Tabatha H. Blount

Reliability and Normative Data for the Behavioral Health Measure (BHM) in Primary Care Behavioral Health Settings

The Behavioral Health Measure (BHM) is a brief self-report measure of general psychological distress and functioning developed for the tracking of mental health outcomes in outpatient psychotherapy settings (Kopta & Lowry, 2002). Although the BHM is used in integrated primary care behavioral health clinics, the scales psychometric properties have not been evaluated in these settings. The current study investigated the BHMs psychometric properties, including its factor structure and reliability, and presents normative data from 3 large integrated primary care clinics. Mean scores for each of the BHMs 4 scales were significantly lower (i.e., more distress) for women than men, with scores being stable across the 3 primary care samples. Confirmatory factor analysis demonstrated adequate fit for the 3-factor and 1-factor models, with fit improving when 3 items were omitted. Internal consistency estimates for the BHMs 4 scales ranged from adequate to very good (α range: .72-.93). The 4 scales were highly intercorrelated, suggesting they measure similar constructs. Results suggest a revised, 17-item version of the BHM has adequate structure and reliability estimates, and is appropriate for use in primary care settings.

Exploring Modeling-based Hypotheses in Preadolescent Girls’ and Boys’ Cognitive Vulnerability to Depression

In a community sample of 163 children (ages 9–12) and their mothers, we explored modeling-based hypotheses that may underlie how cognitive vulnerability components to depression (negative cognitive triad and negative attributional style) are transmitted from mother to preadolescent children. Results found mothers’ negative cognitive triad partially mediated the relation between mothers’ depressive symptoms and children’s negative cognitive triad. Moreover, mothers’ negative cognitive triad was uniquely and significantly related to children’s negative cognitive triad, after statistically adjusting for the effects of mothers’ depressive and anxiety symptoms in our full sample, as well as in a subsample of our mothers with more depressive symptoms. Most importantly, in our full sample and our subsamples with more depressive symptoms, the amount of time that mothers reported spending with their children moderated the relation between mothers’ and children’s negative cognitive triad, with significantly stronger relations found between mothers’ and children’s negative cognitive triad when mothers reported spending higher in comparison to lower amounts of time spent together. Our modeling-based hypotheses with respect to attributional style, and child sex, were not supported. Implications of our findings for further understanding of family-based modeling mechanisms of risk, and directions for future research, are highlighted.

Intensive prolonged exposure therapy for combat-related posttraumatic stress disorder: Design and methodology of a randomized clinical trial

Combat-related posttraumatic stress disorder (PTSD) is the most common psychological health condition in military service members and veterans who have deployed to the combat theater since September 11, 2001. One of the highest research priorities for the Department of Defense and the Department of Veterans Affairs is to develop and evaluate the most efficient and efficacious treatments possible for combat-related PTSD. However, the treatment of combat-related PTSD in military service members and veterans has been significantly more challenging than the treatment of PTSD in civilians. Randomized clinical trials have demonstrated large posttreatment effect sizes for PTSD in civilian populations. However, recent randomized clinical trials of service members and veterans have achieved lesser reductions in PTSD symptoms. These results suggest that combat-related PTSD is unique. Innovative approaches are needed to augment established evidence-based treatments with targeted interventions that address the distinctive elements of combat-related traumas. This paper describes the design, methodology, and protocol of a randomized clinical trial to compare two intensive prolonged exposure therapy treatments for combat-related PTSD in active duty military service members and veterans and that can be administered in an acceptable, efficient manner in this population. Both interventions include intensive daily treatment over a 3-week period and a number of treatment enhancements hypothesized to result in greater reductions in combat-related PTSD symptoms. The study is designed to advance the delivery of care for combat-related PTSD by developing and evaluating the most potent treatments possible to reduce PTSD symptomatology and improve psychological, social, and occupational functioning.

Conjoint Therapy for the Treatment of Chronic Pain: A Descriptive Pilot Study of Couples’ Needs

Objective: Chronic pain is a significant healthcare challenge for the United States. Most treatment and research has focused upon the chronic pain patient; however, partners of chronic pain patients report care-giver burden, poor relationship quality, and physical and psychological health problems. The authors propose a novel therapy for pain management that incorporates partners into pain treatment to improve relationship quality and pain management. The overall objective of this paper is to outline Conjoint Therapy for Pain Management, a behavioral treatment for chronic pain, and report descriptive pilot data from a Needs Assessment focused upon chronic pain patients and their partners to help refine the Conjoint Therapy for Pain Management treatment manual.

Stress and Psychological Resiliency

Over the past decade, there has been an enormous increase in research and scientific publications targeting psychological resiliency. However, compared to the research on the neurobiology of stress, resiliency research is in its relative infancy. Much of the resiliency research has focused on theoretical models and the conceptualization of psychological resiliency. Resiliency research has been limited by (1) the broad use of the term resiliency; (2) the lack of standardized definitions of resiliency; (3) a primary focus on descriptive, assessment, and measurement studies; (4) relatively few randomized controlled trials to evaluate the efficacy of resiliency enhancement programs; and (5) methodological challenges inherent in conducting applied resiliency research. Although many recent programs have been initiated in attempts to enhance psychological resiliency in targeted populations, such as military personnel, relatively few randomized controlled trials have been conducted. Translational research, prospective longitudinal cohort studies, and clinical intervention trials are needed to better understand the behavioral neurobiology of stress and psychological resiliency.