Biomedical subjects

David C Atkins

Publications and source records attributed to David C Atkins.

15 recordsLinked to original sources

PubMed2006

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Adolescent↗

PubMed2006

Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy.

Follow-up data across 2 years were obtained on 130 of 134 couples who were originally part of a randomized clinical trial comparing traditional versus integrative behavioral couple therapy (TBCT vs. IBCT; A. Christensen et al., 2004). Both treatments produced similar levels of clinically significant improvement at 2 years posttreatment (69% of IBCT couples and 60% of TBCT couples). Both treatments showed a "hockey-stick" pattern of change in which satisfaction dropped immediately after treatment termination but then increased for most of follow-up. The break point when couples reversed courses and gained in satisfaction occurred sooner for IBCT than TBCT couples, and those couples who stayed together generally fared better in IBCT than in TBCT. Finally, there was evidence of greater stability during follow-up in IBCT than in TBCT couples. There was little change in individual functioning over follow-up, but when change occurred it was strongly related to change in marital satisfaction. Given that this sample was selected for its significant and chronic distress, the data are encouraging about the long-term impact of behavioral couple therapy.

Adaptation, Psychological↗

PubMed2006

Long-term prediction of marital quality following a relationship education program: being positive in a constructive way.

Relationship education programs such as Ehevorbereitung--Ein Partnerschaftliches Lernprogramm (Premarital Preparation--A Couples' Learning Program) and the Relationship Education and Relationship Enhancement Program (PREP) can help prevent marital distress among newlyweds. Thus, it is important to understand which couples respond best to the intervention and which couples respond less well. E. A. Schilling, D. H. Baucom, C. K. Burnett, E. A. Allen, and L. Ragland (2003) unexpectedly found that the more women increased positive communication in response to PREP, the more likely they were to become distressed in the subsequent 5 years. The current study explores similar issues, investigating a relationship education program in Germany. The current results indicate that couples are susceptible to future relationship distress if women demonstrate extreme increases in positive and decreases in negative communication after intervention. Implications are provided for adapting these relationship education programs in the future.

Adaptation, Psychological↗

PubMed2006

Risk of false positives when identifying malingered profiles using the trauma symptom inventory.

The Trauma Symptom Inventory (TSI; Briere, 1995) is a 100-item self-report measure of posttraumatic symptomatology that includes an Atypical Response (ATR) validity scale designed to differentiate honest from malingered profiles. In this study, using an analogue design to experimentally manipulate honest and malingered responses on the TSI, we found that proposed ATR cut scores produce a significant risk of false positives. Furthermore, the functioning of proposed cut scores worsened when we used posttraumatic stress disorder relevant samples and low estimates of malingering base rates. In light of these findings, the TSI should be used with caution when assessing claims of posttraumatic stress in forensic or disability settings.

Adult↗

PubMed2005

The multidimensional and developmental nature of infidelity: practical applications.

When a partner has been unfaithful, an important therapeutic task is to assess factors that contributed to the affair and that may affect the individual's and couple's healing. This article provides a framework to assess multiple factors and their influence on an affair over time, as well as on responses to an affair. We address factors related to the person involved in an affair, his or her partner, their relationship, and the external context. These factors are considered across six phases of an affair: predisposition, approach, initial involvement, maintenance, disclosure or discovery, and response. A case study is presented to illustrate the usefulness of the framework in working with couples in which there has been an affair.

Adult↗

PubMed2005

Infidelity and behavioral couple therapy: optimism in the face of betrayal.

Infidelity is a common issue with which distressed couples and their therapists grapple. However, there are no data on the efficacy of commonly used therapies to treat couples in which there has been an affair. In the present exploratory study, the authors examined the therapy outcomes of a sample of infidelity couples (n=19) who had participated in a randomized clinical trial of marital therapy (N=134). Results show that infidelity couples began treatment more distressed than noninfidelity couples; however, evidence suggests that couples who had an affair and who revealed this affair prior to or during therapy showed greater improvement in satisfaction than noninfidelity couples. Implications for therapy with infidelity couples are discussed.

Adult↗

PubMed2005

Improving relationships: mechanisms of change in couple therapy.

In a sample of 134 married couples randomly assigned to traditional or integrative behavioral couple therapy (TBCT vs. IBCT), a multivariate hierarchical growth curve analysis using latent variable regression revealed that measures of communication, behavior frequency, and emotional acceptance acted as mechanisms of change. TBCT led to greater changes in frequency of targeted behavior early in therapy, whereas IBCT led to greater changes in acceptance of targeted behavior both early and late in therapy. In addition, change in behavioral frequency was strongly related to improvements in satisfaction early in therapy; however, in the 2nd half of therapy, emotional acceptance was more strongly related to changes in satisfaction. Research and clinical implications are discussed.

Adult↗

PubMed2005

Prediction of response to treatment in a randomized clinical trial of marital therapy.

This study investigated demographic, intrapersonal, and interpersonal predictors of treatment response in a randomized clinical trial of 134 distressed married couples, which examined traditional (N. S. Jacobson & G. Margolin, 1979) and integrative (N. S. Jacobson & A. Christensen, 1996) behavioral couple therapy. Results based on hierarchical linear modeling revealed that interpersonal variables were the strongest predictors, but their effects were largely limited to predicting initial marital dissatisfaction; greater individual mental health was also associated with less distress initially. Couples who were married longer demonstrated stronger treatment gains, and exploratory analyses suggested that sexually dissatisfied couples showed slower initial, but overall more consistent, gains in the integrative versus the traditional approach. Findings are considered in light of the previous literature on predicting response to marital therapy.

Adult↗

PubMed2005

Assessing clinical significance: does it matter which method we use?

Measures of clinical significance are frequently used to evaluate client change during therapy. Several alternatives to the original method devised by N. S. Jacobson, W. C. Follette, & D. Revenstorf (1984) have been proposed, each purporting to increase accuracy. However, researchers have had little systematic guidance in choosing among alternatives. In this simulation study, the authors systematically explored data parameters (e.g., reliability of measurement, pre-post effect size, and pre-post correlation) that might yield differing results among the most widely considered clinical significance methods. Results indicated that classification across methods was far more similar than different, especially at greater levels of reliability. As such, the existing methods of clinical significance appear highly comparable; future directions for clinical significance use and research are discussed.

Data Interpretation, Statistical↗

PubMed2005

Using multilevel models to analyze couple and family treatment data: basic and advanced issues.

Couple and family treatment data present particular challenges to statistical analyses. Partners and family members tend to be more similar to one another than to other individuals, which raises interesting possibilities in the data analysis but also causes significant problems with classical, statistical methods. The present article presents multilevel models (also called hierarchical linear models, mixed-effects models, or random coefficient models) as a flexible analytic approach to couple and family longitudinal data. The article reviews basic properties of multilevel models but focuses primarily on 3 important extensions: missing data, power and sample size, and alternative representations of couple data. Information is presented as a tutorial, with a Web appendix providing datasets with SPSS and R code to reproduce the examples.

Couples Therapy↗

PubMed2005

Infidelity in couples seeking marital therapy.

The revelation of an affair is often an emotionally explosive event for a couple, yet little is known about specific individual and relationship factors that accompany infidelity. The present study examined the qualities of individuals and couples that differentiate couples with (n = 19) and without (n = 115) infidelity using couples from a randomized clinical trial of marital therapy. Findings indicated that couples with infidelity showed greater marital instability, dishonesty, arguments about trust, narcissism, and time spent apart. Gender also proved to be a significant moderator of several effects. Men who had participated in affairs showed increased substance use, were older, and were more sexually dissatisfied. Results offer initial clues to concomitants of affairs for couple therapists.

Age Factors↗

PubMed2004

Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples.

A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of treatment, whereas TBCT couples improved more quickly than IBCT couples early in treatment but then, in contrast to the IBCT group, plateaued later in treatment. Both treatments produced similar levels of clinically significant improvement by the end of treatment (71% of IBCT couples and 59% of TBCT couples were reliably improved or recovered on the Dyadic Adjustment Scale; G. B. Spanier, 1976). Measures of communication also showed improvement for both groups. Measures of individual functioning improved as marital satisfaction improved.

Adult↗

PubMed2004

Gulf War veterans' illnesses: a pilot study of the relationship of illness beliefs to symptom severity and functional health status.

This investigation describes the illness beliefs of veterans regarding their Gulf War-related health concerns and investigates the relationship of these illness beliefs to physical and mental health functioning. Gulf War veterans (N = 583) presenting for evaluation at a Veteran's Affairs and Department of Defense facility completed self-report measures of symptom-related beliefs, psychosocial distress, and functional status. Hierarchical multiple regression analyses were performed to determine the extent that symptom-related beliefs impacted symptom-reporting and functional status independent of demographic factors and psychiatric illness. Several beliefs predicted physical symptom reporting and functional impairment in physical health and mental health domains after controlling for demographic variables and psychiatric illness. Gulf War veterans' illness beliefs may impact clinical outcomes. Discussing illness beliefs and providing accurate information is an important component of medical care for Gulf War veterans.

Adult↗

PubMed2003

Who's dragging their feet? Husbands and wives seeking marital therapy.

Despite its demonstrated efficacy, marital therapy's impact has been limited by couples' general reluctance to seek help until their problems become severe. To understand this delay, 147 married couples (294 individuals) in the process of seeking marital therapy were surveyed. Using multilevel confirmatory factor analysis, three relatively independent steps (problem recognition, treatment consideration, and treatment seeking) were identified. On average, wives were rated as completing all three steps before their husbands. Gender-role orientation, demographics, relationship satisfaction, and specific relationship problems (especially husbands' dissatisfaction with sex) were also predictive of the steps toward therapy. Implications for marital therapy are discussed.

Adult↗

PubMedDate not supplied

Integrating tobacco cessation treatment into mental health care for patients with posttraumatic stress disorder.

The integration of tobacco cessation treatment into mental health care for posttraumatic stress disorder (PTSD), known as Integrated Care (IC), was evaluated in an uncontrolled feasibility and effectiveness study. Veterans (N = 107) in PTSD treatment at two outpatient clinics received IC delivered by mental health practitioners. Outcomes were seven-day point prevalence abstinence measured at two, four, six, and nine months post-enrollment and repeated seven-day point prevalence abstinence (RPPA) obtained across three consecutive assessment intervals (four, six, and nine months). Abstinence rates at the four assessment intervals were 28%, 23%, 25%, and 18%, respectively, and RPPA was 15%. The number of IC sessions and a previous quit history greater than six months predicted RPPA. Stopping smoking was not associated with worsening PTSD or depression.

Behavior Therapy↗