Karen B. Schmaling

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Prevention of Relapse and Recurrence in Major Depression

This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy and that both psychotherapies are less expensive and longer lasting alternatives to medication in the treatment of depression.

The psychology of couples and illness : theory, research, and practice

Basic research on the psychobiology of intimate relationships, T. Groth, G. Fehm-Wolfsdorf, K. Hahlweg coronary heart disease and couples, L. Rankin-Esquer, A. Deeter, C.B. Taylor couples coping with respiratory disorders, K.B. Schmaling, N. Afari rheumatic illnesses and relationships - coping as a joint venture, S. Danoff-Burg, T.A. Revenson helping each other through the night - couples and coping with cancer, W.K. Halford, J.L. Scott, J. Smythe couples with HIV-AIDS, S. Kalichman couples and chronic pain, L. Schwartz, D. Ehde couples and premenstrual syndrome - partners as moderators of symptoms?, A. Jones, V. Theodos, T.G. Sher, M. Young couples facing fertility problems, L. Pasch, A. Christensen alcohol and couples - drinking in an intimate relational context, L.J. Roberts, K.D. Linney couples approaches to smoking cessation, C.A. Palmer, D.H. Baucom, C.M. McBride when the bough breaks - the relationship between chronic illness in children and couple functioning, R. Gaither, K. Bingen, J. Hopkins.

Cognitive therapy versus fluoxetine in the treatment of dysthymic disorder.

We studied the effects of a fixed dose of fluoxetine (20 mg) or cognitive psychotherapy in a 16 week trial of patients with dysthymic disorder. More patients assigned to fluoxetine dropped out of the 16 week treatment (33%) than those assigned to cognitive therapy (9%), but this difference did not attain statistical significance. Both treatments showed improvement over baseline conditions at 8 weeks and further improvement at 16 weeks. There were no statistically significant group differences in treatment response. No follow-up data were collected so the enduring effects of the treatments are unknown. An optimal treatment for dysthymic disorder may be combined psychotherapy and pharmacotherapy for a longer period of time.

Illness behaviors in patients with unexplained chronic fatigue are associated with significant other responses

Chronic fatigue syndrome (CFS) and unexplained chronic fatigue (CF) are characterized by compromised functional status and physical disability. Prior research on chronic pain has suggested that social factors may contribute to disability. This study examined the relationship between significant other responses and patient outcomes in patients with unexplained CF. Questionnaire data were collected from 117 patients on physical function, fatigue, pain, illness behaviors and responses of significant others to them, and depression. Ninety-four SOs reported their perceptions of patient illness behavior and their responses. Thirty-seven of these dyads also completed a series of household activities while being videotaped. Dyadic interactions were coded and analyzed. Both reported and observed solicitous responses by the significant other were associated with reported and observed patient illness behavior. Negative responses to patient illness behavior by significant others were associated with higher levels of patient depressive symptoms. The findings provide support for the role of operant behavioral factors in the context of chronic fatigue. They also suggest that further research on the relationship between dysfunction and significant other responses in patients with CFS or CF appears warranted and may have implications for treatment development.

Variables associated with intimate partner violence in a deploying military sample

Variables associated with intimate partner violence (IPV) were examined within a sample of military personnel preparing to deploy. Soldiers with intimate relationships processed for mobilization through Fort Bliss, Texas, completed a questionnaire that queried demographic information, relationship satisfaction, stress, risky alcohol use behaviors, and tactics used during intimate relationship conflict. Four hundred forty-nine deploying soldiers (15.8% of 2,841 with usable data) reported IPV in the past year. Younger age, less education, less relationship satisfaction, more stress, and risky alcohol use behaviors were significant individual predictors of engaging in IPV. The results of this study are discussed in terms of their implications for targeting efforts to reduce IPV among military personnel.

Significant other responses are associated with fatigue and functional status among patients with chronic fatigue syndrome.

Objective The predictive power of partners’ responses to illness behavior for illness outcomes was investigated among couples in which one person had chronic fatigue syndrome (CFS). Methods One hundred nineteen participants who met case-definition criteria for CFS and were living with a significant other (SO) completed self-report measures of relationship satisfaction, responses of their SO to fatigue symptoms, and outcome measures of fatigue and functional status. Results The results indicated that more frequent solicitous SO responses to illness behavior were predictive of greater fatigue-related severity and bodily pain. Solicitous SO responses to fatigue behavior were particularly influential in the context of a satisfactory relationship. In highly satisfactory relationships, solicitous SO responses were associated with significantly greater fatigue severity and fatigue-related disability than in relationships characterized by low or average satisfaction. Conclusions Solicitous SO responses to CFS-related symptoms are associated with poorer patient outcomes, especially in the context of a satisfactory intimate relationship. Because of the cross-sectional nature of the study, the direction of effects cannot be interpreted unambiguously. SOs may be inadvertently positively reinforcing illness-related behavior: Solicitous partners may help the patient more with tasks of daily living, thereby decreasing the patient’s activity level, which may lead to deconditioning and disability. Alternatively, patients with more severe symptoms and disability may present more opportunities for concerned SO responses, which again may be heightened in the context of a caring, satisfactory relationship. In either case, the results suggest that additional research on the role of solicitous SO responses is warranted.

Ethics Instruction Increases Graduate Students' Responsible Conduct of Research Knowledge but not Moral Reasoning

The purpose of this study was to assess the short-term effectiveness of ethics courses in enhancing responsible conduct of research (RCR) knowledge and moral judgment among graduate students in health-related disciplines. Forty-eight graduate students completed a questionnaire about research experience, knowledge and judgments about appropriate research practices, and a standardized test of moral judgment at the beginning and end of a semester-long ethics course. Knowledge about RCR but not moral judgment increased significantly in some areas. The results are discussed in terms of implications for RCR instruction and of future research designed to improve RCR instruction.

Chronic fatigue and chronic fatigue syndrome: A co-twin control study of functional status

Chronic fatigue syndrome (CFS) and the symptom of chronic fatigue may be accompanied by substantial functional disability. A volunteer sample of twins discordant for fatigue was identified from throughout the US. Fatigued twins were classified using three increasingly stringent definitions: (1) ≥6 months of fatigue (119 pairs); (2) CFS-like illness based on self-report of the Centers for Disease Control and Prevention CFS research definition criteria (74 pairs); and (3) CFS assessed by clinical examination (22 pairs). Twins with chronic fatigue were compared with their unaffected co-twins on the eight standard scales and two physical and mental component summary scales from the medical outcomes study short-form health survey (SF-36). Substantial impairment was observed for fatigued twins across all levels of fatigue, while scores in the healthy twins were similar to US population values. Mean scores among fatigued twins on the physical and mental component summary scales were below 97 and 77%, respectively, of the US population scores. Diminished functional status was found across increasingly stringent classifications of fatigue and was associated with a dramatic decrement in physical functioning. The symptom of fatigue has a pronounced impact on functional status, especially in the domain of physical functioning.

Predictors of aversive alcohol consequences in a military sample

The purpose of this study was to identify predictors of risky alcohol use and alcohol-related consequences among postdeployment soldiers. Demobilizing soldiers completed an assessment packet that included questions about demographic factors, relationships, stress, and alcohol-related consequences. Significant predictors of greater alcohol-related consequences, as assessed with the CAGE questionnaire, included fewer years of formal education, male gender, not being in an intimate relationship, racial/ethnic minority status, enlisted rank, having been deployed to the continental United States, and greater stress, whereas significant predictors of drinking and driving included male gender, not being in an intimate relationship, and greater stress. Identifying the predictors of alcohol consequences that occur upon demobilization may aid in determining which soldiers are at risk for such consequences before deployment and may help to maintain military readiness.