Stanley J. Huey

Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning.

The mechanisms through which multisystemic therapy (MST) decreased delinquent behavior were assessed in 2 samples of juvenile offenders. Sample 1 included serious offenders who were predominantly rural, male, and African American. Sample 2 included substance-abusing offenders who were predominantly urban, male, and Caucasian. Therapist adherence to the MST protocol (based on multiple respondents) was associated with improved family relations (family cohesion, family functioning, and parent monitoring) and decreased delinquent peer affiliation, which, in turn, were associated with decreased delinquent behavior. Furthermore, changes in family relations and delinquent peer affiliation mediated the relationship between caregiver-rated adherence and reductions in delinquent behavior. The findings highlight the importance of identifying central change mechanisms in determining how complex treatments such as MST contribute to ultimate outcomes.

Multisystemic Therapy Effects on Attempted Suicide by Youths Presenting Psychiatric Emergencies.

OBJECTIVE To evaluate the efficacy of multisystemic therapy (MST) in reducing attempted suicide among predominantly African American youths referred for emergency psychiatric hospitalization. METHOD Youths presenting psychiatric emergencies were randomly assigned to MST or hospitalization. Indices of attempted suicide, suicidal ideation, depressive affect, and parental control were assessed before treatment, at 4 months after recruitment, and at the 1-year posttreatment follow-up. RESULTS Based on youth report, MST was significantly more effective than emergency hospitalization at decreasing rates of attempted suicide at 1-year follow-up; also, the rate of symptom reduction over time was greater for youths receiving MST. Also, treatment differences in patterns of change in attempted suicide (caregiver report) varied as a function of ethnicity, gender, and age. Moreover, treatment effects were found for caregiver-rated parental control but not for youth depressive affect, hopelessness, or suicidal ideation. CONCLUSIONS Results generally support MSTs effectiveness at reducing attempted suicide in psychiatrically disturbed youngsters, whereas the effects of hospitalization varied based on informant and youth demographic characteristics.

Culturally adapted versus standard exposure treatment for phobic Asian Americans: Treatment efficacy, moderators, and predictors.

This study is a 6-month follow-up of a randomized pilot evaluation of standard one-session treatment (OST-S) versus culturally adapted OST (OST-CA) with phobic Asian Americans. OST-CA included seven cultural adaptations drawn from prior research with East Asians and Asian Americans. Results from 1-week and 6-month follow-up show that both OST-S and OST-CA were effective at reducing phobic symptoms compared with self-help control. Moreover, OST-CA was superior to OST-S for several outcomes. For catastrophic thinking and general fear, moderator analyses indicated that low-acculturation Asian Americans benefitted more from OST-CA than OST-S, whereas both treatments were equally effective for high-acculturation participants. Although cultural process factors (e.g., facilitating emotional control, exploiting the vertical therapist-client relationship) and working alliance were predictive of positive outcomes, they did not mediate treatment effects. This study offers a potential model for evaluating cultural adaptation effects, as well as the mechanisms that account for such effects.

Black/White Differences in Perceived Weight and Attractiveness among Overweight Women

Numerous studies have reported that Black women are more satisfied with their bodies than White women. The buffering hypothesis suggests that aspects of Black culture protect Black women against media ideals that promote a slender female body type; therefore, Black women are expected to exhibit higher body esteem than White women. To test this hypothesis, the current study aimed to assess the influence of race on weight perception, perceived attractiveness, and the interrelations between body mass index (BMI) and perceived attractiveness among overweight and obese women. Participants were 1,694 respondents of Wave IV of the National Longitudinal Study on Adolescent Health (M = 28.89 years). Black (n = 531) or White (n = 1163) obese or overweight women were included in the current study. As expected, Black women reported lower perceived weight and higher attractiveness than White women, despite higher body mass for Black women. Furthermore, race moderated the relationship between BMI and perceived attractiveness; for White women, a negative relationship existed between BMI and attractiveness, whereas for Black women, BMI and attractiveness were not related. The study findings provide further support for the buffering hypothesis, indicating that despite higher body mass, overweight Black women are less susceptible to thin body ideals than White women.

Culture-responsive one-session treatment for phobic Asian Americans: A pilot study.

In this pilot trial, 15 phobic Asian Americans were randomly assigned to standard one-session treatment (OSTS), culturally adapted one-session treatment (OST-CA), or manualized self-help. At posttreatment, OST (combined standard and culturally adapted) led to greater reductions in phobic avoidance and anxiety than self-help. Moreover, analyses comparing the two active treatments showed trends favoring OST-CA over OST-S. Results suggest that Asian Americans may benefit most from empirically supported treatments that consider Asian cultural values. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Predictors of Treatment Response for Suicidal Youth Referred for Emergency Psychiatric Hospitalization.

This study evaluated factors that predicted poor treatment response for 70 suicidal youth (ages 10 to 17 years; 67% African American) who received either multisystemic therapy (MST) or inpatient psychiatric hospitalization. Following treatment, suicidal youth were classified as either treatment responders or nonresponders based on caregiver or youth report of attempted suicide. Overall, female gender, depressive affect, parental control, caregiver psychiatric distress, and caregiver history of psychiatric hospitalization were associated with suicide attempts. However, controlling for other variables, only depressive affect and parental control predicted treatment nonresponse. These results suggest the need to adapt existing treatments for suicidal youth to better address problems relating to youth depression.

Internet‐delivered eating disorder prevention: A randomized controlled trial of dissonance‐based and cognitive‐behavioral interventions

OBJECTIVE The current study evaluated two web-based programs for eating disorder prevention in high-risk, predominantly ethnic minority women. METHOD Two hundred and seventy-one women with elevated weight concerns were randomized to Internet dissonance-based intervention (DBI-I), Internet cognitive-behavioral intervention (CBI-I), or no intervention (NI). Both interventions consisted of four weekly online sessions. Participants were assessed at pre- and post intervention. Outcome measures included eating pathology, body dissatisfaction, dieting, thin-ideal internalization, and depression. RESULTS At postintervention, DBI-I and CBI-I led to greater reductions in body dissatisfaction, thin-ideal internalization, and depression than NI. In addition, CBI-I was effective at reducing dieting and composite eating pathology relative to NI. No outcome differences were found between the active conditions. Moderation analyses suggested that both active conditions were more effective for ethnic minorities than Whites relative to NI. DISCUSSION Results suggest that both DBI-I and CBI-I are effective at reducing eating disorder risk factors in a high-risk, predominantly minority population relative to no intervention.

Predictive validity of an observer-rated adherence protocol for multisystemic therapy with juvenile drug offenders

OBJECTIVE Multisystemic therapy (MST) is perhaps the best validated treatment for youth who engage in serious and chronic antisocial behavior (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009). Despite evidence suggesting that high treatment adherence is needed to achieve optimal MST outcomes, this research is limited because past studies have relied on adherence reports derived solely from treatment participants (i.e., caregivers, youth, and therapists). To address this gap in the literature, the present study assessed the reliability and predictive validity of an observational protocol for rating adherence to MST. METHOD The sample was drawn from a randomized clinical trial of juvenile drug offenders (77.5% male, 65% African American) referred to one of four treatment conditions (Henggeler et al., 2006). Audiotaped sessions of youth and their families were selected from the first month of MST and trained undergraduate students independently rated therapist adherence to the nine MST treatment principles. We assessed the validity of MST adherence in predicting outcomes at post-recruitment and 12-month follow-up. RESULTS Good interrater reliability (ICC=0.642) was found across all raters for our composite index of adherence. High adherence to MST during the first month of therapy predicted decreases in externalizing behavior at post-recruitment and decreases in youth alcohol consumption at 12-month follow-up. CONCLUSIONS These results provide independent support for the link between treatment fidelity and behavioral outcomes in the context of MST. Further, this study demonstrates the feasibility of using novice, undergraduate judges to reliably code therapist adherence.

A Brief Review and Meta-Analysis of Gang Intervention Trials in North America

This chapter provides a brief review of the literature on controlled, gang intervention evaluations. Thirty-eight studies were included, and all were carried out in North America (primarily the United States). The majority of studies (63 %) were treatment-oriented (versus prevention-oriented; 37 %) trials, with participants who were predominantly male (84 %), youths (87 %), and ethnic minority (81 %). Although many studies showed that intervention was effective at remediating antisocial behavior and gang involvement, a somewhat larger number found only limited or no intervention effects. When meta-analysis was used to assess treatment effects across 26 studies, results were similarly mixed. Random effects analysis showed that intervention effects for antisocial behavior were nonsignificant, d = .07, p = .20, whereas effects for gang involvement were small yet statistically significant, d = .29, p = .03. Methodological challenges and limitations are discussed, as well as research programs that serve as models for how to conduct gang intervention evaluations.

Effects of mental health interventions with Asian Americans: A review and meta-analysis.

Objective: Evidence demonstrating treatment efficacy for ethnic minorities has grown in recent years; however, Asian Americans (i.e., of East Asian or Southeast Asian heritage) are mostly excluded from recent reviews. In this review we (a) synthesize the literature on mental health treatment effects for Asian Americans and (b) evaluate support for competing theoretical perspectives on cultural tailoring. Method: A literature search supplemented with other search strategies identified 21 randomized trials of mental health interventions for Asian Americans (n = 6,377 total participants). The meta-analysis was based on random-effects models. Results: Overall, results show that posttreatment effects were relatively large and significant (d = .75, SE = .14, p = .000). However, there was substantial heterogeneity across studies (ES range = −.04 to 2.61), with moderator analyses indicating that effects differed significantly by target problem, diagnostic status, and comparison group. Also, specificity of cultural tailoring was significantly associated with treatment outcomes, with treatments tailored specifically for Asian subgroups (e.g., Chinese Americans) showing the largest effects (d = 1.10), and those with no cultural tailoring or non-Asian tailoring (d = .25) showing the smallest effects. Conclusions: Findings suggest that mental health treatments are efficacious for Asian Americans and that cultural tailoring can enhance treatment outcomes. In general, these findings lend support to the cultural responsiveness hypothesis, although caveats are noted. Implications for psychotherapy research with Asian Americans are discussed, as well as methodological and conceptual challenges.