Psychological androgyny has often been described as associated with increased behavioral flexibil... more Psychological androgyny has often been described as associated with increased behavioral flexibility, with the availability of skills in both traditionally masculine and feminine areas. Ego development has been described as involving an increasing differentiation of one's perception of self, of behavior, and of one's thoughts and feelings, as welt as an increasing ability to integrate these differentiated aspects. We therefore predicted that androgynous individuals would show higher levels of ego development than sex-typed individuals, who would in turn be higher than undifferentiated subjects. Eighty-four undergraduate and graduate students completed the Washington University Sentence Completion Test and the Personality Research Form AN-DRO scale. No evidence of a relation between these measures was found. Several other negative findings have recently been reported, using other sex role measures. It appears that ego development, as currently measured, is not associated with sex-related self-concepts, as typically measured,. though it may be associated with more androgynous sex role expectations of others, and with self-perceptions of agency and communion. Measures of sex-related self-concepts that provide separate scores for positive and negative attributes should be employed in future studies. Kagan (1964) and Kohlberg (1966), among others, have suggested that highly sex-typed individuals are motivated to behave in ways that confirm their sex role identity and to inhibit behaviors considered inappropriate for their sex. This report is based on a thesis conducted by the first author in partial fulfillment of requirements for a master's degree in psychology, under the supervision of the second author. The authors are grateful to Leo Goldberger, Bob Holt, and an anonymous reviewer for helpful comments on an earlier draft of this report.
The Journal of Behavioral Health Services & Research
The primary aim of the present study is to explore whether brief education can change Chinese ado... more The primary aim of the present study is to explore whether brief education can change Chinese adolescents’ and parents’ beliefs about when counselors would breach confidentiality. The two secondary aims are to examine whether the brief education (1) increases adolescents’ willingness to share private information with their counselor and (2) decreases parents’ expectations of the amount of information their child’s counselor would divulge to them. Results showed that adolescents and parents who read a brief passage about the limitations of confidentiality were significantly less likely to believe counselors would breach confidentiality in situations where counselors reported they would not likely breach confidentiality. Regarding our secondary research aims, results indicate that education increases adolescents’ willingness to share more sensitive information, such as about suicidality and drug use, but it does not change parents’ expectations to have most of the information divulged to them by their child’s counselor.
briefer exposures than did 18 undergraduates who received a neutral mood induction, who did not s... more briefer exposures than did 18 undergraduates who received a neutral mood induction, who did not show threshoM differences across word types. Thus, a negative mood induction procedure facilitated recognition of not only dysphoric content but also elated content stimuli. These findings further demonstrate the breadth of the effects o f mood on cognition, and they also demonstrate the predictive ambiguity o f associative network models of cognition.
The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therap... more The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and (b) compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations (e.g., an adolescent tells his or her therapist that he or she smoked a cigarette, had unprotected sex, or attempted suicide). Nearly half of the parents (46%) and adolescents (41%) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China.
Abstract 1. Discusses the psychopathology of depression, including the evidence regarding chronic... more Abstract 1. Discusses the psychopathology of depression, including the evidence regarding chronicity, relapse, and recurrence rates, comorbidity with other psychological disorders, and the designation of subgroupings of depression. In particular, it is proposed that ...
Background: Depressive disorder is often accompanied by physiological changes that may adversely ... more Background: Depressive disorder is often accompanied by physiological changes that may adversely affect the course of medical illness, including an increase in pro-inflammatory cytokines. Methods: We examine the effects of religious cognitive behavioral therapy (RCBT) vs. conventional CBT (CCBT) on pro-/anti-inflammatory indicators and stress hormones in 132 individuals with major depressive disorder (MDD) and chronic medical illness who were recruited into a multi-site randomized clinical trial. Biomarkers (C-reactive protein and pro-inflammatory cytokines TNF-α,
We tested the hypotheses that bulimic women would be characterized by a high degree of social dep... more We tested the hypotheses that bulimic women would be characterized by a high degree of social dependency and low levels of social support and that bulimic and nonbulimic women would differ in the interaction of these two variables. A secondary hypothesis, derived from Boskind-White and White's feminist account of bulimia, was that bulimic women are characterized in particular by social dependency on men and a lack of social support from men. A group of 23 normal-weight bulimic women were compared with 38 control subjects and were found to differ only in that they reported more social dependency. There was no evidence that bulimics were lacking in social support, compared with controls, nor was there any relation between bulimia and the interaction of social dependency with social support. Contrary to Boskind-White and White's theory, both bulimic and nonbulimic women reported more social dependency on men than on women, and the size of this discrepancy was found to be equal for both samples.
We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously in... more We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously integrated CBT (RCBT) in persons with major depression and chronic medical illness. Participants were randomized to either CCBT (n = 67) or RCBT (n = 65). The intervention in both groups consisted of ten 50-minute sessions delivered remotely during 12 weeks (94% by telephone). Adherence to treatment was similar, except in more religious participants in whom adherence to RCBT was slightly greater (85.7% vs. 65.9%, p = 0.10). The intention-to-treat analysis at 12 weeks indicated no significant difference in outcome between the two groups (B = 0.33; SE, 1.80; p = 0.86). Response rates and remission rates were also similar. Overall religiosity interacted with treatment group (B = -0.10; SE, 0.05; p = 0.048), suggesting that RCBT was slightly more efficacious in the more religious participants. These preliminary findings suggest that CCBT and RCBT are equivalent treatments of major depression i...
To evaluate the role of maladaptive thinking patterns in depression, the authors administered the... more To evaluate the role of maladaptive thinking patterns in depression, the authors administered the Dysfunctional Attitude Scale to 112 depressed patients before and after 3-6 weeks of treatment with antidepressants or placebo. Twenty-two normal subjects were also assessed twice. Depressed patients had a significantly higher initial mean score than control subjects, but during treatment their score significantly decreased, and the posttreatment score of those with complete recoveries was nearly as low as the control subjects' final score. The higher the initial dysfunctional attitude score the poorer the response to treatment. Patients with endogenous depression had significantly lower scores than nonendogenously depressed patients.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
Although there is evidence for the efficacy of antidepressants and for some individual and group ... more Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT). Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in re...
The efficacy of tricyclic antidepressants in treating acute depression has been well established.... more The efficacy of tricyclic antidepressants in treating acute depression has been well established. Morris and Beck1 suggested that antidepressants alleviate depressive symptoms in approximately 70% of depressed patients. However, they also noted that 40% of depressed individuals respond to placebo over a 3- to 4-week period.
The present paper reviews theories of social support and evidence for the role of social support ... more The present paper reviews theories of social support and evidence for the role of social support in the development and progression of coronary heart disease (CHD). Articles for the primary review of social support as a risk factor were identified with MEDLINE (1966-2004) and PsychINFO (1872-2004). Reviews of bibliographies also were used to identify relevant articles. In general, evidence suggests that low social support confers a risk of 1.5 to 2.0 in both healthy populations and in patients with established CHD. However, there is substantial variability in the manner in which social support is conceptualized and measured. In addition, few studies have simultaneously compared differing types of support. Although low levels of support are associated with increased risk for CHD events, it is not clear what types of support are most associated with clinical outcomes in healthy persons and CHD patients. The development of a consensus in the conceptualization and measurement of social support is needed to examine which types of support are most likely to be associated with adverse CHD outcomes. There also is little evidence that improving low social support reduces CHD events.
Religious involvement may help individuals with chronic medical illness cope better with physical... more Religious involvement may help individuals with chronic medical illness cope better with physical disability and other life changes. We examine the relationships between religiosity, depressive symptoms, and positive emotions in persons with major depression and chronic illness. 129 persons who were at least somewhat religious/spiritual were recruited into a clinical trial to evaluate the effectiveness of religious vs. secular cognitive behavioral therapy. Reported here are the relationships at baseline between religious involvement and depressive symptoms, purpose in life, optimism, generosity, and gratefulness using standard measures. Although religiosity was unrelated to depressive symptoms (F=0.96, p=0.43) and did not buffer the disability-depression relationship (B=-1.56, SE 2.90, p=0.59), strong relationships were found between religious indicators and greater purpose, optimism, generosity, and gratefulness (F=7.08, p<0.0001). Although unrelated to depressive symptoms in th...
Intervention studies have found that psychotherapeutic interventions that explicitly integrate cl... more Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients' spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive-behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manua...
Psychotherapy research : journal of the Society for Psychotherapy Research, Jan 11, 2015
Background: Treatments that integrate religious clients' beliefs into therapy may enhance the... more Background: Treatments that integrate religious clients' beliefs into therapy may enhance the therapeutic alliance (TA) in religious clients. Objective: Compare the effects of religiously integrated cognitive behavioral therapy (RCBT) and standard CBT (SCBT) on TA in adults with major depression and chronic medical illness. Method: Multi-site randomized controlled trial in 132 participants, of whom 108 (SCBT = 53, RCBT = 55) completed the Revised Helping Alliance Questionnaire (HAQ-II) at 4, 8, and 12 weeks. Trajectory of change in scores over time was compared between groups. Results: HAQ-II score at 4 weeks predicted a decline in depressive symptoms over time independent of treatment group (B = -0.06, SE = 0.02, p = 0.002, n = 108). There was a marginally significant difference in HAQ-II scores at 4 weeks that favored RCBT (p = 0.076); however, the mixed effects model indicated a significant group by time interaction that favored the SCBT group (B = 1.84, SE = 0.90, degrees of...
Background: Religious practices/experiences (RPE) may produce positive physiological changes in p... more Background: Religious practices/experiences (RPE) may produce positive physiological changes in patients with major depressive disorder (MDD) and chronic medical illness. Here, we report cross-sectional relationships between depressive symptoms, RPE and stress biomarkers (pro-/ anti-inflammatory measures and stress hormones), hypothesizing positive associations between depressive symptoms and stress biomarkers and inverse associations between RPE and stress biomarkers. Methods: We recruited 132 individuals with both MDD and chronic illness into a randomized clinical trial. First, stress biomarkers in the baseline sample were compared to biomarker levels from a community sample. Second, relationships between depressive symptoms and biomarkers were examined, and, finally, relationships between RPE and biomarkers were * Corresponding author. D. L. Bellinger et al. 336 analyzed, controlling for demographics, depressive symptoms, and physical functioning. Results: As expected, inflammatory markers and stress hormones were higher in our sample with MDD compared to community participants. In the current sample, however, depressive symptoms were largely unrelated to stress biomarkers, and were unexpectedly inversely related to proinflammatory cytokine levels (TNF-α, IL-1β). Likewise, while RPE were largely unrelated to stress biomarkers, they were related to the anti-inflammatory cytokine IL-1RA and the stress hormone norepinephrine in expected directions. Unexpectedly, RPE were also positively related to the proinflammatory cytokine IFN-γ and to IFN-γ/IL-4 and IFN-γ/IL-10 ratios. Conclusions: Little evidence was found for a consistent pattern of relationships between depressive symptoms or religiosity and stress biomarkers. Of the few significant relationships, unexpected findings predominated. Future research is needed to determine whether religious interventions can alter stress biomarkers over time in MDD.
reader shares the author's anguish, breakthroughs, triumphs, and ultimately, the implicit optimis... more reader shares the author's anguish, breakthroughs, triumphs, and ultimately, the implicit optimism of his quest. Clearly, the resurrection of neurosis is a noble attempt at a point in history when dysthymia enjoys perhaps a better fate. But, as the author says, words may not be important if we agree on the methodology for research, the clear focus that Winokur has pioneered: the family or genetic background, the premorbid personal behavior, and the presence of overwhelming precipitating factors that give us the opportunity to, at least, get closer to etiology. A productive theoretician, a gifted clinician, and a masterful researcher, Winokur keeps urging us to go to the sources. "'I hold the world but as a world, Gratiano'-said Antonio in Shakespeare's The Merchant of Vinice-'a stage where every man must play a part.'" Winokur is still playing his, showing us the way, challenging us, and seeking to be challenged.
Psychological androgyny has often been described as associated with increased behavioral flexibil... more Psychological androgyny has often been described as associated with increased behavioral flexibility, with the availability of skills in both traditionally masculine and feminine areas. Ego development has been described as involving an increasing differentiation of one's perception of self, of behavior, and of one's thoughts and feelings, as welt as an increasing ability to integrate these differentiated aspects. We therefore predicted that androgynous individuals would show higher levels of ego development than sex-typed individuals, who would in turn be higher than undifferentiated subjects. Eighty-four undergraduate and graduate students completed the Washington University Sentence Completion Test and the Personality Research Form AN-DRO scale. No evidence of a relation between these measures was found. Several other negative findings have recently been reported, using other sex role measures. It appears that ego development, as currently measured, is not associated with sex-related self-concepts, as typically measured,. though it may be associated with more androgynous sex role expectations of others, and with self-perceptions of agency and communion. Measures of sex-related self-concepts that provide separate scores for positive and negative attributes should be employed in future studies. Kagan (1964) and Kohlberg (1966), among others, have suggested that highly sex-typed individuals are motivated to behave in ways that confirm their sex role identity and to inhibit behaviors considered inappropriate for their sex. This report is based on a thesis conducted by the first author in partial fulfillment of requirements for a master's degree in psychology, under the supervision of the second author. The authors are grateful to Leo Goldberger, Bob Holt, and an anonymous reviewer for helpful comments on an earlier draft of this report.
The Journal of Behavioral Health Services & Research
The primary aim of the present study is to explore whether brief education can change Chinese ado... more The primary aim of the present study is to explore whether brief education can change Chinese adolescents’ and parents’ beliefs about when counselors would breach confidentiality. The two secondary aims are to examine whether the brief education (1) increases adolescents’ willingness to share private information with their counselor and (2) decreases parents’ expectations of the amount of information their child’s counselor would divulge to them. Results showed that adolescents and parents who read a brief passage about the limitations of confidentiality were significantly less likely to believe counselors would breach confidentiality in situations where counselors reported they would not likely breach confidentiality. Regarding our secondary research aims, results indicate that education increases adolescents’ willingness to share more sensitive information, such as about suicidality and drug use, but it does not change parents’ expectations to have most of the information divulged to them by their child’s counselor.
briefer exposures than did 18 undergraduates who received a neutral mood induction, who did not s... more briefer exposures than did 18 undergraduates who received a neutral mood induction, who did not show threshoM differences across word types. Thus, a negative mood induction procedure facilitated recognition of not only dysphoric content but also elated content stimuli. These findings further demonstrate the breadth of the effects o f mood on cognition, and they also demonstrate the predictive ambiguity o f associative network models of cognition.
The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therap... more The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and (b) compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations (e.g., an adolescent tells his or her therapist that he or she smoked a cigarette, had unprotected sex, or attempted suicide). Nearly half of the parents (46%) and adolescents (41%) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China.
Abstract 1. Discusses the psychopathology of depression, including the evidence regarding chronic... more Abstract 1. Discusses the psychopathology of depression, including the evidence regarding chronicity, relapse, and recurrence rates, comorbidity with other psychological disorders, and the designation of subgroupings of depression. In particular, it is proposed that ...
Background: Depressive disorder is often accompanied by physiological changes that may adversely ... more Background: Depressive disorder is often accompanied by physiological changes that may adversely affect the course of medical illness, including an increase in pro-inflammatory cytokines. Methods: We examine the effects of religious cognitive behavioral therapy (RCBT) vs. conventional CBT (CCBT) on pro-/anti-inflammatory indicators and stress hormones in 132 individuals with major depressive disorder (MDD) and chronic medical illness who were recruited into a multi-site randomized clinical trial. Biomarkers (C-reactive protein and pro-inflammatory cytokines TNF-α,
We tested the hypotheses that bulimic women would be characterized by a high degree of social dep... more We tested the hypotheses that bulimic women would be characterized by a high degree of social dependency and low levels of social support and that bulimic and nonbulimic women would differ in the interaction of these two variables. A secondary hypothesis, derived from Boskind-White and White's feminist account of bulimia, was that bulimic women are characterized in particular by social dependency on men and a lack of social support from men. A group of 23 normal-weight bulimic women were compared with 38 control subjects and were found to differ only in that they reported more social dependency. There was no evidence that bulimics were lacking in social support, compared with controls, nor was there any relation between bulimia and the interaction of social dependency with social support. Contrary to Boskind-White and White's theory, both bulimic and nonbulimic women reported more social dependency on men than on women, and the size of this discrepancy was found to be equal for both samples.
We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously in... more We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously integrated CBT (RCBT) in persons with major depression and chronic medical illness. Participants were randomized to either CCBT (n = 67) or RCBT (n = 65). The intervention in both groups consisted of ten 50-minute sessions delivered remotely during 12 weeks (94% by telephone). Adherence to treatment was similar, except in more religious participants in whom adherence to RCBT was slightly greater (85.7% vs. 65.9%, p = 0.10). The intention-to-treat analysis at 12 weeks indicated no significant difference in outcome between the two groups (B = 0.33; SE, 1.80; p = 0.86). Response rates and remission rates were also similar. Overall religiosity interacted with treatment group (B = -0.10; SE, 0.05; p = 0.048), suggesting that RCBT was slightly more efficacious in the more religious participants. These preliminary findings suggest that CCBT and RCBT are equivalent treatments of major depression i...
To evaluate the role of maladaptive thinking patterns in depression, the authors administered the... more To evaluate the role of maladaptive thinking patterns in depression, the authors administered the Dysfunctional Attitude Scale to 112 depressed patients before and after 3-6 weeks of treatment with antidepressants or placebo. Twenty-two normal subjects were also assessed twice. Depressed patients had a significantly higher initial mean score than control subjects, but during treatment their score significantly decreased, and the posttreatment score of those with complete recoveries was nearly as low as the control subjects' final score. The higher the initial dysfunctional attitude score the poorer the response to treatment. Patients with endogenous depression had significantly lower scores than nonendogenously depressed patients.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
Although there is evidence for the efficacy of antidepressants and for some individual and group ... more Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT). Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in re...
The efficacy of tricyclic antidepressants in treating acute depression has been well established.... more The efficacy of tricyclic antidepressants in treating acute depression has been well established. Morris and Beck1 suggested that antidepressants alleviate depressive symptoms in approximately 70% of depressed patients. However, they also noted that 40% of depressed individuals respond to placebo over a 3- to 4-week period.
The present paper reviews theories of social support and evidence for the role of social support ... more The present paper reviews theories of social support and evidence for the role of social support in the development and progression of coronary heart disease (CHD). Articles for the primary review of social support as a risk factor were identified with MEDLINE (1966-2004) and PsychINFO (1872-2004). Reviews of bibliographies also were used to identify relevant articles. In general, evidence suggests that low social support confers a risk of 1.5 to 2.0 in both healthy populations and in patients with established CHD. However, there is substantial variability in the manner in which social support is conceptualized and measured. In addition, few studies have simultaneously compared differing types of support. Although low levels of support are associated with increased risk for CHD events, it is not clear what types of support are most associated with clinical outcomes in healthy persons and CHD patients. The development of a consensus in the conceptualization and measurement of social support is needed to examine which types of support are most likely to be associated with adverse CHD outcomes. There also is little evidence that improving low social support reduces CHD events.
Religious involvement may help individuals with chronic medical illness cope better with physical... more Religious involvement may help individuals with chronic medical illness cope better with physical disability and other life changes. We examine the relationships between religiosity, depressive symptoms, and positive emotions in persons with major depression and chronic illness. 129 persons who were at least somewhat religious/spiritual were recruited into a clinical trial to evaluate the effectiveness of religious vs. secular cognitive behavioral therapy. Reported here are the relationships at baseline between religious involvement and depressive symptoms, purpose in life, optimism, generosity, and gratefulness using standard measures. Although religiosity was unrelated to depressive symptoms (F=0.96, p=0.43) and did not buffer the disability-depression relationship (B=-1.56, SE 2.90, p=0.59), strong relationships were found between religious indicators and greater purpose, optimism, generosity, and gratefulness (F=7.08, p<0.0001). Although unrelated to depressive symptoms in th...
Intervention studies have found that psychotherapeutic interventions that explicitly integrate cl... more Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients' spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive-behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manua...
Psychotherapy research : journal of the Society for Psychotherapy Research, Jan 11, 2015
Background: Treatments that integrate religious clients' beliefs into therapy may enhance the... more Background: Treatments that integrate religious clients' beliefs into therapy may enhance the therapeutic alliance (TA) in religious clients. Objective: Compare the effects of religiously integrated cognitive behavioral therapy (RCBT) and standard CBT (SCBT) on TA in adults with major depression and chronic medical illness. Method: Multi-site randomized controlled trial in 132 participants, of whom 108 (SCBT = 53, RCBT = 55) completed the Revised Helping Alliance Questionnaire (HAQ-II) at 4, 8, and 12 weeks. Trajectory of change in scores over time was compared between groups. Results: HAQ-II score at 4 weeks predicted a decline in depressive symptoms over time independent of treatment group (B = -0.06, SE = 0.02, p = 0.002, n = 108). There was a marginally significant difference in HAQ-II scores at 4 weeks that favored RCBT (p = 0.076); however, the mixed effects model indicated a significant group by time interaction that favored the SCBT group (B = 1.84, SE = 0.90, degrees of...
Background: Religious practices/experiences (RPE) may produce positive physiological changes in p... more Background: Religious practices/experiences (RPE) may produce positive physiological changes in patients with major depressive disorder (MDD) and chronic medical illness. Here, we report cross-sectional relationships between depressive symptoms, RPE and stress biomarkers (pro-/ anti-inflammatory measures and stress hormones), hypothesizing positive associations between depressive symptoms and stress biomarkers and inverse associations between RPE and stress biomarkers. Methods: We recruited 132 individuals with both MDD and chronic illness into a randomized clinical trial. First, stress biomarkers in the baseline sample were compared to biomarker levels from a community sample. Second, relationships between depressive symptoms and biomarkers were examined, and, finally, relationships between RPE and biomarkers were * Corresponding author. D. L. Bellinger et al. 336 analyzed, controlling for demographics, depressive symptoms, and physical functioning. Results: As expected, inflammatory markers and stress hormones were higher in our sample with MDD compared to community participants. In the current sample, however, depressive symptoms were largely unrelated to stress biomarkers, and were unexpectedly inversely related to proinflammatory cytokine levels (TNF-α, IL-1β). Likewise, while RPE were largely unrelated to stress biomarkers, they were related to the anti-inflammatory cytokine IL-1RA and the stress hormone norepinephrine in expected directions. Unexpectedly, RPE were also positively related to the proinflammatory cytokine IFN-γ and to IFN-γ/IL-4 and IFN-γ/IL-10 ratios. Conclusions: Little evidence was found for a consistent pattern of relationships between depressive symptoms or religiosity and stress biomarkers. Of the few significant relationships, unexpected findings predominated. Future research is needed to determine whether religious interventions can alter stress biomarkers over time in MDD.
reader shares the author's anguish, breakthroughs, triumphs, and ultimately, the implicit optimis... more reader shares the author's anguish, breakthroughs, triumphs, and ultimately, the implicit optimism of his quest. Clearly, the resurrection of neurosis is a noble attempt at a point in history when dysthymia enjoys perhaps a better fate. But, as the author says, words may not be important if we agree on the methodology for research, the clear focus that Winokur has pioneered: the family or genetic background, the premorbid personal behavior, and the presence of overwhelming precipitating factors that give us the opportunity to, at least, get closer to etiology. A productive theoretician, a gifted clinician, and a masterful researcher, Winokur keeps urging us to go to the sources. "'I hold the world but as a world, Gratiano'-said Antonio in Shakespeare's The Merchant of Vinice-'a stage where every man must play a part.'" Winokur is still playing his, showing us the way, challenging us, and seeking to be challenged.
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Papers by Clive Robins