This article describes the development and validation of a brief self-report scale for diagnosing anorexia nervosa, bulimia nervosa, and binge-eating disorder. Study 1 used a panel of eating-disorder experts and provided evidence for the content validity of this scale. Study 2 used data from female participants with and without eating disorders (N = 367) and suggested that the diagnoses from this scale possessed temporal reliability (mean K -.80) and criterion validity (with interview diagnoses; mean K = .83). In support of convergent validity, individuals with eating disorders identified by this scale showed elevations on validated measures of eating disturbances. The overall symptom composite also showed test-retest reliability (r = .87), internal consistency (mean a -.89), and convergent validity with extant eating-pathology scales. Results implied that this scale was reliable and valid in this investigation and that it may be useful for clinical and research applications.It has been estimated that 10% of female individuals in western countries will suffer from a diagnosable eating disorder (American Psychiatric Association [APA], 1994), making it one of the more prevalent psychiatric problems faced by women. Anorexia nervosa is characterized by (a) extreme emaciation; (b) intense fear of gaining weight or becoming fat despite a low body weight; (c) disturbed perception of weight and shape, an undue influence of weight or shape on self-evaluation, or a denial of the seriousness of the low body weight; and (d) amenorrhea (APA, 1994). This disorder has a lifetime prevalence of almost 1% among females, is refractory to treatment, shows a chronic course, results in serious medical complications, and is associated with psychiatric comorbidity such as mood, anxiety, and personality disorders (Wilson, Heffernan, & Black, 1996).Bulimia nervosa involves (a) recurrent episodes of uncontrollable consumption of large amounts of food, (b) compensatory

We dedicate this study and manuscript to the late Neil S. Jacobson, Ph.D. Dr. Jacobson was the originator of this study and shaped every aspect of its inception and implementation. His untimely death in 1999 left an irreplaceable gap, but his ideas about behavior therapy and his commitment to empirical inquiry have continued to serve as an inspiration and guide. Sandra Coffman and Christopher Martell provided onsite supervision and treatment for the cognitive therapy and behavioral activation conditions, respectively. Steve Sholl and David Kosins provided cognitive therapy. Ruth Herman-Dunn and Tom Linde provided behavioral activation therapy. Linda Cunning, Steven Dager, Kerri Halfant, Helen Hendrickson, and Alan Unis provided pharmacotherapy. Carolyn Bea and Chris Budech coordinated the pharmacotherapy conditions. Peggy Martin completed medical evaluations for the study. Lisa Roberts, and Elizabeth Shilling assisted in the coordination of the study, and David Markley assisted in the training and supervision of the clinical evaluators. Patty Bardina, Evelyn Mercier, Mandy Steiman, and Dan Yoshimoto were project evaluators. Melissa McElrea, Kim Nomensen, and Eric Gortner provided research support. Marina Smith, Jennifer Jones, Patricia Symons, Sonia Venkatraman, and Melissa Wisler conducted the adherence ratings. Virginia Rutter has been an unwavering supporter of this research, for which we are extremely grateful. NIH Public Access AbstractThis study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through one year of follow-up, compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the second year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to medication withdrawal at the level of a nonsignificant trend. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full two-year follow-up, and each was at least as efficacious as continuation medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy, and that both psychotherapies are less expensive and longerlasting alternatives to medication in the treatment of depression. KeywordsBehavioral Activation; Cognitive Therapy; Antidepressant Medication; Major Depression; Relapse; Recurrence Antidepressant medication (ADM) has been shown to prevent the return of symptoms associated with major depression for as long as it is continued or maintained (APA, 2000). However, there is little evidence that having taken ...

A central component of Dialectical Behavior Therapy (DBT) is the teaching of specific behavioral skills with the aim of helping individuals with Borderline Personality Disorder (BPD) replace maladaptive behaviors with skillful behavior. Although existing evidence indirectly supports this proposed mechanism of action, no study to date has directly tested it. Therefore, we examined the skills use of 108 women with BPD participating in one of three randomized control trials throughout one year of treatment and four months of follow-up. Using a hierarchical linear modeling approach we found that although all participants reported using some DBT skills before treatment started, participants treated with DBT reported using three times more skills at the end of treatment than participants treated with a control treatment. Significant mediation effects also indicated that DBT skills use fully mediated the decrease in suicide attempts and depression and the increase in control of anger over time. DBT skills use also partially mediated the decrease of nonsuicidal self-injury over time. Anger suppression and expression were not mediated. This study is the first to clearly support the skills deficit model for BPD by indicating that increasing skills use is a mechanism of change for suicidal behavior, depression, and anger control. KeywordsDialectical Behavior Therapy; Borderline Personality Disorder; Mechanism of Change; Suicidal Behavior; Major Depression; Anger Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment program originally developed to treat suicidal individuals with Borderline Personality Disorder (BPD). The model of BPD that informs DBT suggests that: 1) BPD is a disorder of emotion dysregulation stemming from important deficits in interpersonal, emotion-regulation (including regulation of mood dependent behaviors), and distress tolerance skills, 2) adaptive behavioral skills that individuals do have in their repertoire are often inhibited or interfered with by maladaptive behavior, and 3) maladaptive behaviors (that constitute many of the criteria of BPD) such as suicidal behaviors or other impulsive behaviors are Please address correspondence to Andrada D. Neacsiu, Behavioral Research and Therapy Clinics, Department of Psychology, Box 351525, University of Washington, Seattle, WA 98195-1525. andrada@u.washington.edu.. andrada@u.washington.edu linehan@u.washington.edu slrizvi@rci.rutgers.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptBehav Res Ther. Author manuscript; available in PMC 2011 September 1. N...

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Consistent with the ECM, the interaction between rumination instability and negative affect instability during monitoring significantly predicted NSSI, with the strongest effects occurring for sadness and rumination about past. These findings may enhance conceptualization and treatment of patients with NSSI.

This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n=145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to drop out of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols.

Pharmacotherapy and psychotherapy are generally effective treatments for major depressive disorder (MDD); however, research suggests that patient preferences may influence outcomes. We examined the effects of treatment preference on attrition, therapeutic alliance, and change in depressive severity in a longitudinal randomized clinical trial comparing pharmacotherapy and psychotherapy. Prior to randomization, 106 individuals with MDD reported whether they preferred psychotherapy, antidepressant medication, or had no preference. A mismatch between preferred and actual treatment was associated with greater likelihood of attrition, fewer expected visits attended, and a less positive working alliance at session 2. There was a significant indirect effect of preference match on depression outcomes, primarily via effects of attendance. These findings highlight the importance of addressing patient preferences, particularly in regard to patient engagement, in the treatment of MDD.Keywords patient preferences; depression treatment; working alliance; attrition; indirect effects; multiple mediation Major depressive disorder (MDD) remains a significant public health problem worldwide. Clinical research suggests that the use of pharmacotherapy and psychotherapy, both singly and in combination, are efficacious treatments for depression (see Hollon, Thase, & Markowitz, 2002). However, it is widely recognized that the efficacy of treatments for depression in clinical practice is limited by multiple factors, including premature dropout and non-adherence (e.g., Keller, Hirschfeld, Demyttenaere, & Baldwin, 2002;Melfi, Chawla, Croghan, Hanna, Kennedy, & Sredl, 1998). The preferences of patients for a given © 2010 Elsevier Ltd. All rights reserved.Corresponding author: Bethany M. Kwan, MA, MSPH University of Colorado at Boulder UCB 345 Boulder, CO 80309-0345 bethany.kwan@colorado.edu phone: 1-720-273-2715 fax: 1-303-492-2967. Correspondence concerning this article should be addressed to Sona Dimidjian, who is at the Department of Psychology, University of Colorado, Boulder, CO 80309-0345. sona.dimidjian@colorado.edu. 2 Data on early working alliance was only available for a portion of the sample (57 out of 73; 78.1% patients and therapists). Due to administrative error, fewer patients and providers completed the WAI in the pharmacotherapy condition (29 out of 42; 69.0%) than in the psychotherapy (28 out of 31, or 90.3%).Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Given the limited and at times equivocal findings, greater clarity of the relationship between preference and key clinic...