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How does brief cognitive behavioral therapy work? Potential mechanisms of action for veterans with physical and psychological comorbidities
Title
How does brief cognitive behavioral therapy work? Potential mechanisms of action for veterans with physical and psychological comorbidities.
Creator
Deavers, Frances, Cassisi, Jeffrey, Bowers, Clint, Eldridge, Gloria, University of Central Florida
Abstract / Description
Depression and anxiety are commonly comorbid among patients with chronic medical conditions. These comorbidities are associated with negative outcomes including poorer quality of life and worse physical functioning. Evidence that traditional cognitive behavioral therapy (CBT) is less effective for these populations has led to the development of brief CBT protocols that incorporate physical health self-management skills and are delivered in primary care. To continue refining treatment packages...
Show moreDepression and anxiety are commonly comorbid among patients with chronic medical conditions. These comorbidities are associated with negative outcomes including poorer quality of life and worse physical functioning. Evidence that traditional cognitive behavioral therapy (CBT) is less effective for these populations has led to the development of brief CBT protocols that incorporate physical health self-management skills and are delivered in primary care. To continue refining treatment packages, it is important to understand how brief CBT works. The present study used the transactional model of stress and coping as a framework for investigating potential mechanisms of action of brief CBT. Veterans with chronic obstructive pulmonary disease and/or heart failure and elevated symptoms of depression and/or anxiety were randomized to receive brief CBT (n =180) or enhanced usual care (EUC; n = 122). At 4-month follow-up, depression and anxiety symptoms were significantly lower in veterans who received brief CBT, compared to EUC. Multiple mediation analyses revealed that brief CBT was associated with higher self-efficacy and less avoidant coping at 4-month follow-up, which were in turn associated with less depression and anxiety symptoms. Illness intrusiveness was also a significant mediator of the relationship between brief CBT and anxiety symptoms, but not depression symptoms. In contrast, increases in active coping attributable to brief CBT were not associated with improvements in depression or anxiety symptoms. These results demonstrate the utility of the transactional model of stress and coping as a framework for understanding mechanisms of action of brief CBT in patients with comorbid physical and psychological conditions.
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Date Issued
2017
Identifier
CFE0006733, ucf:51884
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0006733
Modeling Risk for Sexually Transmitted Infections in Women in a Court-Ordered Substance Treatment Program
Title
Modeling Risk for Sexually Transmitted Infections in Women in a Court-Ordered Substance Treatment Program.
Creator
Deavers, Frances, Cassisi, Jeffrey, Bowers, Clint, Eldridge, Gloria, University of Central Florida
Abstract / Description
Developing a comprehensive model of Sexually Transmitted Infection (STI) risk factors and their inter-relationships is vital to improving methods of risk identification and treatment delivery. The CDC posed three general categories that may serve as a framework for such a model: sexual network, individual behavior, and social/ structural risk. None of the extant risk models incorporate measures from all three categories. Additionally, none of these models, generally focused on individual...
Show moreDeveloping a comprehensive model of Sexually Transmitted Infection (STI) risk factors and their inter-relationships is vital to improving methods of risk identification and treatment delivery. The CDC posed three general categories that may serve as a framework for such a model: sexual network, individual behavior, and social/ structural risk. None of the extant risk models incorporate measures from all three categories. Additionally, none of these models, generally focused on individual behavior, use medical data on infection as their outcome variable. This is problematic because the ultimate outcome of infection is also influenced by sexual network and social/ structural variables, in addition to individual behaviors. Therefore the current study aimed to develop a comprehensive model of risk incorporating sexual network, individual behavior, and social/ structural risk variables, using medical data on infection status as the outcome variable. The sample consisted of 506 women in a court-ordered substance treatment program. An Exploratory Factor Analysis provided preliminary evidence for a three factor model corresponding to the CDC framework. However, a Confirmatory Factor Analysis failed to confirm this model. Additionally, a logistic regression suggested that this model has limited clinical utility for this sample. Future studies may more conclusively determine the importance of various STI risk variables, the relationships between them, and whether they mirror the CDC theoretical framework. With rates of infection still high in the United States, and even increasing among women for certain STIs, this is a critical public health issue that should continue to be examined.
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Date Issued
2014
Identifier
CFE0005323, ucf:50502
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0005323