A Comparison of Four Measures of Self-Control Skills

Are Improvements in Cognitive Content and Depressive Symptoms Correlates or Mediators during Acute-Phase Cognitive Therapy for Recurrent Major Depressive Disorder?

The cognitive model of depression posits that cognitive therapy's (CT) effect on depressive symptoms is mediated by changes in cognitive content (e.g., automatic negative thoughts dysfunctional attitudes, failure attributions). We tested improvement and normalization of cognitive content among outpatients (N = 523) with recurrent major depressive disorder treated with acute-phase CT (Jarrett & Thase, 2010; Jarrett et al., 2013). We also tested whether improvement in cognitive content accounted for subsequent changes in depressive symptoms and vice versa. Five measures of content improved substantively from pre- to post-CT (median d = 0.96), and the proportions of patients scoring in "healthy" ranges increased (median 45% to 82%). Evidence for cognitive mediation of symptom reduction was limited (median r = .06), as was evidence for symptom mediation of cognitive content improvement (median r = .07). We discuss measurement and design issues relevant to detection of mediators and consider alternative theories of change.

Moving towards effective chronic illness management: asthma as an exemplar

The United States health care system is at a pivotal point in its ability to manage chronic illness. The demands and philosophical differences between the management of acute and chronic illnesses suggest the need for different strategies for effective and efficient management of chronic illness. The purpose of this article is to discuss the Chronic Care Model and the collaborative approach to managing chronic illnesses. Asthma, as an exemplar, will be used to illustrate the need for the development of new models of collaborative care for the treatment of chronic illnesses.

Measurement of constructs using self-report and behavioral lab tasks: is there overlap in nomothetic span and construct representation for impulsivity?

There has been little empirical evidence examining the overlap in nomothetic span for self-report measures and construct representation for behavioral lab tasks in most psychological constructs. Using the personality trait of impulsivity as an example, the authors completed a meta-analysis of 27 published research studies examining the relationship between these methods. In general, although there is a statistically significant relationship between multidimensional self-report and lab task impulsivity (r = 0.097), practically, the relationship is small. Examining relationships among unidimensional impulsivity self-report and lab task conceptualizations indicated very little overlap in self-report and behavioral lab task constructs. Significant relationships were found between lack of perseverance and prepotent response inhibition (r = 0.099); between lack of planning and prepotent response inhibition (r = 0.106), delay response (r = 0.134), and distortions in elapsed time (r = 0.104); between negative urgency and prepotent response inhibition (r = 0.106); and between sensation seeking and delay response (r = 0.131). Researchers should take care to specify which particular unidimensional constructs are operationalized with not only impulsivity, but with all traits. If self-report and lab task conceptualizations measure disparate aspects of impulsivity, we, as a field, should not expect large conceptual overlap between these methods.

Psychometric properties of the sexual attitudes scale in a sample of unmarried Chinese young adults

In China, the systematic and empirical study of sexual attitudes is difficult, in part, due to the lack of psychometrically robust instruments. This study examined the psychometric properties of the Sexual Attitudes Scale (SAS; Hendrick & Hendrick, 1987) and explored the sexual knowledge, attitudes, and behavior of Chinese young adults. A total of 1,213 unmarried, educated, Chinese young adults completed an online survey. Three factors of the SAS--Permissiveness (Sex centered on self), Responsibility, and Communion (Sex centered on the relationship)--demonstrated satisfactory psychometric properties. The results revealed that participants who were not currently in a romantic relationship were more likely to endorse Permissiveness and less likely to endorse Communion than those who were currently in a romantic relationship. Significant, positive correlations were found between Permissiveness and both the number of previous and current sexual partners. The factor structure of the SAS and the potential applications of this tool in China are discussed.

Comparative efficacy and durability of continuation phase cognitive therapy for preventing recurrent depression: design of a double-blinded, fluoxetine- and pill placebo-controlled, randomized trial with 2-year follow-up

BACKGROUND

Major Depressive Disorder (MDD) is highly prevalent and associated with disability and chronicity. Although cognitive therapy (CT) is an effective short-term treatment for MDD, a significant proportion of responders subsequently suffer relapses or recurrences.

PURPOSE

This design prospectively evaluates: 1) a method to discriminate CT-treated responders at lower vs. higher risk for relapse; and 2) the subsequent durability of 8-month continuation phase therapies in randomized higher risk responders followed for an additional 24 months. The primary prediction is: after protocol treatments are stopped, higher risk patients randomly assigned to continuation phase CT (C-CT) will have a lower risk of relapse/recurrence than those randomized to fluoxetine (FLX).

METHODS

Outpatients, aged 18 to 70 years, with recurrent MDD received 12-14 weeks of CT provided by 15 experienced therapists from two sites. Responders (i.e., no MDD and 17-item Hamilton Rating Scale for Depression

RESULTS

The trial began in 2000. Enrollment is complete (n=523). The follow-up continues.

CONCLUSIONS

The trial evaluates the preventive effects and durability of acute and continuation phase treatments in the largest known sample of CT responders collected worldwide.

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Key Words

• relapse prevention
• recurrent depression
• cognitive therapy
• fluoxetine
• longitudinal follow-up

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MESH Headings

• Adolescent
• Adult
• Aged
• Antidepressive Agents, Second-Generation/therapeutic use
• Cognitive Behavioral Therapy
• Depressive Disorder, Major/prevention & control
• Depressive Disorder, Major/therapy
• Double-Blind Method
• Female
• Fluoxetine/therapeutic use
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Research Design
• Secondary Prevention
• Young Adult

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Grants

• K24 MH001571 NIMH NIH HHS
• K24-MH001571 NIMH NIH HHS
• R01 MH-58356 NIMH NIH HHS
• R01 MH058397 NIMH NIH HHS
• R01 MH069618 NIMH NIH HHS
• R01 MH058397-11 NIMH NIH HHS
• R01 MH-69219 NIMH NIH HHS
• R01 MH-58397 NIMH NIH HHS
• R01 MH069619-05 NIMH NIH HHS
• R01 MH-69618 NIMH NIH HHS
• L40 MH069219 NIMH NIH HHS
• R01 MH069619 NIMH NIH HHS
• R01 MH058356 NIMH NIH HHS
• K24 MH001571-10 NIMH NIH HHS

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Affiliation(s)

Robin B. Jarrett Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9149, United States of America; 214-648-5345; fax 214-648-5340
Michael E. Thase The University of Pennsylvania School of Medicine, 3535 Market Street, Suite 670, Philadelphia, PA, 19104, United States of America. Philadelphia, Veterans Affairs Medical Center and University of Pittsburgh Medical Center

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