide data on the value of behavioral techniques in the treatment of depression. The thesis comprised one analogue treatment study and two controlled treatment experiments. The strategies employed in the studies were: (1) increasing pleasant activity levels, (2) Sensory Awareness Training, (3) Relaxation Training, and (4) Task Assignment. In Study 1 eighty university students were randomly assigned to pleasant activity monitoring or no-monitoring groups, and to activity related instruction or no-instruction groups. All subjects monitored mood level (weekly) via standard depression inventories, and obtained reinforcement level (monthly) over a twenty week treatment period. The treatment period occurred between occasions of university examinations. The effect of monitoring activities which were rated as enjoyable and activity-related instructions was not different from no-monitoring or no-instructions either overall or in interaction with components of trend. Mood was found to be negatively correlated with the number of activities engaged in, even when both variables were measured weekly. Depression level also varied with the occurrence of external events such as examinations and recess. It was concluded that if increasing pleasant activity levels is of benefit in the treatment of depression, it is not so simply due to the effects of monitoring or instructions. Study 2 employed Sensory Awareness Training and Relaxation Training in the treatment of outpatient, primary-unipolar depressed females. The subjects were volunteers obtained through public advertisement. The behavioral treatments were compared to a control/treatment condition and psychological assessment took place at pre-treatment, posttreatment, follow-up and at a long term follow-up. The dependent variable was a linear combination of a variety of self-report, obtrusive and unobtrusive measures which had distinguished between the depressed pre-treatment sample and a non-depressed group. The results indicated that all subjects demonstrated a decrease in depression following treatment, which was maintained up to follow-up testing. The treatment conditions did not differ from one another in regard to this effect. Sensory Awareness Training and Relaxation Training subjects had not relapsed up to the time of the long term follow-up (12 months posttreatment). Study 3 was designed to examine the efficacy of Relaxation Training when employing a sample of depressed females who displayed little or no anxiety. Relaxation Training was compared to Task Assignment which involved improving subjects interpersonal relationships and increasing pleasant activity levels. Groups were also employed to control for the effects of: (1) nonspecific factors (Waiting List), and (2) support and discussion (Client-Oriented Therapy). The results indicated once again that all subjects demonstrated a significant decrease in depression, and that the treatment groups did not differ from one another over the experimental period. The results of the present research suggest that demand factors such as instructions and subject expectations are not related to the outcome of research employing behavioral techniques in the treatment of depression. The value of the behavioral techniques employed however, was not affirmed. Depression in outpatient volunteers was found to decrease uniformly under the influence of nonspecific factors. Spontaneous remission and the effects of pre-experimental testing were regarded as the factors responsible for the decline in subjects' depression.

This study investigated the relative effectiveness of (1) modeling, (2) modeling plus behavior rehearsal, and (3) modeling, behavior rehearsal,_ and videotaped feedback in assertive training.. Twelve psychiatric outpatients were randomly assigned to three treatment groups, ,each of which received 5 hours of training. Four additional subjects served as a waiting .list control group. The dependent measures used were the Assertive Behavior Situation Test (ABST), a behavioral role-play test, and two additional paper and pencil measures (Constriction Scale and Fear of Negative Evaluation). Each of these measures was administered at pre- and post-test sessions. Split-plot 4.2 analyses of variance (Kirk, 1968) yielded a significant trial effect on both of the pencil and paper measures but not on the ABST. There were no significant group effects on any of the measures, nor were there any group X trial interactions. The implications of these results on previously reported assertive training research were briefly discussed.

The purpose of this study was to examine the contribution of social/living skills to outcome in exposure and response prevention therapy for a group of obsessive-compulsive patients. A model is presented which emphasizes the role of social/living skills and the ability to develop alternative behaviors for improving in this type of therapy. Twenty patients were treated with ten sessions of exposure and response prevention therapy. These participants also completed a battery of social/living skills and obsessive-compulsive measures at three time periods: 1) pre-test, 2) post-test, and 3) two-week follow-up. The results indicated that 1) patients as a group improved as a result of exposure and response prevention, and 2) moderate support was found for the notion that social/living skills are a factor in outcome. A revised model is presented which suggests that exposure and response prevention produces differential effects, depending on whether or not the patient's ritual behaviors are anxiety based. Specifically, patients whose rituals produce relief from anxiety appear to benefit most from exposure and response prevention, compared to those patients whose rituals do not result in anxiety relief. It is suggested that those patients who do not benefit from this therapy require a more extensive functional analysis of the problem.

The problem of this study is to determine the relative effectiveness of the three counseling procedures of modeling, assertive training, and modeling plus assertive training for increasing assertive behavior in low assertive junior college students.

The purpose of the present study was to attempt to use the principles of behavior therapy and group psychotherapy to enhance social adjustment of the geriatric patients in an institutional environment. There are several factors positively related to satisfactory adjustment to old age such as educational level, marital status, employment history, religion, health, and membership in groups.