Michael G. Dow

Cognitive-behavioral treatment of depressed inpatients

Forty-seven depressed inpatients were randomly assigned to one of three treatment conditions: 1) standard treatment (hospital milieu, pharmacotherapy, medication and management sessions), 2) cognitive therapy (cognitive therapy + standard treatment), or 3) social skills training (social skills training + standard treatment). All treatments began while the patients were in the hospital and continued for 4 months on an outpatient basis after discharge. The results from analyses of measures of psychiatric symptoms administered at discharge from the hospital and at the end of outpatient treatment are reported in this paper. All treatment groups evidenced significant improvement at discharge and end of outpatient treatment relative to pretreatment levels of symptoms. While there were no significant differences between the treatment groups at discharge from the hospital, the patients assigned to the cognitive therapy and the social skills training groups manifested lower levels of symptoms at the end of outpatient treatment than did the Standard Treatment group.

Characteristics of depressed patients with elevated levels of dysfunctional cognitions.

The characteristics of subjects with elevated scores on both the Dysfunctional Attitudes Scale and Cognitive Bias Questionnaire were studied in a sample of 72 depressed inpatients. In comparison with low cognitive dysfunctional subjects (n =48), subjects with elevated dysfunctional cognitions (n =24) revealed greater severity of depression, more hopelessness, higher frequencies of automatic thoughts, less social support, and overall poorer social adjustment. Furthermore, the data suggest that age of depression onset, duration of current depressive episode, and number of previous depressive episodes are associated with elevated levels of dysfunctional cognitions. There were no differences between high and low dysfunctional cognitive groups with respect to DSM-III melancholic diagnosis or response on the dexamethasone suppression test.

HIV risk factors for persons with serious mental illness

HIV risk factors were assessed among 120 persons in treatment for serious mental illness. Although subjects had good general knowledge regarding HIV, many engaged in high risk behaviors. Condom use was infrequent among those who had multiple sexual partners, and sharing needles was common for those who used IV drugs. Clearly, factual knowledge about HIV was not sufficient to prevent risky behavior. Nearly half of the sample was categorized as at medium to high risk, and almost half of the participants, especially those at medium risk, underestimated their own level of risk. The results suggest that education and intervention strategies should focus on increasing the accuracy of the individuals risk assessment as well as changing attitudes towards condoms and improving skills in using condoms. Assessing personal risk and adopting risk-reduction strategies are the keys to successful AIDS prevention for persons with serious mental illness.

Attributional, perceptual, and affective responses to depressed and nondepressed marital partners

Husbands of wives with (n = 22) or without (n = 23) a history of a depressive disorder indicated their attributions about and affective reactions to real and hypothetical positive and negative events occurring to their wives, rated their wives on personality traits categorized as depression-related and depression-neutral, and reported their own marital satisfaction. Husbands of depressed, relative to nondepressed, wives made more dispositional attributions, reported more negative affect in reaction to negative events, and indicated less marital satisfaction. Depressed wives were rated more negatively on both depression-related and depression-neutral personality traits. Results are interpreted as suggesting that spouses of depressed wives have a generalized negative view of their wives, which may also be operating within distressed marriages.

Training Psychiatric Patients to Discuss Medication Issues Effects on Patient Communication and Knowledge of Medications

Psychiatric inpatients were randomly assigned to a medication-related communication skills program or to a control condition that consisted of a medication education program. The medication communication program emphasized learning to ask physicians questions about medications, to describe current problems, and to make relevant requests. Although patients in both groups improved their knowledge of medications, the medication communication skills program had the added impact of teaching patients to ask more questions of a doctor and to engage in longer conversations. Moreover, patients who completed the medication communication program were rated as more assertive, as having acquired more information about a new medication that was prescribed, as having greater social skill, as being more likely to be compliant with medication, and as having greater eye contact. These results suggest that the use of a medication-related communication skills program may be a somewhat novel and effective way to increase patient involvement in treatment and to facilitate the elicitation of information about the prescribed medication regimen.

Risk adjustment of Florida mental health outcomes data: Concepts, methods, and results

This article discusses outcome evaluation systems for mental health programs. It reviews and critically evaluates design and analysis methods for strengthening the validity of such uncontrolled comparisons. The article examines methods for statistically adjusting preexisting groups, now referred to as risk adjustment or case-mix adjustment, and offers guidelines for determining when this procedure is appropriate. Then, analyses on two dependent variables—a global rating of functioning and a consumer satisfaction measure—available from an outcomes evaluation system currently underway in Florida are used to demonstrate the proposed method of risk adjustment. Results for 24 providers of mental health services showed that while risk adjustment only made a small difference in the overall provider rankings, the ranking of some specific providers changed considerably. The article concludes with a discussion of the implications of this research.

Assisting clients of community mental health centers to secure SSI benefits: a controlled evaluation.

The entire caseloads of three Community Mental Health Centers were screened on variables normally assessed in the SSI application process. These data were then used to classify each individual as Possibly Eligible for SSI benefits, or as Probably Not Eligible. The Possibly Eligible subjects were randomly assigned to either the Experimental condition, in which subjects were helped to apply for SSI, or the Control condition, in which no intervention was provided. Results showed that the Experimental subjects were almost twice as likely to secure SSI benefits as the Control subjects. The usefulness of the screening form was supported in that control subjects were almost five times more likely to be awarded SSI, compared with subjects who had been classified as Probably Not Eligible.

The internet II: Future effects on cognitive behavioral practice

The Internet is a vast international network of computers linked to each other. Users can send electronic mail quickly and easily to each other—free or at low cost. Users can also access pages of information stored as computer files on publicly available locations called Websites. The development and widespread use of electronic mail and the World Wide Web (WWW) has many implications for clinical practice, prevention, education, and research related to cognitive behavior therapy. This article presents an overview of current usage on the Internet, provides examples of how mental health professionals can use the Web to enhance practice, presents speculation about possible future applications of the Internet, and discusses major changes that may take place that would affect clinicians, researchers, and consumers of cognitive behavior therapy.

Can Strengthening Parenting Couples’ Relationships Reduce At-Risk Parenting Attitudes?

Low-income, unwed expectant or new parents are considered at risk of faulty parenting. This study examined whether participation in the 6-week Love’s Cradle relationship enhancement curriculum would also increase positive nonabusive parenting attitudes. Participants were 138 low-income, pregnant or postpartum adults representing 69 romantic dyads who were seeking relationship education. Measures assessed before and after the group intervention suggested statistically significant improvements in all areas of dyadic adjustment (consensus, satisfaction, cohesion, and affectional expression) and most parenting attitudes (empathy toward children’s needs, belief in corporal punishment, role responsibilities, and children’s power and independence). Subgroup analyses explored differences by gender, abuse history, and ethnicity resulting in implications for working with Hispanic couples, and for couples where the male has a history of childhood abuse. This suggested relationship between improving the quality of a couple’s relationship and a reduction in potentially abusive parenting may have implications for strengthening families.