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Background: Although the importance of sleep difficulties in emotional disorders has long been acknowledged, the nature of the potential reciprocal relationship between sleep and depressive symptoms is not yet well understood. The coronavirus disease 19 pandemic provided a unique opportunity to study the interrelation of these symptoms over a period marked by increases in sleep and psychological difficulties. Methods: Using online data collection, we followed 1200 adults (59% male) through 1 year of the pandemic. Measures of sleep disturbance and depressive symptoms were assessed at eight time points. Factor analysis of the items from these two measures suggested separate insomnia and depressive symptom factors. A random intercept cross‐lagged panel model was used to assess within‐person relationships between factor analysis‐informed subscales of insomnia and depressive symptoms. Results: Depressive symptoms predicted subsequent changes in insomnia symptoms; however, insomnia did not predict changes in depressive symptoms. Conclusions: Our findings suggest the impact of depressive symptoms on insomnia is evident, but the reverse is not. Implications of this finding along with the need for research addressing depressive symptoms and insomnia as treatment targets are discussed. [ABSTRACT FROM AUTHOR]

Background: Interventions teaching cognitive-behavioral skills feature prominently among evidence-based treatments for emotional disorders. However, the relative impact of interventions that teach one cognitive-behavioral skill in-depth (i.e., an entrée intervention) versus those that provide limited coverage of multiple skills (i.e., a sampler intervention) remains unclear. In this study, we compared these two approaches using unguided single-session internet-based cognitive-behavioral interventions. Methods: A total of 657 participants living in the U.S. with elevated depressive symptoms were randomly assigned to the entrée, sampler, or no-intervention control conditions. The entrée approach focused in-depth on developing one skill and the sampler condition introduced three skills. Both interventions lasted approximately 30 min. All participants completed measures of depressive symptoms, loneliness, and coping skill use and quality before the intervention and a week after the intervention. Results: There were no condition differences in change in depressive symptoms, coping skill usage, coping skill quality, or loneliness. Those in the sampler condition were less likely to drop out than those in the entrée condition. In addition, condition differences were moderated by initial depressive symptom severity, such that among the more severely depressed the sampler condition led to greater symptom reduction than the entrée and control conditions. Conclusions: We did not find overall differences between the entrée, sampler, and control conditions on primary outcomes. Nonetheless, the differences that did emerge suggest offering a variety of skills improves retention and provides greater relief for those with high initial depressive symptom severity in single-session internet-based interventions. Clinicaltrials.gov ID NCT04643964, registered on 11/12/2020. [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy (CBT) appears to achieve its effects at least in part by fostering the development of CBT skills. In an effort to leverage CBT skill development, our group developed and tested a skill‐enhanced version of CBT (CBT‐SE) in a recent trial. In this paper, we describe our work with a client who participated in a 12‐week course of CBT‐SE as part of that trial. Although homework is a critical aspect of CBT, the greater emphasis on skill development in CBT‐SE means that homework is even more central. This client's course of treatment illustrates the potential benefits of a strong focus on skill development and the use of specific homework assignments to foster mastery and ongoing use of CBT skills. The client developed CBT skills at a rapid pace early in treatment and exhibited enduring symptom reductions. The experience of this client reinforces the value of a focus on CBT skills and highlights strategies for fostering skill development. Given the evidence in support of the therapeutic value of CBT skills and the well‐established benefits of homework assignment, we encourage use of skill enhancing procedures, including in‐session procedures and assignments that help clients develop and maintain ongoing skill use. [ABSTRACT FROM AUTHOR]

Objectives: The coronavirus disease 2019 (COVID‐19) pandemic was associated with substantial increases in anxiety and depressive symptoms. To understand individual risk, we examined a large set of potential risk factors for anxiety and depression in the pandemic context. Methods: Adults in the United States (N = 1200) completed eight online self‐report assessments over 12 months of the COVID‐19 pandemic. Area under the curve scores summarized cumulative experiences of anxiety and depression over the assessment period. A machine learning approach to elastic net regularized regression was used to select predictors of cumulative anxiety and depression severity from a set of 68 sociodemographic, psychological, and pandemic‐related baseline variables. Results: Cumulative anxiety severity was most strongly explained by stress and depression‐related variables (such as perceived stress) and select sociodemographic characteristics. Cumulative depression severity was predicted by psychological variables, including generalized anxiety and depressive symptom reactivity. Being immunocompromised or having a medical condition were also important. Conclusions: By considering many predictors, findings provide a more complete view than previous studies focused on specific predictors. Important predictors included psychological variables suggested by prior research and variables more specific to the pandemic context. We discuss how such findings can be used in understanding risk and planning interventions. [ABSTRACT FROM AUTHOR]

Objective: Understanding how people respond to information about treatment options is important for informing efforts that promote treatment initiation and adherence. We examined the impact of informational treatment videos on treatment naive participants' views regarding the credibility of and their expectations for three treatment options. Materials and Methods: Adults (N = 300) who had experienced elevated depressive symptoms but had not participated in a treatment for depression were randomly assigned to one of four conditions. Three of the conditions were shown videos, providing information about (1) cognitive behavioral therapy (CBT), (2) antidepressant medication (ADM), or (3) the combination of CBT and ADM. The fourth condition was not shown a video. Participants' self‐reported views of the credibility of and expectations for treatment served as primary outcome variables. Results: Compared with the control condition, videos about active treatments enhanced credibility and expectations for those treatments. When comparing CBT and ADM alone, messaging about either treatment enhanced credibility of and expectations for that treatment. The CBT only video produced the most positive expectations and highest credibility for CBT. Likewise, the ADM only video led to the most positive expectations and credibility for ADM. The video focused on combined treatment did not lead to particularly positive views of the combined treatment option. Conclusion: These findings demonstrate the importance of providing focused messaging to enhance the credibility of and expectations for treatment. Future research is needed to examine the impact of messaging in different contexts, as well as the impact of such messaging on treatment seeking, adherence, and outcomes. [ABSTRACT FROM AUTHOR]

Objective: Previous studies of cognitive therapy (CT) for depression have examined therapist adherence and the therapeutic alliance as predictors of subsequent symptom change. However, little is known about these CT process variables when CT is delivered in combination with antidepressant medication. Method: In a sample of 176 depressed outpatients randomized to the combined condition of a clinical trial, we examined ratings of adherence and alliance as predictors of subsequent session-to-session symptom change across early CT sessions. Results: Both adherence to Behavioral Methods/Homework and the therapeutic alliance significantly predicted session-to-session symptom change. In models in which patients' medication regimen and prior symptom change were covaried, only Behavioral Methods/Homework remained a significant predictor of subsequent symptom change. Conclusions: Our findings highlight the utility of Behavioral Methods/Homework in combined treatment for promoting early session-to-session symptom change. (Contains 1 figure, 2 tables, and 4 footnotes.)

Objective: In this Phase II trial, we evaluated a novel psychological treatment for depressed patients coping with the stresses of cancer. Effectiveness of a combined biobehavioral intervention (BBI) and cognitive behavior therapy (CBT) was studied. Method: Participants were 36 cancer survivors (mean age = 49 years; 88% Caucasian; 92% female) diagnosed with major depressive disorder. A single group pre-post design was used. Treatment consisted of up to 20 individual 75-min combined BBI/CBT sessions. Outcomes were change in interviewer (Hamilton Rating Scale for Depression; Williams, 1988) and self-rated depressive symptoms (Beck Depression Inventory-Second Edition; Beck, Steer, & Brown, 1996) as well as change in cancer relevant symptoms (Fatigue Symptom Inventory [Hann et al., 1998] and Brief Pain Questionnaire [Daut, Cleeland, & Flanery, 1983]) and quality of life (Medical Outcomes Study Short Form-36; Ware et al., 1995). Mixed-effects modeling, a reliability change index, and generalized linear models were used. All analyses were intent-to-treat. Results: Depressive symptoms significantly improved. In addition, 19 of 21 study completers met criteria for remission. Significant improvements were also noted in fatigue and mental health quality of life. Both concurrent anxiety disorders and high levels of cancer stress (Impact of Events Scale; Horowitz, Wilner, & Alvarez, 1979) were each associated with beginning and concluding treatment with greater depressive symptoms. Conclusions: CBT components were successfully incorporated into a previously efficacious intervention for reducing cancer stress. The BBI/CBT intervention warrants further research in evaluating its efficacy compared with well-established treatments for depression. (Contains 2 figures and 4 tables.)

Objective: The efficacy of cognitive therapy (CT) for depression has been well established. Measures of the adequacy of therapists' delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have shown an association between CT competence and outcome, researchers have yet to address whether competence ratings predict subsequent outcomes. Method: In a sample of 60 moderately to severely depressed outpatients from a clinical trial, we examined competence ratings (using the Cognitive Therapy Scale) as a predictor of subsequent symptom change. Results: Competence ratings predicted session-to-session symptom change early in treatment. In analyses focused on prediction of symptom change following 4 early sessions through the end of 16 weeks of treatment, competence was shown to be a significant predictor of evaluator-rated end-of-treatment depressive symptom severity and was predictive of self-reported symptom severity at the level of a nonsignificant trend. To investigate whether competence is more important to clients with specific complicating features, we examined 4 patient characteristics as potential moderators of the competence-outcome relation. Competence was more highly related to subsequent outcome for patients with higher anxiety, an earlier age of onset, and (at a trend level) patients with a chronic form of depression (chronic depression or dysthymia) than for those patients without these characteristics. Competence ratings were not more predictive of subsequent outcomes among patients who met (vs. those who did not meet) criteria for a personality disorder (i.e., among personality disorders represented in the clinical trial). Conclusions: These findings provide support for the potential utility of CT competence ratings in applied settings. (Contains 5 footnotes, 2 tables, and 1 figure.)

Cognitive therapy (CT) for depression is designed to teach patients material that is believed to help prevent relapse following successful treatment. This study of 35 moderately to severely depressed patients who responded to CT provides the 1st evidence to suggest that both development and independent use of these competencies predict reduced risk for relapse. Among patients who responded to treatment, both CT coping skills and in-session evidence of the independent implementation of CT material predicted lower risk for relapse in the year following treatment. These relationships were not accounted for by either symptom severity at the end of treatment or symptom change from pre- to posttreatment. Self-esteem, assessed at posttreatment, failed to predict risk for relapse in the year following treatment. Thus, CT coping skills and independent use of CT principles, but not overall satisfaction with oneself, appear to play an important role in relapse prevention.

The therapeutic alliance is a dyadic process involving both patient and therapist perspectives. We investigated the effect of patient and therapist agreement on the alliance in cognitive behavioral therapy for depression. Patients (N = 191) were drawn from two studies of cognitive behavioral therapy for depression provided over 16 weeks. Alliance data were collected from patients and therapists at the first four sessions. Patients provided symptom data at each session. We used multilevel polynomial regression with response surface analysis to investigate the effect of alliance agreement and disagreement on symptoms. The within-person strength of patient and therapist-rated alliance (given agreement) predicted lower within-person symptoms. The nature and degree of the discrepancy in patient and therapist alliance scores was not a significant predictor. Patients and therapist alliance strength in early sessions (given agreement) predicted greater symptom change. Future research is needed to examine whether specific patient characteristics can be used to identify for whom the alliance plays a more or less important role. [ABSTRACT FROM AUTHOR]

Despite its considerable potential, psychotherapy research has made limited use of small-scale experimental study designs to test intervention components. This study employs such a design to test the immediate effects on emotional experience of two approaches to changing negative thoughts, cognitive restructuring and fostering positive thinking. Cognitive restructuring draws on the strategies core to cognitive behavioral therapies. Fostering positive thinking has also received attention, though less so as a psychological intervention. We tested the benefits of these strategies over a brief interval by randomizing 230 participants to complete a worksheet introducing one of the two strategies. Participants reported their skills prior to exposure to these worksheets and affect was assessed immediately prior to and following use of worksheets. Participants' negative affect reduced following both strategies. Conditions did not differ significantly in affect change. Analysis of potential moderators showed that, among those with higher levels of cognitive behavioral therapy skills, the positive thinking condition produced greater gains in positive affect than the cognitive restructuring condition. These results indicate that both forms of brief interventions promote reductions in negative affect. Positive thinking interventions, which are not focused on the accuracy of one's thinking, appear to be particularly effective in promoting positive affect. [ABSTRACT FROM AUTHOR]