Andrea K. Wittenborn

Augmenting Antidepressant Medication Treatment of Depressed Women With Emotionally Focused Therapy for Couples: A Randomized Pilot Study

This is the first study to evaluate adding emotionally focused therapy for couples (EFT) to antidepressant medication in the treatment of women with major depressive disorder and comorbid relationship discord. Twenty-four women and their male partners were randomized to 6 months of medication management alone (MM) or MM augmented with EFT (MM + EFT). MM followed the Texas Medication Algorithm Project guidelines. Fifteen EFT sessions were delivered following the EFT treatment manual. The primary outcome was severity of depressive symptoms (assessed by the 30-item Inventory of Depressive Symptomatology-Clinician Rated version [IDS-C(30) ] administrated by evaluators blinded to cell assignment). Secondary outcome was relationship quality as assessed by the Quality of Marriage Index. Results from assessments at intake, termination, and two posttreatment follow-ups were analyzed using growth analysis techniques. IDS-C(30) scores improved over 6 months of treatment, regardless of the treatment assignment, and women receiving MM + EFT experienced significantly more improvement in relationship quality compared with women in MM. Because relationship discord after depression treatment predicts worse outcome, interventions improving relationship quality may reduce depression relapse and recurrence. Testing this hypothesis in larger samples with longer follow-up could contribute to knowledge on the mechanisms involved in determining the course of depressive illness.

Multicultural Supervision: Lessons Learned About an Ongoing Struggle

This article examines the experiences of seven diverse therapists in a supervision course as they wrestled with the real-world application of multicultural supervision. Existing literature on multicultural supervision does not address the difficulties that arise in addressing multicultural issues in the context of the supervision relationship. The experiences of six supervisory candidates and one mentoring supervisor in addressing multicultural issues in supervision are explored. Guidelines for conversations regarding multicultural issues are provided.

Modeling the hypothalamus-pituitary-adrenal axis: A review and extension

Multiple models of the hypothalamus-pituitary-adrenal (HPA) axis have been developed to characterize the oscillations seen in the hormone concentrations and to examine HPA axis dysfunction. We reviewed the existing models, then replicated and compared five of them by finding their correspondence to a dataset consisting of ACTH and cortisol concentrations of 17 healthy individuals. We found that existing models use different feedback mechanisms, vary in the level of details and complexities, and offer inconsistent conclusions. None of the models fit the validation dataset well. Therefore, we re-calibrated the best performing model using partial calibration and extended the model by adding individual fixed effects and an exogenous circadian function. Our estimated parameters reduced the mean absolute percent error significantly and offer a validated reference model that can be used in diverse applications. Our analysis suggests that the circadian and ultradian cycles are not created endogenously by the HPA axis feedbacks, which is consistent with the recent literature on the circadian clock and HPA axis.

Lessons From Work—Life Research for Developing Human Resources

The problem and the solution. Human resource development (HRD) and work/life share several goals. Both are concerned with ensuring workers are effective and with the “business case” justifying their efforts within organizations. This article develops insights for HRD professionals by drawing on articles identified in the international competition for the Rosabeth Moss Kanter Award for Excellence in Work—Family Research. Specifically, work hours and work overload as well as gender and gender inequity are powerful influences on worker effectiveness. Several exemplary articles also generate important information for the business case for work/life. This article provides access to resources that can support HRD efforts in organizations.

Emotionally Focused Family Therapy and Play Therapy Techniques

Emotionally Focused Family Therapy provides a framework for understanding childrens behaviors in terms of attachment needs of comfort and support. However, when working with young children, play therapy is often developmentally preferred over “talk therapy.” By integrating play therapy techniques within an Emotionally Focused Family Therapy theoretical framework, therapists can help parents understand and meet their childs needs for affection and comfort. This article will discuss how play therapy techniques can be integrated with an Emotionally Focused Family Therapy theoretical framework for work with young children and their families.

Repairing Alliance Ruptures in Emotionally Focused Couple Therapy: A Preliminary Task Analysis

For mental health professionals, navigating ruptures in the therapeutic alliance can be difficult. In order to aid practitioners through this therapeutic impasse, the development of an alliance rupture repair model in Emotionally Focused Therapy (EFT) was achieved by conducting a preliminary task analysis. A rational model of alliance rupture repair in EFT was formulated from data analysis of a thought experiment with four experienced certified EFT therapists. The rational model was then compared with the empirical analysis of alliance rupture repair sequences during EFT sessions with a certified EFT therapist. The final rational-empirical model and treatment implications are discussed.

Illustrating idiographic methods for translation research: moderation effects, natural clinical experiments, and complex treatment-by-subgroup interactions

A critical juncture in translation research involves the preliminary studies of intervention tools, provider training programs, policies, and other mechanisms used to leverage knowledge garnered at one translation stage into another stage. Potentially useful for such studies are rigorous techniques for conducting within-subject clinical trials, which have advanced incrementally over the last decade. However, these methods have largely not been utilized within prevention or translation contexts. The purpose of this manuscript is to demonstrate the flexibility, wide applicability, and rigor of idiographic clinical trials for preliminary testing of intervention mechanisms. Specifically demonstrated are novel uses of state-space modeling for testing intervention mechanisms of short-term outcomes, identifying heterogeneity in and moderation of within-person treatment mechanisms, a horizontal line plot to refine sampling design during the course of a clinic-based experimental study, and the need to test a treatment’s efficacy as treatment is administered along with (e.g., traditional 12-month outcomes).

An Attachment and Affect Regulation Based Multiple Couple Group Intervention for Couples Transitioning to Marriage/Commitment

This article outlines a multiple couple group intervention (MCGI) for couples transitioning to marriage or commitment. The MCGI, based on attachment and affect regulation theories, aims to prevent or disrupt negative patterns of interacting and increase partners’ abilities to seek support and provide comfort in their relationships. The MCGI offers a process-oriented alternative to the current skills-based programs for couples. Preliminary evaluations of the manualized treatment indicate promise.

The Evaluation of a Multiple Couple Group Intervention for Couples Transitioning to Marriage: A Mixed-Methods Pilot Project

The Multiple Couple Group Intervention (MCGI) provides an alternative to current programs for couples transitioning to marriage or commitment. The MCGI offers a unique focus on strengthening attachment bonds at a time in couple relationships when acceptance of such revision may be more likely. The transition to marriage appears to be a time of particular developmental importance, according to attachment theory, and intervention during this transition may prevent or minimize future difficulties and adverse outcomes in couple partnerships. Preliminary results from this uncontrolled, Stage I pilot trial demonstrate promise. Mixed-methods findings from the first study of the MCGI and implications for program development are discussed in this article.

Modeling and estimating the feedback mechanisms among depression, rumination, and stressors in adolescents

The systemic interactions among depressive symptoms, rumination, and stress are important to understanding depression but have not yet been quantified. In this article, we present a system dynamics simulation model of depression that captures the reciprocal relationships among stressors, rumination, and depression. Building on the response styles theory, this model formalizes three interdependent mechanisms: 1) Rumination contributes to ‘keeping stressors alive’; 2) Rumination has a direct impact on depressive symptoms; and 3) Both ‘stressors kept alive’ and current depressive symptoms contribute to rumination. The strength of these mechanisms is estimated using data from 661 adolescents (353 girls and 308 boys) from two middle schools (grades 6–8). These estimates indicate that rumination contributes to depression by keeping stressors ‘alive’—and the individual activated—even after the stressor has ended. This mechanism is stronger among girls than boys, increasing their vulnerability to a rumination reinforcing loop. Different profiles of depression emerge over time depending on initial levels of depressive symptoms, rumination, and stressors as well as the occurrence rate for stressors; levels of rumination and occurrence of stressors are stronger contributors to long-term depression. Our systems model is a steppingstone towards a more comprehensive understanding of depression in which reinforcing feedback mechanisms play a significant role. Future research is needed to expand this simulation model to incorporate other drivers of depression and provide a more holistic tool for studying depression.