Informed by this summary of the evidence, we propose a transdiagnostic therapy approach that aims to integrate treatment elements found in empirically supported CBT-based interventions for SUD and depression. By targeting shared cognitive-affective processes underlying SUD-depression, transdiagnostic treatment models have the potential to offer a novel clinical approach to treating this difficult-to-treat comorbidity and relevant, co-occurring psychiatric disturbances, such as posttraumatic stress.

Over the subsequent 3 years, Brown continued to interview women and expanded her study to include men. After conducting more than 700 interviews with men and women, including more than 100 mental health professionals, she found that the main concerns of men were the same as those of women: Shame created pervasive feelings of fear, blame, disconnec-CONNECTIONS 357

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Objective Assess perceptions of prevalence, safety, and screening practices for cigarettes and secondhand smoke exposure (SHSe), marijuana (and synthetic marijuana), electronic nicotine delivery systems (ENDS; e.g., e-cigarettes), nicotine replacement therapy (NRT), and smoking-cessation medications during pregnancy, among primary care physicians (PCPs) providing obstetrical care. Methods A web-based, cross-sectional survey was e-mailed to 3750 US physicians (belonging to organizations within the Council of Academic Family Medicine Educational Research Alliance). Several research groups’ questions were included in the survey. Only physicians who reported providing “labor and delivery” obstetrical care responded to questions related to the study objectives. Results A total of 1248 physicians (of 3750) responded (33.3%) and 417 reported providing labor and delivery obstetrical care. Obstetrical providers (N=417) reported cigarette (54%), marijuana (49%), and ENDS use (24%) by “Some (6–25%)” pregnant women, with 37% endorsing that “Very Few (1–5%)” pregnant women used ENDS. Providers most often selected that very few pregnant women used NRT (45%), cessation medications (i.e., bupropion or varenicline; 37%), and synthetic marijuana (23%). Significant proportions chose “Don’t Know” for synthetic marijuana (58%) and ENDS (27%). Over 90% of the sample perceived that use of or exposure to cigarettes (99%), synthetic marijuana (99%), SHS (97%), marijuana (92%), or ENDS (91%) were unsafe, with the exception of NRT (44%). Providers most consistently screened for cigarette (85%) and marijuana use (63%), followed by SHSe in the home (48%), and ENDS (33%) and synthetic marijuana use (28%). Fewer than a quarter (18%) screened consistently for all substances and SHSe. A third (32%) reported laboratory testing for marijuana and 3% reported laboratory testing for smoking status. Conclusion This sample of PCPs providing obstetrical care within academic settings perceived cigarettes, marijuana, and ENDS use to be prevalent and unsafe during pregnancy. Opportunities for increased screening during pregnancy across these substances were apparent.

Objectives.-Maternal depression in the postpartum period is prevalent and associated with negative child outcomes, including behavior problems and cognitive delays. Mothers of children admitted directly after birth to the neonatal intensive care unit (NICU) are at even higher risk for depressive symptoms and infants born premature and/or at low birth weight may be more vulnerable to the adverse effects of maternal depression. Understanding mechanisms, particularly modifiable mechanisms, involved in the development or persistence of depressive symptoms is critically important for developing effective treatments.Methods.-The longitudinal, secondary analysis investigated the role of psychological inflexibility (rigidly avoiding or attempting to control distressing internal experiences, precluding present moment awareness of contingencies and engagement with important values) as a mediator of the relationship between early (1-2 weeks postpartum) and later (3 and 6 months postpartum) depressive postpartum symptoms among mothers (N = 360) with an infant in the neonatal intensive care unit.Results.-Psychological inflexibility measured two weeks after infant discharge from the hospital fully mediated the relationship between early and later depressive symptoms at 3 months postpartum, with partial mediation at 6 months, while controlling for factors previously found predictive of postpartum depression.Conclusions.-Acceptance and Mindfulness therapies which specifically target psychological inflexibility may be promising interventions to reduce depressive symptoms postpartum among new mothers with a NICU infant.

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