Michael S. Christopher

An affective-motivational model of marijuana and alcohol problems among college students.

The study examined models of marijuana (n = 309) and alcohol (n = 731) problems. Impulsivity was directly associated with both marijuana- and alcohol-related problems. Negative mood regulation expectancies were indirectly associated with marijuana problems through coping motives. Sensation seeking was indirectly associated with alcohol problems through enhancement motives. Affect lability and negative affect were indirectly associated with alcohol problems though coping motives. In both models, coping motives were directly associated with use-related problems. A multigroup analysis indicated that the association between negative affect and coping motives as well as use and problems was stronger among participants using both alcohol and marijuana relative to alcohol only. Enhancement motives were a stronger predictor of alcohol use among participants using alcohol only.

Development and Validation of the Cognitive-Behavioral Therapy Skills Questionnaire

Although several theories exist to describe why patients improve in cognitive-behavioral therapy (CBT), in only a limited number of studies has CBT skill acquisition been examined, particularly among patients with complex clinical profiles. Thus, the overarching aim of this research was to develop a tool to measure patients’ use of CBT skills, such that it would have clinical utility for patients and therapists during treatment. In Study 1, the authors developed an initial set of items for the Cognitive-Behavioral Therapy Skills Questionnaire (CBTSQ). They submitted these items to an exploratory factor analysis in an initial administration (n = 350) and to a confirmatory factor analysis in a second administration (n = 378). Results indicated that there were two factors (Behavioral Activation and Cognitive Restructuring) with good factor structure and internal consistency, and both the factors evidenced expected relationships with other constructs. In Study 2, the criterion validity of the CBTSQ was investigated on a patient sample in a CBT-oriented treatment setting. Results showed that CBTSQ scores increased following treatment, and Cognitive Restructuring and Behavioral Activation scores predicted reduction of overall psychiatric symptoms and depression. Thus, the CBTSQ appears to be a promising measure of CBT skill acquisition and treatment outcome as well as an instrument that can help patients and therapists monitor progress specifically related to a CBT skills training treatment approach.

Assessing “Western” Mindfulness Among Thai Theravāda Buddhist Monks

Mindfulness has its roots in Eastern contemplative traditions and is rapidly gaining popularity in Western psychology. However, questions remain regarding the validity of Western operationalizations of mindfulness. Therefore, the purpose of this study was to assess the applicability of several Western mindfulness measures among a sample of Thai Theravāda Buddhist monks. Twenty-four monks recruited from Buddhist temples in Thailand participated in the study. The monks evinced similar associations between mindfulness and related variables as American validation study samples did, and on two facets of mindfulness the monks’ mean scores were greater than an American college student sample. However, the American sample endorsed significantly higher scores on three other facets of mindfulness. These results raise concerns about whether these scales are measuring mindfulness as it is conceptualized in a Buddhist context. Future research with larger samples is needed to further assess the cultural validity and measurement equivalence of Western mindfulness measures across cultural groups.

Cognitive and behavioral changes related to symptom improvement among patients with a mood disorder receiving intensive cognitive-behavioral therapy.

Objective To examine the relationship between cognitive and behavioral changes associated with cognitive-behavioral therapy (CBT) and treatment response in an intensive partial hospital (PH) setting. Methods Study participants were 105 patients with mood disorders receiving treatment in a private psychiatric PH setting. The flexible treatment model used evidence-based CBT interventions adapted to the PH context, with emphases on psychoeducation and skills training. Participants completed self-report measures at admission and discharge to assess psychological distress, depression, negative automatic thoughts, and behavioral activation. Mean treatment duration was 9 days. Results Decreased negative automatic thoughts and increased behavioral activation predicted reduction of depressive symptoms; however, only decreased negative automatic thoughts was predictive of patients overall level of psychological distress. Conclusions These results suggest that a CBT intervention adapted for use in a PH setting can be an effective treatment for severe mood disorders. Furthermore, although the design used in this study precludes causal inferences, depressive symptom improvement appears to be associated with decreased negative automatic thoughts and increased behavioral activation. Implications for the delivery of CBT in PH programs and future directions for research are discussed. (Journal of Psychiatric Practice 2009;15:95–102)

Short-Term Cognitive Behavioral Partial Hospital Treatment: A Pilot Study

Objective. Brief, cost-contained, and effective psychiatric treatments benefit patients and public health. This naturalistic pilot study examined the effectiveness of a 2-week, cognitive-behavioral therapy (CBT) oriented partial hospital program. Methods. Study participants were 57 patients with mood, anxiety, and/or personality disorders receiving treatment in a private psychiatric partial hospital (PH) setting. A flexible treatment model was used that adapts evidence-based CBT treatment interventions to the PH context with emphases on psychoeducation and skills training. Participants completed self-report measures at admission and after 1 and 2 weeks, to assess stabilization and functional improvements, with added attention to the acquisition of cognitive and behavioral skills. The data were analyzed using repeated measures analyses of variance and correlation. Results. Participants reported a decrease in symptoms and negative thought patterns, improved satisfaction with life, and acquisition and use of cognitive and behavioral skills. Skill acquisition was correlated with symptom reduction, reduced negative thought patterns, and improved satisfaction with life. Conclusions. Results of this pilot study suggest that a 2-week PH program can be effective for a heterogeneous patient population with mood, anxiety, and/or personality disorders. These findings are promising given the prevalence of treatments of such brief duration in private sector PH programs subject to the managed care marketplace. Future studies are planned to test this flexible PH treatment model, with particular attention to the effectiveness of the CBT approach for the treatment of different disorders and to whether effectiveness is sustained at follow-up. Further study should also examine whether skill acquisition is a mechanism of change for symptom reduction and functional improvements.

Albert Ellis and the Buddha: rational Soul Mates? A comparison of Rational Emotive Behaviour Therapy (REBT) and Zen Buddhism

Although religion and psychology are generally conceived of as distinct domains, the theoretical underpinnings of certain psychological theories are inextricably related to religious ideology. This relationship is perhaps best exemplified by the theoretical and applied similarity between Buddhist principles and Albert Elliss Rational Emotive Behaviour Therapy (REBT). Sharing a common purpose, both the Buddha and Ellis set out to improve the human condition, and to do so in a rational, empirical manner. The significance of these parallels is discussed in relation to the incorporation of early Buddhist and Zen Buddhism concepts into the current practice of REBT.