Lissette M. Saavedra

Cognitive behavioral treatment for childhood anxiety disorders: long-term effects on anxiety and secondary disorders in young adulthood

BACKGROUNDnThe present studys aim was to examine the long-term effects (8 to 13 years post-treatment; M = 9.83 years; SD = 1.71) of the most widely used treatment approaches of exposure-based cognitive behavioral treatment for phobic and anxiety disorders in children and adolescents (i.e., group treatment and two variants of individual treatment). An additional aim was to compare the relative long-term efficacy of the treatment approaches.nnnMETHODnAt long-term follow-up, participants (N = 67) were between 16 and 26 years of age (M = 19.43 years, SD = 3.02). Primary outcome was the targeted anxiety disorder and targeted symptoms. Secondary outcomes were other disorders and symptoms not directly targeted in the treatments including (1) other anxiety disorders and symptoms, (2) depressive disorders and symptoms, and (3) substance use disorders and symptoms.nnnRESULTSnLong-term remission for anxiety disorders and symptoms targeted in the treatments was evident 8 to 13 years post-treatment. Long-term remission also was found for the secondary outcomes. There were more similarities than differences in the long-term gains when comparing the treatment approaches.nnnCONCLUSIONSnConsistent with past research, the studys findings provide further evidence that the short-term benefits of exposure-based CBT for childhood phobic and anxiety disorders using both group and individual treatment may extend into the critical transition years of young adulthood.

Fathers' Ratings in the Assessment of Their Child's Anxiety Symptoms : A Comparison to Mothers' Ratings and Their Associations With Paternal Symptomatology

We examined the comparability between mothers and fathers ratings in the assessment of their childs anxiety symptoms. The sample consisted of 78 youth (6 to 17 years) and their mothers and fathers who presented to a childhood anxiety disorders specialty research clinic. Using intraclass correlation coefficients, mother?father agreement of their childs anxiety symptoms was found to be moderate. Mean differences between mothers and fathers ratings of their childs anxiety were not significantly different. Both maternal and paternal self-ratings of psychopathology predicted respective ratings of their childs anxiety. Although either mothers or fathers can provide useful information, use of multiple informants is encouraged, especially when parental psychopathology is present. Additional implications and suggestions for future research are discussed.

Attendance and Substance Use Outcomes for the Seeking Safety Program: Sometimes Less Is More

OBJECTIVEnThis study uses data from the largest effectiveness trial to date on treatment of co-occurring posttraumatic stress and substance use disorders, using advances in statistical methodology for modeling treatment attendance and membership turnover in rolling groups.nnnMETHODnWomen receiving outpatient substance abuse treatment (N = 353) were randomized to 12 sessions of Seeking Safety or a health education control condition. Assessments were completed at baseline and at 1 week, 3, 6, and 12 months posttreatment. Outcome measures were alcohol and cocaine use in the prior 30 days captured using the Addiction Severity Index. Latent class pattern mixture modeling (LCPMM) was used to estimate attendance patterns and to test for treatment effects within and across latent attendance patterns and group membership turnover.nnnRESULTSnAcross LCPMM analyses for alcohol and cocaine use, similar treatment attendance patterns emerged: Completers never decreased below an 80% probability of attendance, droppers never exceeded a 41% probability of attendance, and titrators demonstrated a 50% to 80% probability of attendance. Among completers, there were significant decreases in alcohol use from baseline to 1-week posttreatment, followed by nonsignificant increases in alcohol during follow-up. No differences between treatment conditions were detected. Titrators in Seeking Safety had lower rates of alcohol use from 1-week through 12-month follow-up compared with control participants. Droppers had nonsignificant increases in alcohol during both study phases. Cocaine use findings were similar but did not reach significance levels.nnnCONCLUSIONSnThe impact of client self-modulation of treatment dosage and group membership composition may influence behavioral treatment outcomes among this population.

Indirect effects of 12-session seeking safety on substance use outcomes: overall and attendance class-specific effects.

OBJECTIVESnThis study examined in- and post-treatment mediation effects of a 12-session dose of Seeking Safety (SS)-an integrative cognitive behavioral treatment for comorbid PTSD and SUDs-on alcohol and cocaine outcomes in comparison to Womens Health Education (WHE) in a seven-site randomized controlled effectiveness trial.nnnMETHODSnWomen (nu2009=u2009353) enrolled in outpatient substance abuse treatment, who had experienced multiple traumas in childhood and/or adulthood and who had comorbid PTSD, were randomly assigned to receive SS or WHE delivered in open enrollment groups for 12 sessions in 6 weeks (unlike the full 25-topic SS protocol). Data were analyzed under two forms of longitudinal mediation analysis, each accounting for changes over time in group membership and group context, respectively.nnnRESULTSnWomen in SS, compared to WHE, showed significantly steeper decreases in PTSD frequency and severity, which in turn, showed significant impact in reducing both cocaine and alcohol use. This pattern was strongest for those who completed most of the treatment sessions, which was the majority of patients in the trial; these patterns only emerged during the in-treatment phase.nnnCONCLUSIONSnUse of an integrated approach to PTSD/SUD such as SS can be helpful to more rapidly reduce PTSD, which consequently reduce SUD symptoms, particularly for those who attend most of the available treatment sessions.nnnSCIENTIFIC SIGNIFICANCEnThis is one of the first studies to illustrate such effects in treating comorbid PTSD and SUD in the context of a highly impaired population delivered by community-based providers. (Am J Addict 2014;23:218-225).

Estimating statistical power for open-enrollment group treatment trials

Modeling turnover in group membership has been identified as a key barrier contributing to a disconnect between the manner in which behavioral treatment is conducted (open-enrollment groups) and the designs of substance abuse treatment trials (closed-enrollment groups, individual therapy). Latent class pattern mixture models (LCPMMs) are emerging tools for modeling data from open-enrollment groups with membership turnover in recently proposed treatment trials. The current article illustrates an approach to conducting power analyses for open-enrollment designs based on the Monte Carlo simulation of LCPMM models using parameters derived from published data from a randomized controlled trial comparing Seeking Safety to a Community Care condition for women presenting with comorbid posttraumatic stress disorder and substance use disorders. The example addresses discrepancies between the analysis framework assumed in power analyses of many recently proposed open-enrollment trials and the proposed use of LCPMM for data analysis.

Maximizing Effectiveness Trials in PTSD and SUD Through Secondary Analysis: Benefits and Limitations Using the National Institute on Drug Abuse Clinical Trials Network "Women and Trauma" Study as a Case Example

Recent federal legislation and a renewed focus on integrative care models underscore the need for economical, effective, and science-based behavioral health care treatment. As such, maximizing the impact and reach of treatment research is of great concern. Behavioral health issues, including the frequent co-occurrence of substance use disorders (SUD) and posttraumatic stress disorder (PTSD), are often complex, with a myriad of factors contributing to the success of interventions. Although treatment guides for comorbid SUD/PTSD exist, most patients continue to suffer symptoms following the prescribed treatment course. Further, the study of efficacious treatments has been hampered by methodological challenges (e.g., overreliance on superiority designs (i.e., designs structured to test whether or not one treatment statistically surpasses another in terms of effect sizes) and short term interventions). Secondary analyses of randomized controlled clinical trials offer potential benefits to enhance understanding of findings and increase the personalization of treatment. This paper offers a description of the limits of randomized controlled trials as related to SUD/PTSD populations, highlights the benefits and potential pitfalls of secondary analytic techniques, and uses a case example of one of the largest effectiveness trials of behavioral treatment for co-occurring SUD/PTSD conducted within the National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) and producing 19 publications. The paper concludes with implications of this secondary analytic approach to improve addiction researchers ability to identify best practices for community-based treatment of these disorders. Innovative methods are needed to maximize the benefits of clinical studies and better support SUD/PTSD treatment options for both specialty and non-specialty healthcare settings. Moving forward, planning for and description of secondary analyses in randomized trials should be given equal consideration and care to the primary outcome analysis.

Maternal Depressive Symptoms and Adolescent Alcohol Use: The Mediating Role of Youth Depressive Symptoms

The purpose of this study was to explore the influence of maternal depressive symptoms on adolescent alcohol use among a sample of Latino/Latina youth aged 10 to 16 years from a high-risk community. Direct and mediating effects of youth depressive symptoms, controlling for levels of concurrent emotion dysregulation, on alcohol use were examined. Participants consisted of 525 children and their mothers randomly sampled from low-income schools with high rates of substance use. The panel design included four waves, and we used structural equation modeling with a longitudinal mediational framework. Results indicated that the relationship between maternal depressive symptoms and adolescent alcohol use was mediated by adolescents’ symptoms of depression for girls only. Findings are discussed in the context of the development of skills to cope with negative affect and the influence parental depressive symptoms may have on this process.The purpose of this study was to explore the influence of maternal depressive symptoms on adolescent alcohol use among a sample of Latino/Latina youth aged 10 to 16 years from a high-risk community. Direct and mediating effects of youth depressive symptoms, controlling for levels of concurrent emotion dysregulation, on alcohol use were examined. Participants consisted of 525 children and their mothers randomly sampled from low-income schools with high rates of substance use. The panel design included four waves, and we used structural equation modeling with a longitudinal mediational framework. Results indicated that the relationship between maternal depressive symptoms and adolescent alcohol use was mediated by adolescents’ symptoms of depression for girls only. Findings are discussed in the context of the development of skills to cope with negative affect and the influence parental depressive symptoms may have on this process.