Browsing by Subject "Cognitive behavioral therapy"
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Item Externalizing behaviors in youth with anxiety : a replication and extension of previous findings(2019-09-18) Mitchell, Abigail Grace; Stark, Kevin Douglas; Carlson, Cindy; Pustejovsky, James; Smits, JasperThis study examined the nature of externalizing behaviors among 500+ youth ages 7-17 with a primary diagnosis of Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder (SAD), and/or Social Phobia (SoP). It builds on previous findings suggesting that externalizing symptoms may be an under-recognized feature of childhood anxiety disorders (Garland & Garland, 2001; Mireault, Rooney, Kouwenhoven, & Hannan, 2008; Williams, Dahan, Silverman, & Pettit, 2013). As a first step, this study employed two exploratory techniques that sought to classify participants into subgroups based on their presentation of externalizing symptoms. Results of a two-step cluster analysis indicated a best-fitting 2-cluster model in which subgroups differed by average severity of aggressive behaviors. Results of the second classification approach, Latent Class Analysis (LCA), indicated a best-fitting 3-class model in which subgroups differed by overall severity of externalizing symptoms. These results were largely similar to a prior study that used the same approach to classify a similar sample of anxious youth (Williams et al., 2013). A comparison of subgroups within each analysis suggested that externalizing problems among anxious youth are related to anxiety severity, anxiety subtype, and to youth age; no relation was found with regard to youth gender. Furthermore, exploratory findings highlighted a handful of specific behaviors that are particularly likely to co-occur with childhood anxiety (e.g., arguing, disobedience, temper tantrums). These behaviors may reflect the youth’s attempt to avoid anxiety-induced distress. A second phase of analysis utilized post-treatment data to examine the relationship between externalizing behaviors and response to anxiety treatment. Contrary to the investigator’s hypothesis, results of regression analyses indicated that externalizing symptoms prior to treatment were not significantly related to child treatment response, suggesting that anxious youth with greater externalizing problems may benefit from treatment as much as those who do not present with these behavioral challenges. Taken together, these findings have implications for the identification, assessment, and treatment of youth anxiety disorders.Item How is school-based mental health educationally relevant? Exploring the academic outcomes of a CBT intervention for trauma in schools(2016-08) Mitchell, Abigail Grace; Stark, Kevin Douglas; Carlson, Cindy IThe psychological and behavioral effects of trauma are well documented, as are its significant disruptions to developmental trajectories over the lifespan. Besides providing access to children, schools offer familiar and supportive settings in which to conduct trauma therapy. The proposed study uses a randomized controlled design to examine the impact of participation in a school-based treatment program for youth experiencing posttraumatic stress (CBITS). Participants include a sample of 160 sixth graders from a low-income background who have experienced trauma and report elevated levels of posttraumatic stress. In addition to symptom indicators, measures of student engagement and classroom behavior will be collected prior to and following the intervention. Post-score differences between intervention and control groups will be analyzed for each outcome with adjustment for baseline differences. It is expected that students in the intervention group will exhibit lower levels of PTSD, more positive classroom behavior, and higher perceived engagement in learning. These predictions align with research documenting the relationship between academic and socio-emotional functioning. Well-developed school-based programs have the potential to address macro-level disparities in care and to improve academic functioning for students experiencing posttraumatic stress. Finally, addressing trauma in the schools is a wise investment that will head off future social service costs.Item The impact of a blended cognitive remediation and cognitive behavioral group therapy for pediatric oncology survivors : a mixed methods approach(2013-08) Judd-Glossy, Laura Elizabeth; Stark, Kevin DouglasAdvances in cancer treatment have led to a significant increase in the number of pediatric oncology survivors. These survivors often have late effects in their cognitive, academic, executive, and psychological functioning subsequent to their chemotherapy and radiation treatment. In particular, executive functioning (EF), which is crucial for cognitive and academic functioning, has been recognized as an area that is impacted by treatment. Several studies have described cognitive remediation programs that seek to improve EF skills in pediatric oncology survivors. Although these programs have led to improvements in EF skills, they are often difficult to replicate due to the extensive time requirement. Many survivors also experience distress and anxiety and would likely benefit from cognitive behavioral therapy, which has been shown to be an effective intervention for children with internalizing disorders. Thus, a brief intervention that combines treatment for executive functioning and psychological distress is warranted. A mixed methods study was conducted to evaluate the impact of a nine-week blended cognitive remediation and cognitive behavior therapy group for pediatric oncology survivors and their parents. Participants were pediatric cancer survivors, age 9-14, and their parents who were referred through a local children's hospital that specialized in oncology treatment. Pre and post measures of EF, psychological functioning, and parental stress were examined. Semi-structured interviews with participants and their parents were completed and analyzed to learn more about the function of short-term group therapy for pediatric oncology survivors. Content analysis of the parent support group sessions was also conducted. Significant changes were found for youth internalizing symptoms, youth adaptive skills, youth executive functioning, and parental stress. There was also a positive correlation between parental stress and parent-rated youth internalizing problems as well as parent-rated youth behavioral symptoms and a negative correlation between parental stress and parent-rated youth adaptive behavior. Qualitative interviews indicated that participants felt that the intervention was helpful. Themes from the parent group included the challenge of managing late effects, balancing multiple roles, and coping with distress. Implications, limitations, and recommendations for further areas of research are presented.Item Impact of childhood anxiety on family functioning in a cognitive behavioral therapy treatment program with parent training(2017-05) Cantu, Annette Lynn; Keith, Timothy, 1952-This study will investigate the relation between family functioning and child anxiety during a cognitive behavior therapy (CBT) intervention for youth with anxiety and their families, including whether child anxiety level can predict family functioning levels post-treatment when controlling for pre-treatment levels of anxiety and family functioning. The study will include analyses at multiple time points. Also assessed will be whether adding a parent component to CBT treatment for children with anxiety will help predict overall family functioning. Data analytic methods used will be a Pearson product-moment correlation for the first research question and a linear multiple regression design for the second and third questions.Item Mechanisms of change in CBT for depressed early adolescent girls : mediating effects of the cognitive triad on cognitive interventions for depressive symptoms(2009-12) Monnat, Lynn Mie 1970-; Stark, Kevin DouglasDepression is an increasingly common health problem among youth. There is growing empirical evidence that CBT is a promising treatment for childhood depression. It remains unclear what treatment-specific effects of CBT contribute to therapeutic gains. Cognitive theories propose that a primary mechanism of change in CBT are cognitive interventions that target depressogenic cognitions regarding the self, world, and future (cognitive triad), which are thought to mediate depression. The effects of cognitive interventions on depressive symptoms are thus hypothesized to be mediated by changes in the cognitive triad. No studies have investigated whether CBT for depressed youth works by treating the cognitive triad through the implementation of cognitive techniques. As part of a larger study analyzing the mechanisms of change in CBT for depressed youth, the purpose of this study was to investigate: (1) whether specific cognitive techniques are related to depressive symptom reduction in youth, and (2) if improvements in depressive symptoms are mediated through the cognitive triad of depressed youth. Participants were 42 girls, aged 8 to 14, who completed a manualized CBT protocol for depression in group format. Girls completed a diagnostic interview for depression and self-report measures assessing the cognitive triad. Group therapy sessions were coded for cognitive interventions. Results indicated a non-significant relation between levels of cognitive interventions and post-treatment depression scores, after controlling for pre-treatment depression. Therefore, tests of mediation were discontinued. Relevant control variables were added to the model to reduce error variance. After controlling for pre-treatment depression, age, presence of learning disorder, mastery of therapeutic skills, and behavioral interventions, cognitive interventions were significantly and positively associated with post-treatment depression. The relation between cognitive interventions and the cognitive triad was non-significant and meditational analyses were discontinued. Exploratory factor analysis revealed four cognitive interventions factors that were consistent with CBT theory. Further analyses revealed that all factors were not significantly related to post-treatment depression. Tests of interactions between cognitive interventions and behavioral interventions, age, and mastery level of therapeutic skills were also non-significant. Implications, limitations, and recommendations for further areas of research are presented.Item Mechanisms of change in cognitive behavioral therapy for depressed early adolescent females : mediating effects of the cognitive triad on cognitive, behavioral, problem solving, and relational components of the ACTION treatment for depression(2012-08) Arora, Prerna, 1980-; Carlson, Cindy I., 1949-; Stark, Kevin Douglas; Tharinger, Deborah J.; Pituch, Keenan A.; Loukas, Alexandra; Kaslow, Nadine J.Childhood depression is a widespread, stable disorder, and recurring disorder (Kovacs, Feinberg, Crouse-Novak, Paulauskas, & Finkelstein, 1984). Cognitive-Behavioral therapy is an empirically supported intervention for the treatment of depression (Weersing & Weisz, 2002; Weisz, McCarty, & Valeri, 2006). CBT for depression is often comprised of cognitive, behavioral, problem-solving, and relational interventions (McCarty & Weisz, 2007). While it is evident that CBT as a whole is efficacious, there exists a dearth of knowledge concerning the specific components within CBT, which contribute to symptom reduction in youth (Kazdin & Weisz, 1998; Kennard et al., 2009). Therefore, the manner in which CBT accomplishes change is not well understood (Shirk & Karver, 2006). Specifically, while cognitive theories assert that interventions targeted at modifying negative cognitions reduce depression (Beck, 1967), few studies, particularly with regards to depressed youth, have addressed this (Stice, Rohde, Seeley, & Gau, 2010). As such, this hypothesis concerning the role of depressogenic cognitions as mediators between certain CBT interventions and symptom reduction remains unsubstantiated (Weersing, Rozenman, & Gonzales, 2009). The current study assessed whether higher levels of cognitive, behavioral, problem solving, and relational components were associated with lower levels of post-treatment depression, as well as whether they were mediated through changes in the cognitive triad, a measure of depressogenic thinking. No studies have assessed the effectiveness of discrete interventions incorporated in CBT treatments for depression in youth, further examining whether noted changes in depression are mediated through cognitions, specifically the cognitive triad. Participants included 40 depressed females, aged 9 to 14, assessed using self-report measures and a diagnostic interview for depression, who engaged in treatment using a manualized group CBT treatment protocol. Results from hierarchical linear models indicated that higher participant cognitive triad scores and higher relational interventions were associated with lower post-treatment depression scores. However, subsequent analyses revealed that higher aggregated behavioral-problem-solving interventions scores were associated with lower post-treatment depression scores, while higher aggregated cognitive-relational intervention scores were associated with higher post-treatment depression scores. Implications, limitations, and recommendations for further areas of research are discussed.Item The mediating effect of acculturation on the effectiveness of culturally adapted cognitive behavioral therapy with Mexican Americans suffering from depression(2009-05) Villalobos, Griselda; Padilla, Yolanda C.; Holleran, Lori K.The purpose of this research study is to explore the role of culture in how Mexican Americans respond to mental health treatment. Cultural background is likely to affect not only the meaning attributed to mental illness, but also help-seeking and responses to treatment. Creating a match between treatment modalities and people's cultural backgrounds requires consideration of a person's cultural context. Cultural characteristics can vary not only across cultural groups, but even within groups can change across time. This study used a quasi-experimental pretest/posttest comparison group design to analyze culturally adapted cognitive behavioral therapy (CACBT) with Mexican Americans diagnosed with depression. A purposive nonprobability sample of 81 adult Mexican Americans diagnosed with depression was recruited from a mental health agency in El Paso, Texas. Forty-eight participants were assigned to a treatment group, which received CACBT, and 33 to a comparison group, which received treatment as usual. Depression was measured using the Patient Health Questionnaire (PHQ-9). Participant acculturation level was measured using the Acculturation Rating Scale for Mexican Americans-II. Independent and paired t tests were used to examine the effectiveness of the culturally adapted intervention. OLS regression analyses examined whether acculturation mediated the relationship between the culturally adapted intervention and depression. No direct effect was found between CACBT and depression relative to treatment as usual. The results showed that CACBT and treatment as usual both decreased depression scores. However, the interaction effect between acculturation and group assignment was significantly related to posttest depression scores. Thus, the effect of CACBT varied according to acculturation level. This study demonstrates the role that acculturation plays in how Mexican Americans respond to mental health treatment. An implication for social work practice is the need to use evidence-based practices that have been tested for their cultural appropriateness with Mexican Americans.Item The relation between comorbid anxiety and treatment outcome in depressed early adolescent girls(2009-08) Hamilton, Amy Melissa; Stark, Kevin DouglasPrevious research has suggested that depressive disorders are common in youth and are associated with many negative outcomes. As a result, understanding how to treat depression effectively is very important. It is unclear; however, what factors predict treatment success or failure for depressed youth. Researchers are starting to investigate whether comorbid anxiety is a possible moderator of treatment outcome for youth with depression. Studies of the relation between comorbid anxiety and treatment outcome have produced mixed findings and have almost exclusively focused on older depressed adolescents. There is also limited research exploring whether parent intervention moderates the effect of comorbid anxiety on treatment outcome in depressed youth. This study focused on investigating the relation between comorbid anxiety and treatment outcome in a sample of 84 depressed female early adolescents who received either group cognitive behavioral therapy (CBT) or group CBT plus a parent intervention. The addition of parent intervention was explored as a moderator of the relation between anxiety and treatment outcome. Treatment outcome was measured by changes in depression severity and global functioning during treatment. The depression severity and global functioning scores of depressed girls with comorbid anxiety were also compared to depressed girls without comorbid anxiety prior to treatment to determine whether the first group of girls entered treatment with a different level of psychopathology. Participants and their primary caregivers were administered a semi-structured diagnostic interview which was used as a measure of depression severity, global functioning, anxiety severity, and to determine whether participants met diagnostic criteria for depressive and anxiety diagnoses. The results of this study suggested that depressed youth with comorbid anxiety or higher anxiety severity started out treatment with higher depression severity and lower functioning. Results also suggested that comorbid anxiety was not related to negative treatment outcome and that youth with comorbid anxiety actually experienced larger reductions in depression severity over the course of treatment than youth without comorbid anxiety. Parent intervention did not significantly moderate the effect of comorbid anxiety on treatment outcome. The study’s limitations, implications of the results, and recommendations for future research were discussed.Item Understanding participants’ perspectives : a qualitative study of a cognitive-behavioral intervention with a parent-training component for anxious youth(2017-08-07) Jones, Hannah Linley; Stark, Kevin Douglas; Carlson, Cindy I; Ainslie, Ricardo C; Reddick, Richard JAnxiety disorders are the most common psychological disorders in school-age children. This high prevalence is problematic because anxiety can have detrimental impairments on children and adolescents’ behavioral, social, academic, and emotional functioning. Therefore, many researchers have investigated the most effective treatments for anxious youth. Many randomized control trials have demonstrated that Cognitive-Behavioral Therapy (CBT) is effective for treating pediatric anxiety. However, research has also shown that there is a significant proportion of anxious youth who continue to have an anxiety disorder diagnosis post-treatment. Furthermore, while research demonstrates that CBT can treat anxiety, little is known about how or why this intervention is beneficial. It is unclear if the effectiveness stems from certain aspects of the CBT treatment itself, such as exposures or cognitive restructuring, or if treatment is successful due to other more universal aspects of the intervention, such as a strong therapeutic alliance or certain client characteristics. Some researchers also posit that including parents in the treatment of anxious youth should help to enhance the effectiveness of CBT interventions, but the research has yielded mixed results. Gaining insights into the perspectives of youth and parents who have completed a CBT intervention could help clarify the beneficial aspects of treatment. CBT is part of a collaborative process between the therapist and the client, but if the participants’ perspectives on the treatment process and outcome are not obtained, then a key person responsible for change is being neglected. In order to truly understand how children and adolescents change in therapy, the participants have to be given a platform to share and amplify their voices and make their perspectives known. The primary aim of this dissertation study was to support youth and parents in sharing their perspective in order to gain a greater understanding of the lived experiences of what it is like to participate in a CBT intervention program. This study evaluated youth and parents’ perspectives through semi-structured interviews. A qualitative research method was used to assess the thoughts, feelings, and experiences of the participants of a CBT intervention program with a parent-training component. Specifically, interpretative phenomenological analysis was used to gain a better understanding of the therapeutic change experience.