Following from the seminal work of Ferster, Lewinsohn, and Jacobson, as well as theory and research on the Matching Law, Lejuez, Hopko, LePage, Hopko, and McNeil developed a reinforcement-based depression treatment that was brief, uncomplicated, and tied closely to behavioral theory. They called this treatment the brief behavioral activation treatment for depression (BATD), and the original manual was published in this journal. The current manuscript is a revised manual (BATD-R), reflecting key modifications that simplify and clarify key treatment elements, procedures, and treatment forms. Specific modifications include (a) greater emphasis on treatment rationale, including therapeutic alliance; (b) greater clarity regarding life areas, values, and activities; (c) simplified (and fewer) treatment forms; (d) enhanced procedural details, including troubleshooting and concept reviews; and (e) availability of a modified Daily Monitoring Form to accommodate low literacy patients. Following the presentation of the manual, the authors conclude with a discussion of the key barriers in greater depth, including strategies for addressing these barriers.

A large percentage of individuals entering residential treatment for substance abuse dropout of treatment early, often leading to subsequent relapse. Although a number of studies have investigated the predictors of treatment dropout, the particular characteristics that affect one's ability to cope with the initial stages of treatment and abstinence have not been addressed. As one line of research, the concept of distress tolerance, defined as one's ability to tolerate either psychological or physical distress, has been shown to be related to early lapse in abstinence attempts in illicit drug users, smokers, and gamblers. Although clearly applicable, the relationship between distress tolerance and early treatment dropout has yet to be examined. Thus, in the current study it was hypothesized that levels of distress tolerance would predict whether individuals dropout of treatment within 30 days. Specifically, 122 individuals entering a residential substance abuse treatment facility completed a battery of selfreport measures assessing characteristics previously demonstrating a relationship with residential substance abuse treatment dropout, namely demographic variables, mood variables, levels of psychopathology, substance-use severity, social support, and treatment readiness. Additionally, participants completed behavioral measures of psychological and physical distress tolerance. As hypothesized, logistic regression analyses indicated that psychological distress tolerance predicted early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development/modification are discussed.

There is growing interest in non-invasive brain stimulation (NIBS) as a novel treatment option for substance-use disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience demonstrating links between neural circuits and drug consuming behavior, as well as recent FDA-approval of NIBS treatments for mental health disorders that share overlapping pathology with SUDs. As with any emerging field, enthusiasm must be tempered by reason; lessons learned from the past should be prudently applied to future therapies. Here, an international ensemble of experts provides an overview of the state of transcranial-electrical (tES) and transcranial-magnetic (TMS) stimulation applied in SUDs. This consensus paper provides a systematic literature review on published data-emphasizing the heterogeneity of methods and outcome measures while suggesting strategies to help bridge knowledge gaps. The goal of this effort is to provide the community with guidelines for best practices in tES/TMS SUD research. We hope this will accelerate the speed at which the community translates basic neuroscience into advanced neuromodulation tools for clinical practice in addiction medicine.

This study examined the reliability and validity of the youth version of the Balloon Analogue Risk Task (BART-Y) for assessing adolescent risk behaviors among a sample of 98 inner-city African American adolescents (M age = 14.8, SD = 1.5). In addition to a relation with sensation seeking, BART-Y responding evidenced a significant relation with a composite of risk behaviors across substance use, sexual behavior, delinquency, and health domains. BART-Y responding also explained unique variance in a composite of these risk behaviors above and beyond demographic variables and risk-related personality constructs, including sensation seeking and impulsivity.

A large body of research has examined the development of internalizing and externalizing symptoms in childhood and early adolescence. Notably, there is significant concomitant impairment associated with early adolescent symptomatology, as well as association of these symptoms with future development of psychopathology, poor physical health, self-destructive thoughts and behaviors, criminal behavior, and HIV risk behaviors. Drawing on negative reinforcement theory, the current study sought to examine the potential role of distress tolerance, defined as the ability to persist in goal-directed activity while experiencing emotional distress, as a potential mechanism that may underlie both internalizing and externalizing symptoms among 231 Caucasian and African American youth (M age = 10.9 years; 45.5% female; 54.5% Caucasian ethnicity). A series of regressions resulted in significant moderated relationships, such that low distress tolerance conferred increased risk for alcohol use among Caucasians, delinquent behavior among African Americans, and internalizing symptoms among females. Clinical implications, including the potential role of negative reinforcement models in early intervention with young adolescents, are discussed.

significant clinical and public health implications. Compared with the general population, mood disorders are up to 4.7 times more prevalent in illicit drug-dependent samples. 1-3 Prevalence rates of major depressive disorder among treatment-seeking cocaine-and opiate-dependent patients are especially high, ranging from 25% to 61%. 4-6 These elevated rates are particularly important because there is extensive evidence that depressed drug users are significantly more likely than nondepressed drug users to drop out of substance use treatment and relapse to drug

Distress intolerance may be an important individual difference variable in understanding maladaptive coping responses across diagnostic categories. However, the measurement of distress intolerance remains inconsistent across studies and little evidence for convergent validity among existing measures is available. This study evaluated the overlap among self-report and behavioral measures of distress intolerance in four samples, including an unselected sample, a sample of patients with drug dependence, and two samples of cigarette smokers. Results suggested that the self-report measures were highly correlated, as were the behavioral measures; however, behavioral and self-report measures did not exhibit significant associations with each other. There was some evidence of domain specificity, with anxiety sensitivity demonstrating strong associations with somatic distress intolerance, and a lack of association between behavioral measures that elicit affective distress and those that elicit somatic distress. These findings highlight a potential divergence in the literature relative to the conceptualization of distress intolerance as either sensitivity to distress or as the inability to persist at a task when distressed. Further research is needed to elucidate the conceptualization and measurement of distress intolerance to facilitate future clinical and research applications of this construct.

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