James P. LePage

A Brief Behavioral Activation Treatment for Depression: A Randomized Pilot Trial within an Inpatient Psychiatric Hospital

The brief behavioral activation treatment for depression (BATD) is a relatively uncomplicated, time-efficient, and cost-effective method for treating depression. Because of these features, BATD may represent a practical intervention within managed care-driven, inpatient psychiatric hospitals. Based on basic behavioral theory and empirical evidence supporting activation strategies, we designed a treatment to increase systematically exposure to positive activities and thereby help to alleviate depressive affect. This study represents a pilot study that extends research on this treatment into the context of an inpatient psychiatric unit. Results demonstrate effectiveness and superiority of BATD as compared with the standard supportive treatment provided within the hospital. A large effect size was demonstrated, despite a limited sample size. The authors discuss the limitations of the study and future directions.

A Brief Behavioral Activation Treatment for Depression

A time-limited behavioral treatment of depression is described, based upon the matching law, targeting both environmental factors maintaining depressive behaviors and factors limiting the occurrence of more healthy behaviors. This treatment is designed to reduce depression by way of a gradual increase in desired, healthy activity. Three case studies using this intervention are provided, with marked improvement evidenced in each case. Although considerably more work is necessary to establish the clinical utility of this treatment, it appears to be a parsimonious and useful approach that may help to shed light on the active ingredients of the successful treatment of depression.

The Association Between Healthy Lifestyle Behaviors and Relapse Rates in a Homeless Veteran Population

This study evaluates the association between Healthy Lifestyle Behaviors (HLBs) and relapse rates in a homeless residential rehabilitation program. Ninety-seven homeless veterans with Substance Dependence in Early Remission were evaluated. Veterans recorded recreational, social, coping/spiritual, and substance recovery activities. Those who relapsed during residential treatment were compared to those who did not. Higher numbers of HLBs were associated with lower relapse rates during treatment. No differences were found between the two groups in the number of recovery activities performed. HLBs proved better predictors of success than recovery behaviors. Implications and limitations are discussed.

The Emotional Impact of Chosen and Imposed Thoughts

Two studies tested the idea that perceptions of choice can alter the self-relevance and emotional impact of thoughts. Participants who were initially in either a positive or negative mood engaged in a thought exercise that involved either positive or negative thinking. Half of the participants received information stressing the optional nature of the task, thereby fostering a sense of choice and personal determination. The results indicate that under high-choice, mood-incongruent thinking was especially self-relevant, memorable, and produced the most mood change. The findings raise new considerations for self-perception and cognitive dissonance theories and offer insights into the relationship between cognition and emotion.

Effects of structured vocational services on job-search success in ex-offender veterans with mental illness: 3-month follow-up

With the high number of incarcerated veterans with mental illness and substance dependence returning to the community annually, a significant need exists for technologies that will help them return to employment. This study evaluates three methods of assistance: (1) basic vocational services, (2) self-study of a vocational manual designed for formerly incarcerated veterans, and (3) a group led by vocational staff using the vocational manual. We evaluated 69 veterans to determine the number finding employment within 3 months after enrollment in the study. The group format was expected to be superior to self-study, and self-study was expected to be superior to basic services. Though the group format was found to be superior to both self-study and basic services, the results for self-study and basic services were statistically similar. Limitations and directions for future refinement are discussed.

Effects of structured vocational services in ex-offender veterans with mental illness: 6-month follow-up

With more than 200,000 veterans incarcerated, a significant need exists for the development of technologies that help veterans with felony histories return to employment. This study evaluated the effect of three methods of vocational assistance on competitive employment over a 6 mo follow-up period: (1) basic vocational services, (2) self-study using a vocational manual designed for formerly incarcerated veterans, and (3) a group led by vocational staff using the vocational manual. We evaluated 111 veterans for time to obtain and total time of competitive employment. The group format was expected to be superior to the self-study and the self-study superior to basic services. Findings indicated that the group format was associated with quicker employment and more total employment than the basic and self-study conditions. Limitations and directions for future refinement are discussed.

Reliability and validity of World Health Organization Quality of Life-100 in homeless substance-dependent veteran population.

The number of homeless individuals and specifically homeless veterans is increasing. Accurate assessment of quality of life is an important need in working with this population because of the myriad problems encountered. However, the reliability and validity of quality-of-life instruments have not been assessed in this population. This study evaluated the psychometric properties of the U.S. version of the World Health Organization Quality of Life-100 in a homeless veteran population. Results found adequate internal consistency for all domain and most facet scores, while test-retest stability varied for the facet scores. We confirmed validity by using subsamples with physical, emotional, and social problems and by comparing scores from populations that returned to the community with employment and housing. Limitations and directions for future study are discussed.

Holistics 3.0 for Health

Human health is part of an interdependent multifaceted system. More than ever, we have increasingly large amounts of data on the body, both spatial and non-spatial, its systems, disease and our social and physical environment. These data have a geospatial component. An exciting new era is dawning where we are simultaneously collecting multiple datasets to describe many aspects of health, wellness, human activity, environment and disease. Valuable insights from these datasets can be extracted using massively multivariate computational techniques, such as machine learning, coupled with geospatial techniques. These computational tools help us to understand the topology of the data and provide insights for scientific discovery, decision support and policy formulation. This paper outlines a holistic paradigm called Holistics 3.0 for analyzing health data with a set of examples. Holistics 3.0 combines multiple big datasets set in their geospatial context describing as many areas of a problem as possible with machine learning and causality, to both learn from the data and to construct tools for data-driven decisions.

Utility of the Neurobehavioral Cognitive Status Examination (Cognistat) with Geriatric Mental Health Outpatients

Cognitive examination of older adults is important due to the risk for age-related cognitive disorders. Demand for efficient tools has resulted in multiscale measures such as the Neurobehavioral Cognitive Status Examination (NCSE). Advantages of the NCSE include high sensitivity, test tolerability, a relatively detailed memory assessment, and inclusion of multiple ability areas. We explored the utility of the NCSE in identifying cognitive impairment and/or dementia. Geropsychiatric outpatients completed the NCSE as part of a comprehensive evaluation. The NCSE proved effective at discriminating the presence or absence of any cognitive disorder. However, the NCSE showed limited clinical utility in identifying etiologies of dysfunction.

Individual Placement and Support in Spinal Cord Injury: A Longitudinal Observational Study of Employment Outcomes

OBJECTIVE To determine the effects of a 24-month program of Individual Placement and Support (IPS) supported employment (SE) on employment outcomes for veterans with spinal cord injury (SCI). DESIGN Longitudinal, observational multisite study of a single-arm, nonrandomized cohort. SETTING SCI centers in the Veterans Health Administration (n=7). PARTICIPANTS Veterans with SCI (N=213) enrolled during an episode of either inpatient hospital care (24.4%) or outpatient care (75.6%). More than half the sample (59.2%) had a history of traumatic brain injury (TBI). INTERVENTION IPS SE for 24 months. MAIN OUTCOME MEASURE Competitive employment. RESULTS Over the 24-month period, 92 of 213 IPS participants obtained competitive jobs for an overall employment rate of 43.2%. For the subsample of participants without TBI enrolled as outpatients (n=69), 36 obtained competitive jobs for an overall employment rate of 52.2%. Overall, employed participants averaged 38.2±29.7 weeks of employment, with an average time to first employment of 348.3±220.0 days. Nearly 25% of first jobs occurred within 4 to 6 months of beginning the program. Similar employment characteristics were observed in the subsample without TBI history enrolled as outpatients. CONCLUSIONS Almost half of the veterans with SCI participating in the 24-month IPS program as part of their ongoing SCI care achieved competitive employment, consistent with their expressed preferences at the start of the study. Among a subsample of veterans without TBI history enrolled as outpatients, employment rates were >50%. Time to first employment was highly variable, but quite long in many instances. These findings support offering continued IPS services as part of ongoing SCI care to achieve positive employment outcomes.