The current study examined whether elevations on four variables (drive for thinness, depressed mo... more The current study examined whether elevations on four variables (drive for thinness, depressed mood, maladaptive cognitions, and ineffectiveness) were related to increased risk of developing an eating disorder over a 4-year prospective interval. Subjects (N = 191) were female undergraduates who were assessed with the Anorexia-Bulimia Inventory (ABI), Eating Disorder Inventory (EDI), and a structured clinical interview. Results indicated that individuals with elevated scores on each of the four variables at the initial assessment did not show higher absolute eating disorder incidence rates over the 4-year interval. However, initial scores on the four variables together lll explained approximately 13% of both anorexia and bulimia symptom severity variance at the final assessment. Changes over time in the four variables were more highly related to later symptom severity, explaining 34% of the variance in anorexic severity and 16% in bulimic severity. Thus, the findings suggest that ini...
Background Manualized cognitive and behavioral therapies are increasingly used in primary care en... more Background Manualized cognitive and behavioral therapies are increasingly used in primary care environments to improve nonpharmacological pain management. The Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) intervention, recently implemented by the Defense Health Agency for use across the military health system, is a modular, primary care–based treatment program delivered by behavioral health consultants integrated into primary care for patients experiencing chronic pain. Although early data suggest that this intervention improves functioning, it is unclear whether the benefits of BCBT-CP are sustained. The purpose of this paper is to describe the methods of a pragmatic clinical trial designed to test the effect of monthly telehealth booster contacts on treatment retention and long-term clinical outcomes for BCBT-CP treatment, as compared with BCBT-CP without a booster, in 716 Defense Health Agency beneficiaries with chronic pain. Design A randomized pragmatic clinical...
Journal of Clinical Psychology in Medical Settings, 2018
The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of beh... more The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of behavioral health services into primary care settings. Implementation of the PCBH model has grown over the past two decades, yet research and training efforts have been slowed by inconsistent terminology and lack of a concise, operationalized definition of the model and its key components. This article provides the first concise operationalized definition of the PCBH model, developed from examination of multiple published resources and consultation with nationally recognized PCBH model experts. The definition frames the model as a team-based approach to managing biopsychosocial issues that present in primary care, with the over-arching goal of improving primary care in general. The article provides a description of the key components and strategies used in the model, the rationale for those strategies, a brief comparison of this model to other integration approaches, a focused summary of PCBH model outcomes, and an overview of common challenges to implementing the model.
There are 2.1 million current military servicemembers and 21 million living veterans in the Unite... more There are 2.1 million current military servicemembers and 21 million living veterans in the United States. Although they were healthier upon entering military service compared to the general U.S. population, in the longer term veterans tend to be of equivalent or worse health than civilians. One primary explanation for the veterans' health disparity is poorer health behaviors during or after military service, especially areas of physical activity, nutrition, tobacco, and alcohol. In response, the Department of Defense and Department of Veterans Affairs continue to develop, evaluate, and improve health promotion programs and healthcare services for military and veteran health behavior in an integrated approach. Future research and practice is needed to better understand and promote positive health behavior during key transition periods in the military and veteran life course. Also paramount is implementation and evaluation of existing interventions, programs, and policies across the population using an integrated and person centered approach.
Journal of Clinical Psychology in Medical Settings, 2016
The expansion of integrated, collaborative, behavioral health services in primary care requires a... more The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed. Keywords Training Á Integrated primary care Á Collaborative primary care Á Primary care behavioral health Á Mental health The integration of behavioral health providers into primary care clinics to provide integrated healthcare services is expanding across the U.S., from small primary care clinics, to large private healthcare organizations, Federally Qualified Health Centers, and large government healthcare programs in the Department of Veterans Affairs (VA), Department of Defense (DoD), and Indian Health Service (Kelly & Coons, 2012). With the expansion of integrated services has come a workforce shortage in behavioral health providers with appropriate training and experience to work effectively in primary care (Hall et al., 2015). The majority of traditionally trained behavioral health providers do not have the skill sets to effectively work in a fast-paced primary care environment using a population health approach to services. Leaders in the integrated primary care field have concluded that successful integrated care providers need training in clinical health psychology, teambased communication skills to function effectively as an interdisciplinary team member, and supervised experience in the specific integrated model of care. Training approaches such as day-long continuing education workshops or integrated primary care certificate programs, while useful, do not provide adequate depth or the on-site training
Gender differences in self-reported internalizing symptoms of children in grades 3-6 were investi... more Gender differences in self-reported internalizing symptoms of children in grades 3-6 were investigated. Using the Internalizing Symptoms Scale for Children (ISSC), and normative data from a large, nationwide sample, self-reported internalizing symptom scores of boys (n = 876) were compared to those of girls (n = 840). Total internalizing scores of girls were significantly (p < .001) larger than those of boys, indicating a higher degree of self-reported internalizing symptoms. The average scores of the girls were approximately one third of a standard deviation higher than the average scores of the boys. Using a discriminant function analysis, the ISSC item scores were found to be reasonably effective in classifying subjects by gender. Seven critical self-report items that contributed the most to the separation of subjects by gender were identified. Implications of this study for psychoeducational assessment practice, early identification of internalizing problems, and subsequent i...
The rapid expansion of integrated behavioral health care in primary care medical settings introdu... more The rapid expansion of integrated behavioral health care in primary care medical settings introduces a number of ethical challenges faced by teams of health professionals from different disciplines. As military health care settings have increasingly implemented primary care behavioral health models of service delivery, distinct ethical dilemmas have emerged. This article examines two of these ethical issues, competence and multiple relationships, through presentation of clinical scenarios in military integrated primary care settings. Relevant professional ethical guidelines for psychologists, social workers, and physicians are examined. Recommendations for the ethical practice of primary care behavioral health, as well as suggestions for future development of professional ethical guidelines, are discussed.
Concern about weight gain after tobacco cessation is a potential barrier to quitting tobacco. Few... more Concern about weight gain after tobacco cessation is a potential barrier to quitting tobacco. Few studies, however, have examined the role of body image in cessation-related weight concerns and anticipated relapse. This study investigated relationships between current body image dissatisfaction, anticipated body image dissatisfaction (discrepancy between anticipated post-cessation body shape and desired body shape), cessation-related weight concerns, and intention to resume tobacco with weight gain. Body image dissatisfaction was significantly related to cessation-related weight concerns. Participants who reported current dissatisfaction with their body image were 2.6 times more likely to intend to resume tobacco use with cessation-related weight gain than those with no body image dissatisfaction. Individuals with anticipated body image dissatisfaction were 3.4 times more likely to intend to resume tobacco compared to individuals with no anticipated body image dissatisfaction. Women and normal weight individuals with anticipated body image dissatisfaction appear to be at particularly high risk for intending to relapse. Results suggest that tobacco cessation interventions may need to target concerns about body image as well as weight gain.
Journal of Clinical Psychology in Medical Settings, 2021
Pragmatic trials testing the effectiveness of interventions under "real world" conditions help br... more Pragmatic trials testing the effectiveness of interventions under "real world" conditions help bridge the research-to-practice gap. Such trial designs are optimal for studying the impact of implementation efforts, such as the effectiveness of integrated behavioral health clinicians in primary care settings. Formal pragmatic trials conducted in integrated primary care settings are uncommon, making it difficult for researchers to anticipate the potential pitfalls associated with balancing scientific rigor with the demands of routine clinical practice. This paper is based on our experience conducting the first phase of a large, multisite, pragmatic clinical trial evaluating the implementation and effectiveness of behavioral health consultants treating patients with chronic pain using a manualized intervention, brief cognitive behavioral therapy for chronic pain (BCBT-CP). The paper highlights key choice points using the PRagmatic-Explanatory Continuum Indicator Summary (PRECIS-2) tool. We discuss the dilemmas of pragmatic research that we faced and offer recommendations for aspiring integrated primary care pragmatic trialists.
Professional Psychology Research and Practice, Nov 30, 2003
... Anxiety includes all anxiety disorders as well as adjustment disorder with anxiety. ... invol... more ... Anxiety includes all anxiety disorders as well as adjustment disorder with anxiety. ... involves (a) providing introductions and obtaining informed con-sent, (b) rapidly identifying the main ... Another common obstacle to effectively managing time in-volves the overuse of strategies ...
The current study examined whether elevations on four variables (drive for thinness, depressed mo... more The current study examined whether elevations on four variables (drive for thinness, depressed mood, maladaptive cognitions, and ineffectiveness) were related to increased risk of developing an eating disorder over a 4-year prospective interval. Subjects (N = 191) were female undergraduates who were assessed with the Anorexia-Bulimia Inventory (ABI), Eating Disorder Inventory (EDI), and a structured clinical interview. Results indicated that individuals with elevated scores on each of the four variables at the initial assessment did not show higher absolute eating disorder incidence rates over the 4-year interval. However, initial scores on the four variables together lll explained approximately 13% of both anorexia and bulimia symptom severity variance at the final assessment. Changes over time in the four variables were more highly related to later symptom severity, explaining 34% of the variance in anorexic severity and 16% in bulimic severity. Thus, the findings suggest that ini...
Background Manualized cognitive and behavioral therapies are increasingly used in primary care en... more Background Manualized cognitive and behavioral therapies are increasingly used in primary care environments to improve nonpharmacological pain management. The Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) intervention, recently implemented by the Defense Health Agency for use across the military health system, is a modular, primary care–based treatment program delivered by behavioral health consultants integrated into primary care for patients experiencing chronic pain. Although early data suggest that this intervention improves functioning, it is unclear whether the benefits of BCBT-CP are sustained. The purpose of this paper is to describe the methods of a pragmatic clinical trial designed to test the effect of monthly telehealth booster contacts on treatment retention and long-term clinical outcomes for BCBT-CP treatment, as compared with BCBT-CP without a booster, in 716 Defense Health Agency beneficiaries with chronic pain. Design A randomized pragmatic clinical...
Journal of Clinical Psychology in Medical Settings, 2018
The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of beh... more The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of behavioral health services into primary care settings. Implementation of the PCBH model has grown over the past two decades, yet research and training efforts have been slowed by inconsistent terminology and lack of a concise, operationalized definition of the model and its key components. This article provides the first concise operationalized definition of the PCBH model, developed from examination of multiple published resources and consultation with nationally recognized PCBH model experts. The definition frames the model as a team-based approach to managing biopsychosocial issues that present in primary care, with the over-arching goal of improving primary care in general. The article provides a description of the key components and strategies used in the model, the rationale for those strategies, a brief comparison of this model to other integration approaches, a focused summary of PCBH model outcomes, and an overview of common challenges to implementing the model.
There are 2.1 million current military servicemembers and 21 million living veterans in the Unite... more There are 2.1 million current military servicemembers and 21 million living veterans in the United States. Although they were healthier upon entering military service compared to the general U.S. population, in the longer term veterans tend to be of equivalent or worse health than civilians. One primary explanation for the veterans&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; health disparity is poorer health behaviors during or after military service, especially areas of physical activity, nutrition, tobacco, and alcohol. In response, the Department of Defense and Department of Veterans Affairs continue to develop, evaluate, and improve health promotion programs and healthcare services for military and veteran health behavior in an integrated approach. Future research and practice is needed to better understand and promote positive health behavior during key transition periods in the military and veteran life course. Also paramount is implementation and evaluation of existing interventions, programs, and policies across the population using an integrated and person centered approach.
Journal of Clinical Psychology in Medical Settings, 2016
The expansion of integrated, collaborative, behavioral health services in primary care requires a... more The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed. Keywords Training Á Integrated primary care Á Collaborative primary care Á Primary care behavioral health Á Mental health The integration of behavioral health providers into primary care clinics to provide integrated healthcare services is expanding across the U.S., from small primary care clinics, to large private healthcare organizations, Federally Qualified Health Centers, and large government healthcare programs in the Department of Veterans Affairs (VA), Department of Defense (DoD), and Indian Health Service (Kelly & Coons, 2012). With the expansion of integrated services has come a workforce shortage in behavioral health providers with appropriate training and experience to work effectively in primary care (Hall et al., 2015). The majority of traditionally trained behavioral health providers do not have the skill sets to effectively work in a fast-paced primary care environment using a population health approach to services. Leaders in the integrated primary care field have concluded that successful integrated care providers need training in clinical health psychology, teambased communication skills to function effectively as an interdisciplinary team member, and supervised experience in the specific integrated model of care. Training approaches such as day-long continuing education workshops or integrated primary care certificate programs, while useful, do not provide adequate depth or the on-site training
Gender differences in self-reported internalizing symptoms of children in grades 3-6 were investi... more Gender differences in self-reported internalizing symptoms of children in grades 3-6 were investigated. Using the Internalizing Symptoms Scale for Children (ISSC), and normative data from a large, nationwide sample, self-reported internalizing symptom scores of boys (n = 876) were compared to those of girls (n = 840). Total internalizing scores of girls were significantly (p < .001) larger than those of boys, indicating a higher degree of self-reported internalizing symptoms. The average scores of the girls were approximately one third of a standard deviation higher than the average scores of the boys. Using a discriminant function analysis, the ISSC item scores were found to be reasonably effective in classifying subjects by gender. Seven critical self-report items that contributed the most to the separation of subjects by gender were identified. Implications of this study for psychoeducational assessment practice, early identification of internalizing problems, and subsequent i...
The rapid expansion of integrated behavioral health care in primary care medical settings introdu... more The rapid expansion of integrated behavioral health care in primary care medical settings introduces a number of ethical challenges faced by teams of health professionals from different disciplines. As military health care settings have increasingly implemented primary care behavioral health models of service delivery, distinct ethical dilemmas have emerged. This article examines two of these ethical issues, competence and multiple relationships, through presentation of clinical scenarios in military integrated primary care settings. Relevant professional ethical guidelines for psychologists, social workers, and physicians are examined. Recommendations for the ethical practice of primary care behavioral health, as well as suggestions for future development of professional ethical guidelines, are discussed.
Concern about weight gain after tobacco cessation is a potential barrier to quitting tobacco. Few... more Concern about weight gain after tobacco cessation is a potential barrier to quitting tobacco. Few studies, however, have examined the role of body image in cessation-related weight concerns and anticipated relapse. This study investigated relationships between current body image dissatisfaction, anticipated body image dissatisfaction (discrepancy between anticipated post-cessation body shape and desired body shape), cessation-related weight concerns, and intention to resume tobacco with weight gain. Body image dissatisfaction was significantly related to cessation-related weight concerns. Participants who reported current dissatisfaction with their body image were 2.6 times more likely to intend to resume tobacco use with cessation-related weight gain than those with no body image dissatisfaction. Individuals with anticipated body image dissatisfaction were 3.4 times more likely to intend to resume tobacco compared to individuals with no anticipated body image dissatisfaction. Women and normal weight individuals with anticipated body image dissatisfaction appear to be at particularly high risk for intending to relapse. Results suggest that tobacco cessation interventions may need to target concerns about body image as well as weight gain.
Journal of Clinical Psychology in Medical Settings, 2021
Pragmatic trials testing the effectiveness of interventions under "real world" conditions help br... more Pragmatic trials testing the effectiveness of interventions under "real world" conditions help bridge the research-to-practice gap. Such trial designs are optimal for studying the impact of implementation efforts, such as the effectiveness of integrated behavioral health clinicians in primary care settings. Formal pragmatic trials conducted in integrated primary care settings are uncommon, making it difficult for researchers to anticipate the potential pitfalls associated with balancing scientific rigor with the demands of routine clinical practice. This paper is based on our experience conducting the first phase of a large, multisite, pragmatic clinical trial evaluating the implementation and effectiveness of behavioral health consultants treating patients with chronic pain using a manualized intervention, brief cognitive behavioral therapy for chronic pain (BCBT-CP). The paper highlights key choice points using the PRagmatic-Explanatory Continuum Indicator Summary (PRECIS-2) tool. We discuss the dilemmas of pragmatic research that we faced and offer recommendations for aspiring integrated primary care pragmatic trialists.
Professional Psychology Research and Practice, Nov 30, 2003
... Anxiety includes all anxiety disorders as well as adjustment disorder with anxiety. ... invol... more ... Anxiety includes all anxiety disorders as well as adjustment disorder with anxiety. ... involves (a) providing introductions and obtaining informed con-sent, (b) rapidly identifying the main ... Another common obstacle to effectively managing time in-volves the overuse of strategies ...
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Papers by Anne Dobmeyer