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Objective: Examine the relationship between internalized stigma, experiential avoidance (EA), and suicidal thoughts and behaviors (STBs) in a sample of college students, and explore whether EA accounts for part of the relationship between internalized stigma, EA, and STBs. Participants: College students (N=78) completed online questionnaires about demographic information, internalized stigma, EA, and STBs. Results: A simple mediation model evaluated the indirect effect of internalized stigma on STBs through EA, controlling for the presence of a mental health disorder diagnosis. Results: Internalized stigma, STBs, and EA were all positively correlated. EA partially mediated the relationship between internalized stigma and STBs. Conclusion: Despite decades of research and prevention efforts, STBs remain a pervasive problem. There is an urgent need to identify modifiable predictors of STBs. Internalized stigma is a risk factor for STBs, and recent research suggests EA might be a mechanism linking internalized stigma and STBs. Our findings suggest EA might represent a modifiable mechanism of change in the context of both anti-stigmatization and suicide prevention programs. [ABSTRACT FROM AUTHOR]

Emotion regulation has become ubiquitous in the study of psychopathology and a growing number of treatment outcome studies are collecting data on emotion regulation skill use. However, traditional measures of emotion regulation fail to capture important nuances in emotion regulation processes, their relationship to psychopathology, and how individuals use emotion regulation skills over time and across contexts. Novel methodologies are particularly needed for measuring emotion regulation in the context of treatment studies. In this article, we discuss a proposed methodology, the combination of ecological momentary assessment (EMA), and single-case experimental design (SCED), for measuring emotion regulation strategy use in the context of treatment outcome studies. To inform this discussion, we provide a brief overview of common approaches to assessing emotion regulation skill use in the context of treatment outcome research. We then describe the utility of intensive data capture (EMA) in the context of idiographic treatment studies (SCED), present a case study to illustrate the different uses of data collected through EMA in the context of a SCED study, and discuss considerations for implementing this method in clinical practice. [ABSTRACT FROM AUTHOR]

No studies to date examine predictors of treatment satisfaction following intensive cognitive-behavioral therapy interventions among adolescents. Given the challenges to treatment adherence among adolescents, and the promise intensive interventions hold for providing rapid symptom relief and increasing access to care, data examining adolescents' satisfaction with intensive programs are needed. Twenty-four adolescents (ages 12–17) with panic disorder received an eight-day intensive cognitive-behavioral therapy intervention. Pre-treatment characteristics and clinical outcome variables were examined as predictors of satisfaction at post-treatment and three-months follow-up. Multiple regression analyses revealed that higher levels of overall symptom interference at baseline and greater reductions in agoraphobic fear during treatment predicted greater treatment satisfaction at post-treatment. Only satisfaction at post-treatment significantly predicted treatment satisfaction at follow-up, highlighting the potential influence of treatment satisfaction on long-term perceptions of treatment. Considerations for fostering treatment satisfaction in the context of intensive interventions are discussed. [ABSTRACT FROM AUTHOR]

The current study examined whether characteristics of adolescents (i.e., externalizing problems) and their environments (i.e., social support, adverse childhood experiences) relate to academic goal setting, appraisals, and outcomes. Adolescents (n = 99; 87% Black/African American) 13–16 years old completed baseline interviews, and 80% also completed follow‐up interviews. Adolescents with more externalizing problems set fewer academic goals, and youth with social networks characterized by greater support (and less strain) appraised their academic goals as more supported and achievable. Adolescents' appraisals of their academic goals, but not how many academic goals they had, predicted grades at follow‐up. Increasing social support (and reducing social strain) may foster adolescents' positive appraisals of their academic goals, which may promote academic achievement. [ABSTRACT FROM AUTHOR]

Despite the substantial evidence that supports the efficacy of cognitive-behavioral therapy for the treatment of anxiety and related disorders, our understanding of mechanisms of change throughout treatment remains limited. The goal of the current study was to examine changes in experiential avoidance across treatment in a sample of participants (N = 179) with heterogeneous anxiety disorders receiving various cognitive-behavioral therapy protocols. Univariate latent growth curve models were conducted to examine change in experiential avoidance across treatment, followed by parallel process latent growth curve models to examine the relationship between change in experiential avoidance and change in anxiety symptoms. Finally, bivariate latent difference score models were conducted to examine the temporal precedence of change in experiential avoidance and change in anxiety. Results indicated that there were significant reductions in experiential avoidance across cognitive-behavioral treatment, and that change in experiential avoidance was significantly associated with change in anxiety. Results from the latent difference score models indicated that change in experiential avoidance preceded and predicted subsequent changes in anxiety, whereas change in anxiety did not precede and predict subsequent changes in experiential avoidance. Taken together, these results provide additional support for reductions in experiential avoidance as a transdiagnostic mechanism in cognitive-behavioral therapy. [ABSTRACT FROM AUTHOR]

Dropout from psychotherapy is common and can have negative effects for patients, providers, and researchers. A better understanding of when and why patients stop treatment early, as well as actionable factors contributing to dropout, has the potential to prevent it. Here, we examined dropout from a large randomized controlled trial of transdiagnostic versus single-diagnosis cognitive-behavioral treatment (CBT) for patients with anxiety disorders (n = 179; Barlow et al., 2017). We aimed to characterize the timing of and reasons for dropout and test whether participants who dropped out had different symptom trajectories than those who completed treatment. Results indicated that overall, the greatest risk of dropout was prior to the first treatment session. In single-diagnosis CBT, dropout risk was particularly elevated before the first session and after other early sessions, whereas in transdiagnostic CBT, dropout risk was low and stable before and during treatment. Participants most often dropped out due to failure to comply with study procedures or dissatisfaction with or desiring alternative treatment. Results from multilevel models showed that trajectories of anxiety symptoms did not significantly differ between dropouts and completers. These findings suggest that there may be specific time windows for targeted and timely interventions to prevent dropout from CBT. [ABSTRACT FROM AUTHOR]

To examine whether the Unified Protocol (UP) remains equivalent to single-disorder protocols (SDPs) in the treatment of anxiety disorders at 12-month follow-up. We report results from the 12-month follow-up of a recent randomized equivalence trial [1]. Data are from 179 participants (55.31% female sex, 83.24% White, average age 30.66) who met criteria for a principal anxiety disorder and were randomized to either the UP or SDP conditions. Consistent with the parent trial, the primary outcome was principal diagnosis clinician severity rating (CSR) from the Anxiety Disorder Interview Schedule (ADIS). Secondary outcomes included anxiety, depression, and impairment. Missing data were accommodated using multiple imputation (10,000 imputed data sets) under a missing at random assumption. Equivalence between the UP and SDPs was tested using slope difference scores from latent growth models and 95% confidence interval of between-condition effect sizes. The results indicated that the UP and SDP conditions remained equivalent with regard to principal diagnosis clinician severity rating at 12-month follow-up. In addition, there were no significant differences between conditions on secondary outcomes at 12-month follow-up. The UP continues to yield outcomes comparable to SDPs at 12-month follow-up, and therefore provides a single intervention that can be used to treat the most commonly occurring psychiatric disorders with durable effects. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to examine the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) for individuals diagnosed with a depressive disorder.Method: Participants included 44 adults who met criteria for major depressive disorder, persistent depressive disorder, or another specified depressive disorder according to the Anxiety Disorder Interview Schedule (ADIS). These individuals represent a subset of patients from a larger clinical trial comparing the UP to single-disorder protocols (SDPs) for discrete anxiety disorders and a waitlist control (WLC) condition (Barlow et al., 2017); inclusion criteria for the parent study required participants to have a principal anxiety disorder.Results: Significant reductions in depressive symptoms were observed within the UP condition across clinician-rated and self-report measures of depression from baseline to post-treatment, as well as to the 12-month follow-up assessment. Compared to the WLC group, individuals in the UP condition demonstrated significantly lower levels on our continuous, clinician-rated measure of depressive symptoms at post-treatment. There were no differences between the UP and SDP conditions on depressive symptoms at post-treatment or at the 12-month follow-up timepoint.Conclusions: In this exploratory set of analyses, the UP evidenced efficacy for reduction of depressive symptoms, adding to the growing support for its utility in treating depression. [ABSTRACT FROM AUTHOR]

Objectives: There are no known studies of concurrent exposure to high temperature and yoga for the treatment of depression. This study explored acceptability and feasibility of heated (Bikram) yoga as a treatment for individuals with depressive symptoms. Design: An 8-week, open-label pilot study of heated yoga for depressive symptoms. Subjects: 28 medically healthy adults (71.4% female, mean age 36 [standard deviation 13.57]) with at least mild depressive symptoms (Hamilton Rating Scale for Depression [HRSD-17] score ≥10) who attended at least one yoga class and subsequent assessment visit. Intervention: Participants were asked to attend at least twice weekly community held Bikram Yoga classes. Assessments were performed at screening and weeks 1, 3, 5, and 8. Hypotheses were tested using a modified-intent-to-treat approach, including participants who attended at least one yoga class and subsequent assessment visit (N = 28). Results: Almost half of our subjects completed the 8-week intervention, and close to a third attended three quarters or more of the prescribed 16 classes over 8 weeks. Multilevel modeling revealed significant improvements over time in both clinician-rated HRSD-17 (p = 0.003; dGLMM = 1.43) and self-reported Beck Depression Inventory (BDI; p < 0.001, dGLMM = 1.31) depressive symptoms, as well as the four secondary outcomes: hopelessness (p = 0.024, dGLMM = 0.57), anxiety (p < 0.001, dGLMM = 0.78), cognitive/physical functioning (p < 0.001, dGLMM = 1.34), and quality of life (p = 0.007, dGLMM = 1.29). Of 23 participants with data through week 3 or later, 12 (52.2%) were treatment responders (≥50% reduction in HRSD-17 score), and 13 (56.5%) attained remission (HRSD score ≤7). More frequent attendance was significantly associated with improvement in self-rated depression symptoms, hopelessness, and quality of life. Conclusions: The acceptability and feasibility of heated yoga in this particular sample with this protocol warrants further attention. The heated yoga was associated with reduced depressive symptoms, and other improved related mental health symptoms, including anxiety, hopelessness, and quality of life. [ABSTRACT FROM AUTHOR]