The efficacy of booster maintenance sessions in behavior therapy: Review and methodological critique

Relapse and Relapse Prevention

Most psychological disorders and problem behaviors are characterized by very high rates of postremittance relapse. Thus, advances in the long-term efficacy of psychological interventions require understanding the causes and processes of relapse, with the ultimate goal of developing strategies that reduce the probability of relapse. Existing psychological theory and interventions relevant to relapse and relapse prevention (RP) are reviewed, with a focus on addictive behaviors. The past two decades have produced increased attention toward the relapse problem and important advances in the conceptualization of relapse (i.e., as a process rather than a discrete event). Further progress will require the translation of basic theory into applied theory, the development of integrative theories of relapse, and the design and testing of theory-based, multimodal RP interventions.

Benefits of expressive writing in lowering rumination and depressive symptoms

Depression-vulnerable college students (with both elevated prior depressive symptoms and low current depressive symptoms) wrote on 3 consecutive days in either an expressive writing or a control condition. As predicted, participants scoring above the median on the suppression scale of the Emotion Regulation Questionnaire (Gross & John, 2003) showed significantly lower depression symptoms at the 6-month assessment when they wrote in the expressive writing versus the control condition. Additional analyses revealed that treatment benefits were mediated by changes in the Brooding but not the Reflection scale of the Ruminative Response Scale (Nolen-Hoeksema & Morrow, 1991). A "booster" writing session predicted to enhance treatment benefits failed to have a significant effect.

Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders

Participants were 30 adult outpatients diagnosed with avoidant personality disorder or obsessive-compulsive personality disorder who enrolled in an open trial of cognitive therapy for personality disorders. Treatment consisted of up to 52 weekly sessions. Symptom evaluations were conducted at intake, at Sessions 17 and 34, and at the last session. Alliance variables were patients' first alliance rating and "rupture-repair" episodes, which are disruptions in the therapeutic relationship that can provide corrective experiences and facilitate change. Stronger early alliances and rupture-repair episodes predicted more improvement in symptoms of personality disorder and depression. This work points to potentially important areas to target in treatment development for these personality disorders.

Combating substance abuse with ibogaine: pre- and posttreatment recommendations and an example of successive model fitting analyses

Ibogaine is an indole alkaloid derived from the root bark of the African shrub Tabernan the iboga and it has been used for many years as a medicinal and ceremonial agent in West Central Africa. Furthermore, both anecdotal observations and recent studies suggest that ibogaine alleviates withdrawal symptoms and reduces drug cravings. Although ibogaine articles typically include information bearing on the duration of drug abstinence following treatment, little if any attention is given to the psychological and environmental factors that might facilitate a positive treatment outcome. Hence, a major purpose of the present review is to suggest a number of theory-driven, pretreatment and posttreatment recommendations that have good potential for enhancing ibogaine's effectiveness. The second major purpose of this review is to demonstrate, through a reanalysis of previously published results, the utility of conducting successive model fitting analyses on ibogaine treatment data. Such analyses are useful for determining both the strength and form of the association between pre-ibogaine treatment variables and post-ibogaine treatment outcomes. Finally, in order to facilitate future quantitative reviews, the authors recommend that a minimum set of patient- and treatment-related variables be included in all ibogaine publications involving human participants.

Auffrischungssitzungen zur Steigerung der Effektivität des Denktrainings für Kinder I

Zusammenfassung: In der Pädagogischen Psychologie fehlen bislang Studien, in denen versucht wird, die Effekte von Trainings durch die Implementation von Auffrischungssitzungen zu sichern oder zu verstärken. In der vorliegenden Studie mit N = 107 Grundschulkindern aus zweiten Klassen wird im Anschluss an das Denktraining für Kinder I nach Klauer (1989) der Effekt einer sieben Monate später durchgeführten Auffrischungssitzung geprüft. Zunächst zeigten sich die bekannten Effekte einer Steigerung der Intelligenztestleistungen durch das Training. Vor allem aber konnte gezeigt werden, dass die Kinder, die an der Auffrischungssitzung teilnahmen, gegenüber den Kindern stärkere Zuwächse erzielten, die das reine Denktraining erhielten oder zur Kontrollgruppe gehörten. Die Überlegenheit der Kinder aus der Gruppe mit der Auffrischungssitzung konnte auch weitere fünf Monate später bestätigt werden. Vorgeschlagen wird Auffrischungssitzungen in Trainingsprogramme zu integrieren.

Outpatient mental health care, self-help groups, and patients' one-year treatment outcomes

OBJECTIVE

To examine the association between the duration and amount of outpatient mental health care, participation in self-help groups, and patients' casemix-adjusted one-year outcomes.

METHODS

A total of 2,376 patients with substance use disorders, 35% of whom also had psychiatric disorders, were assessed at entry to treatment and at a one-year follow-up. Information about the duration and amount of outpatient mental health care was obtained from a centralized health services utilization database.

RESULTS

Patients who obtained regular outpatient mental health care over a longer interval and patients who attended more self-help group meetings had better one-year substance use and social functioning outcomes than did patients who were less involved in formal and informal care. The amount of outpatient mental health care did not independently predict one-year outcomes.

CONCLUSIONS

The duration of outpatient mental health care and the level of self-help involvement are independently associated with less substance use and more positive social functioning. The provision of low intensity treatment for a longer time interval may be a cost-effective way to enhance substance abuse and psychiatric patients' long-term outcomes.

Booster sessions and long-term effects of behavioral family therapy on adolescent substance use and school performance

This study investigated the long-term impact on adolescent substance use and academic failure of 6 months of booster sessions following the termination of behavioral family therapy. Subjects were four 14-16-year-old white and Hispanic males and females whose parents or teachers had referred them for 5-12 months of behavioral family therapy. The first subject received no booster sessions; after the typical decrease in substance use and academic problems at the end of treatment, his problems recurred and subsequently worsened during follow-up. The other three subjects responded similarly to behavioral family therapy, but this was followed by 6 months of booster sessions, leading to a second decrease in substance use and academic problems. Improvement was maintained throughout follow-up. These results suggest that booster sessions can prevent the recurrences of adolescent problem behavior that often follow treatment termination.