Cognitive-behavioral Skills Training Research Articles

LESSONS LEARNED DEVELOPING A NUTRITIONAL ADHERENCE INTERVENTION FOR DEMENTIA PREVENTION: A QUALITATIVE ANALYSIS

Abstract Lifestyle interventions show considerable promise in delaying the onset and reducing risk for Alzheimer’s disease and related dementias (ADRD). Unfortunately, scalable interventions that address issues of long-term adherence have not been adequately developed or disseminated. Especially important for this effort is iterative evaluation and adaptation of interventions using participant feedback throughout the development process. Using the NIH ORBIT model for behavioral intervention development, our team has established the proof-of-concept (N=9) and pilot tested (N=58) a Mediterranean ketogenic nutrition (MKN) adherence program for older adults at risk for ADRD. This program incorporates motivational interviewing strategies and cognitive behavioral skills training to enhance uptake and long-term adherence to MKN. For each of these pilots, participants completed exit interviews at the conclusion of the 6-week, group intervention and 3-months post-intervention. Qualitative and quantitative data on the acceptability of the program, as well as detailed participant feedback about their experience and recommendations for improvements were collected. While quantitative data demonstrate high acceptability, thematic analysis of qualitative interviews demonstrate a range of recommendations for enhancing and refining important components of the intervention that will be necessary for future scaling and dissemination. We discuss important themes, future directions of this work, and implications for lifestyle intervention development more broadly.

Effectiveness of social management training on executive functions in males with Klinefelter syndrome (47, XXY)

Men with an extra X chromosome are at risk for social difficulties in which executive functions are known to play an important role. The aim of this study was to examine the potential efficacy of a novel neurocognitive-behavioral treatment program tailored to the specific vulnerabilities of Klinefelter syndrome (47, XXY). Social Management Training (SMT) aimed to increase the ability of individuals to regulate their thoughts, emotions and behaviors in ways that are socially adaptive. 16 Adolescents and men with Klinefelter Syndrome participated in SMT. This novel group treatment program consists of 10 sessions and includes psychoeducation, cognitive-behavioral skills training, home-assignments, and relaxation exercises. There were pre- and posttest cognitive assessments (five months apart) of executive functioning including sustained attention, inhibition, cognitive flexibility and working memory, as well as self-evaluation of executive functioning in daily life. Significant pre- to posttest improvements in inhibitory control (performance test) and metacognition skills (self-report) were found, with effects sizes of 1.3 and 0.5, respectively. No effects of intervention were found on sustained attention, cognitive flexibility and working memory. These findings suggest that SMT, with a key focus on executive dysfunction and tailored to the behavioral and cognitive profile of males with Klinefelter syndrome, may be a promising and potentially efficacious treatment approach for improving self-control and social adaptation, although larger and randomized controlled studies are warranted.

Examining Predictors of Depression and Anxiety Symptom Change in Cognitive Behavioral Immersion: Observational Study

Background Depressive and anxiety disorders are the most common mental disorders, and there is a critical need for effective, affordable, and accessible interventions. Cognitive Behavioral Immersion (CBI) is a novel group-based cognitive behavioral skills training program delivered by lay coaches in the metaverse that can be accessed through various modalities including virtual reality (VR) head-mounted displays or flat-screen devices. Combining its ability to offer empirically supported therapy skills in a digital setting that can still facilitate interpersonal variables (eg, working alliance and sense of social support) with the aid of lay coaches, CBI has the potential to help fill this critical need. Objective This study had 2 primary aims. First, we aimed to examine changes in depression and anxiety symptoms in a sample of individuals who participated in CBI. Second, we aimed to examine 2 interpersonal process variables (working alliance and web-based social support) as predictors of symptom changes. We predicted CBI participants would experience depression and anxiety symptom improvements and that such improvements would be associated with an increase in both interpersonal process variables. Methods The study sample consists of 127 participants who endorsed clinical levels of depression or anxiety symptoms during their first CBI session and attended at least 2 sessions. Participants were asked to complete self-report measures of depression symptoms, anxiety symptoms, alliance, and web-based social support throughout their participation in CBI. Results Repeated measures ANOVAs determined that depression and anxiety symptom scores differed significantly across sessions (Ps<.01). We also found participants’ web-based social support predicted improvement in depression symptoms (P=.01), but neither the alliance nor web-based social support predicted change in anxiety symptoms (Ps>.05). We also observed a significant difference in anxiety symptoms between participants who used a VR head-mounted display to access CBI and those who did not, such that participants who used VR head-mounted displays endorsed lower anxiety symptoms than those who did not at nearly every session (P=.04). Conclusions Participation in CBI is associated with both depression and anxiety symptom improvement. Web-based social support may play an important role in fostering changes in depression symptoms. Future studies are encouraged to continue examining the process of change in CBI with special attention paid to methods that can elucidate causal mechanisms of change.

Understanding female survivors of interpersonal trauma and their experience of the ‘Survive & Thrive’ course

The majority of publications have concentrated on individual psychological interventions with a limited focus on manualized group-based approaches for those presenting with mental health difficulties following a history of trauma. Survive & Thrive (S&T) is a psychoeducational course designed for survivors of interpersonal trauma which utilizes cognitive behavioural skills training while delivering psychoeducation on how a history of victimization can impact on the survivors’ life. This qualitative study was designed to gain an insight into female survivors of interpersonal trauma experience of S&T and the associated group dynamics component to evaluate this psychological intervention. The participants described their experience of S&T as a journey towards recovery. The study highlights the benefits of group-based interventions in regard to learning experience within a social context whilst also identifying areas for further development based on the participants’ feedback.

Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction

There are few available culturally and linguistically adapted behavioral health interventions for substance use among Spanish-speaking adults. The authors describe the cultural adaptation of an innovative computer-based training for cognitive behavioral therapy program (CBT4CBT). Based in cognitive-behavioral skills training, CBT4CBT utilizes a telenovela to teach monolingual Spanish-speaking adults who have migrated to the United States to recognize triggers; avoid these situations; and cope more effectively with the consequences of substance use. Participants endorsed high levels of satisfaction with the program content and found the material to be easy to understand and relevant to their life experiences.

Targeted eHealth Intervention to Reduce Breast Cancer Survivors' Fear of Recurrence: Results From the FoRtitude Randomized Trial.

BackgroundFear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS), yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, “FoRtitude,” to reduce FoR using cognitive behavioral skills training and telecoaching. MethodsBCS (N = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years postprimary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomly assigned to 3 cognitive behavioral skills (relaxation, cognitive restructuring, worry practice) vs an attention control condition (health management content [HMC]) and to telecoaching (motivational interviewing) vs no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory at baseline and at 4 and 8 weeks. Fear of Cancer Recurrence Inventory scores over time were compared using mixed-effects models. All statistical tests were 2-sided.ResultsFCRI scores [SD] decreased statistically significantly from baseline to postintervention (T0 = 53.1 [17.4], T2 = 41.9 [16.2], P < .001). The magnitude of reduction in FCRI scores was comparable across cognitive behavior therapy (CBT) and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score [SD] = 26.6 [7.2] vs 21.0 [10.5], P < .001).ConclusionsBCS experienced statistically significant reductions in FoR postintervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research is needed on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.

Gender roles are related to cortisol habituation to repeated social evaluative stressors in adults: secondary analyses from a randomized controlled trial

Masculine and feminine gender roles influence stressor appraisals and coping in everyday life, but their effect on stress response systems like the hypothalamic-pituitary-adrenocortical axis is unclear. Accordingly, the present study tested the association between gender roles and cortisol responses to repeated stress as part of secondary analyses of data from a randomized controlled trial examining the effects of stress management interventions on cortisol habituation. Participants (Nfinal = 86; 72% female) completed a baseline survey assessing gender role endorsement using the Bem Sex Role Inventory, from which 4 groups were derived: masculine (n = 20), feminine (n = 20), androgynous (high masculinity, high femininity; n = 22), and undifferentiated (low masculinity, low femininity; n = 24). Following the stress management intervention (mindfulness-based stress reduction or cognitive-behavioral skills training) or waitlist period control, participants completed the Trier Social Stress Test on two laboratory visits (48 h apart). Salivary cortisol was assessed 0, 25, 35, and 60 min post-stressor during both laboratory visits. Androgynous and undifferentiated individuals both exhibited a significant decrease in total cortisol from visit 1 to visit 2 (i.e. habituation) whereas feminine and masculine individuals did not. Undifferentiated individuals exhibited greater habituation than feminine and masculine individuals, whereas androgynous individuals only exhibited greater habituation than the feminine group. Controlling for study condition assignment did not alter these results. Results imply that gender roles may be implicated in stress-related disease because of their association with HPA axis functioning during episodes of acute stress.

Criminal thinking and gang affiliation: antecedents and consequences

Purpose The purpose of this paper is to clarify the relationship between gang affiliation and criminal thinking. Design/methodology/approach A sample of 1,354 youth (1,170 males, 184 females) from the Pathways to Desistance Study served as participants in this study, and a causal mediation path analysis was performed on proactive and reactive criminal thinking, gang affiliation and subsequent offending. Findings Using three waves of data, it was determined that the pathway running from reactive criminal thinking to gang affiliation to proactive criminal thinking was significant, whereas the pathway running from proactive criminal thinking to gang affiliation to reactive criminal thinking was not. A four-wave model, in which violent and income offending were appended to the three-wave model, disclosed similar results. Practical implications Two separate targets for intervention with youth at risk for gang involvement: proactive and reactive criminal thinking. The impulsive, irresponsible, reckless and disinhibited nature of reactive criminal thinking may best be managed with a secondary prevention approach and cognitive-behavioral skills training; the planned, cold, calculating and amoral nature of proactive criminal thinking may best be managed with a tertiary prevention approach and moral retraining. Trauma therapy may be of assistance to youth who have been victimized over the course of their gang experience. Originality/value These findings reveal evidence of a gang selection effect that is independent of the well-documented peer selection effect, in which reactive criminal thinking led to gang affiliation in youthful offenders, particularly non-White offenders, and a gang influence effect, independent of the frequently observed peer selection effect, in which gang affiliation contributed to a rise in proactive criminal thinking.

Stress management interventions for intensive and critical care nurses: A systematic review

The level of occupational stress of nurses working in intensive and critical care units is high. Although many studies have assessed the effectiveness of stress management interventions among intensive and critical care nurses, the methodological quality of these studies remains unclear. The purpose of this review was to summarize and appraise the methodological quality of primary studies on interventions for management of occupational stress among intensive and critical care nurses. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted to identify primary studies that assessed the effectiveness of interventions in managing occupational stress among intensive and critical care nurses using multiple databases from January 2009 to June 2019. Twelve studies published between 2011 and 2019 were eligible for inclusion. These included studies were classified as being of good or fair quality. The consensus across the included studies was that, compared with control condition, cognitive-behavioural skills training and mindfulness-based intervention were more effective in reducing occupational stress among intensive and critical care unit nurses. Further research should focus on methodologically strong studies by blinding the outcome assessors, using Randomized Controlled Trial (RCT) design with an active control group, using standardized assessment tools, and reporting enough details about the stress management intervention-related adverse events. This review demonstrates the need for high methodological quality studies to rigorously evaluate the effectiveness of stress management interventions before it can be recommended for use in clinical practice to reduce stress in intensive and critical care unit nurses. In addition, attention should be given to developing research protocols that place more emphasis on interventions aimed at the organization level to address the growing problem of occupational stress among intensive and critical care nurses.

Long-term Results From the FRESH RCT: Sustained Reduction of Children's Tobacco Smoke Exposure

Standard care interventions to reduce children's tobacco smoke exposure (TSE) may not be sufficient to promote behavior change in underserved populations. A previous study demonstrated the short-term efficacy of an experimental counseling intervention, Family Rules for Establishing Smokefree Homes (FRESH) compared with standard care on boosting low-income children's TSE reduction and maternal smoking at 16-week end of treatment (EOT). This study tested long-term posttreatment efficacy of this treatment through a 12-month follow-up. This study was a two-arm RCT. Maternal smokers (n=300) not seeking cessation treatment were recruited from low-income, urban communities. Participants exposed their <4-year-old children to tobacco smoke daily. Data collection and analyses occurred from 2006 to 2018. The FRESH behavioral intervention included 2 home visits and 7 phone sessions. FRESH used cognitive behavioral skills training, support, problem-solving, and positive social reinforcement to facilitate the adoption of increasingly challenging TSE-protection behaviors. No nicotine-replacement therapy or medication was provided. Primary outcomes were child cotinine (TSE biomarker) and reported TSE from EOT through 12 months after treatment. A secondary outcome was bioverified maternal smoking cessation. Compared with controls, children in FRESH had significantly lower cotinine (β= -0.31, p<0.01) and lower maternal-reported TSE (β= -1.48, p=0.001) through the 12-month follow-up. A significant effect of time (β= -0.03, p=0.003) reflected a posttreatment decrease in cotinine. There was no treatment × time interaction, suggesting the treatment effect at EOT was sustained after treatment. Compared with controls, FRESH mothers maintained significantly higher odds of quitting smoking from EOT through 12-month follow-up (OR=8.87, 95% CI=2.33, 33.75). Study results with a sample of underserved maternal smokers demonstrated that the short-term effect of FRESH counseling at 16-week EOT was maintained through 12 months after treatment-for both bioverified child TSE reduction and maternal smoking cessation. Smokers in low-income communities demonstrate elevated challenges to success in standard smoking treatment. FRESH follow-up results suggest the high potential value of more-intensive behavioral intervention for vulnerable smokers. This study is registered at www.clinicaltrials.gov NCT02117947.

RESPON SOSIAL DAN KEMAMPUAN SOSIALISASI PASIEN ISOLASI SOSIAL MELALUI MANAJEMEN KASUS SPESIALIS KEPERAWATAN JIWA

Background: Social isolation is a condition of loneliness felt by the individual being unable to make contact with other people. Social isolation can result in further on the issue of fulfillment of basic needs, so it would appear hallucinations that endanger themselves and others.&#x0D; Objective: The purpose of writing scientific papers to describe social changes, and socialization capabilities in social isolation’s patients using nursing care management of psychiatric specialist.&#x0D; Methods: Nursing orders given to 22 clients using nurses action, Social Skills Training (SST), and Cognitive-Behavioral and Social Skills Training (CBSST).&#x0D; Result: Results obtained reduction in social symptoms of social isolation mark that includes withdraw behaviour, interaction difficulties, refuse to communicate with others, fail to interact with others nearby, disabillity to participate in social activities, ignoring the environtment, and mistrust with others. The result also shown the improvement of socialization patient ability.&#x0D; Conclusion: : There were reduction in symptoms of social isolation obviously showed on social aspects as well as an increase in the client's ability to socialize. Recommendations of this study was to use a combination of measures such as nurses and specialist nurses Social Skills Training and Cognitive-Behavioral and Social Skills Training on clients with social isolation.&#x0D; Key Words : Social Skills Training, Cognitive-Behavioral and Social Skills Training

An mHealth Intervention to Improve Young Gay and Bisexual Men's Sexual, Behavioral, and Mental Health in a Structurally Stigmatizing National Context.

BackgroundYoung gay and bisexual men (YGBM) in some Eastern European countries, such as Romania, face high stigma and discrimination, including in health care. Increasing HIV transmission is a concern given inadequate prevention, travel to high-prevalence countries, and popularity of sexual networking technologies.ObjectiveThis study aimed to adapt and pilot test, in Romania, a preliminarily efficacious mobile health (mHealth) HIV-prevention intervention, created in the United States, to reduce HIV risk among YGBM.MethodsAfter an intervention formative phase, we enrolled 43 YGBM, mean age 23.2 (SD 3.6) years, who reported condomless sex with a male partner and at least 5 days of heavy drinking in the past 3 months. These YGBM completed up to eight 60-minute text-based counseling sessions grounded in motivational interviewing and cognitive behavioral skills training with trained counselors on a private study mobile platform. We conducted one-group pre-post intervention assessments of sexual (eg, HIV-risk behavior), behavioral (eg, alcohol use), and mental health (eg, depression) outcomes to evaluate the intervention impact.ResultsFrom baseline to follow-up, participants reported significant (1) increases in HIV-related knowledge (mean 4.6 vs mean 4.8; P=.001) and recent HIV testing (mean 2.8 vs mean 3.3; P=.05); (2) reductions in the number of days of heavy alcohol consumption (mean 12.8 vs mean 6.9; P=.005), and (3) increases in the self-efficacy of condom use (mean 3.3 vs mean 4.0; P=.01). Participants reported significant reductions in anxiety (mean 1.4 vs mean 1.0; P=.02) and depression (mean 1.5 vs mean 1.0; P=.003). The intervention yielded high acceptability and feasibility: 86% (38/44) of participants who began the intervention completed the minimum dose of 5 sessions, with an average of 7.1 sessions completed; evaluation interviews indicated that participation was rewarding and an “eye-opener” about HIV risk reduction, healthy identity development, and partner communication.ConclusionsThis first mHealth HIV risk-reduction pilot intervention for YGBM in Eastern Europe indicates preliminary efficacy and strong acceptability and feasibility. This mobile prevention tool lends itself to broad dissemination across various similar settings pending future efficacy testing in a large trial, especially in contexts where stigma keeps YGBM out of reach of affirmative health interventions.

Testing the Efficacy of Combined Motivational Interviewing and Cognitive Behavioral Skills Training to Reduce Methamphetamine Use and Improve HIV Medication Adherence Among HIV-Positive Gay and Bisexual Men.

Prior research has identified subgroups of HIV-positive gay and bisexual men (GBM) based upon information, motivation, and behavioral skills (IMB) profiles related to HIV medication adherence and methamphetamine use. We conducted a randomized controlled trial of a combined motivational interview (MI) and cognitive behavioral therapy (CBT) intervention tailored specifically to the unique context of HIV-positive GBM, and tested whether IMB profiles moderated treatment effects. HIV-positive GBM (N = 210) were randomized to MI + CBT or an attention-matched education control. Both conditions resulted in reduced methamphetamine use, improved medication adherence (and higher CD4 and lower viral loads), and fewer acts of condomless anal sex at 3, 6, 9 and 12months post-intervention. Furthermore, the MI + CBT condition achieved greater improvements in medication adherence for men who had greater barriers to change compared to similarly-classified men in the control condition, suggesting the importance of pre-intervention profiles for tailoring future interventions.

Respon Sosial dan Kemampuan Sosialisasi Pasien Isolasi Sosial melalui Manajemen Kasus Spesialis Keperawatan Jiwa

Background: Social isolation is a condition of loneliness felt by the individual being unable to make contact with other people. Social isolation can result in further on the issue of fulfillment of basic needs, so it would appear hallucinations that endanger themselves and others. Objective: The purpose of writing scientific papers to describe social changes, and socialization capabilities in social isolation’s patients using nursing care management of psychiatric specialist. Methods: Nursing orders given to 22 clients using nurses action, Social Skills Training (SST), and Cognitive-Behavioral and Social Skills Training (CBSST). Result: Results obtained reduction in social symptoms of social isolation mark that includes withdraw behaviour, interaction difficulties, refuse to communicate with others, fail to interact with others nearby, disabillity to participate in social activities, ignoring the environtment, and mistrust with others. The result also shown the improvement of socialization patient ability. Conclusion: : There were reduction in symptoms of social isolation obviously showed on social aspects as well as an increase in the client's ability to socialize. Recommendations of this study was to use a combination of measures such as nurses and specialist nurses Social Skills Training and Cognitive-Behavioral and Social Skills Training on clients with social isolation. Key Words : Social Skills Training, Cognitive-Behavioral and Social Skills Training

Meta-analytic evidence of the effectiveness of stress management at work

ABSTRACTTo increase employees’ psychological health and to achieve a competitive advantage, organizations are increasingly introducing flexible work arrangements (FWAs) and stress management training (SMT). This paper provides meta-analytic evidence of the effects of two forms of FWA (flexitime and telecommuting) and three forms of SMT (cognitive-behavioural skills training, relaxation techniques and multiple SMT) on employees’ psychological health, job satisfaction, job performance and absenteeism. Applying the conservation of resource theory, we conjecture that both FWAs and SMT improve all four employee-related outcomes. Quantitative meta-analyses based on 43 primary studies and 22,882 employees show that both FWAs and SMT are positively associated with psychological health and job satisfaction. However, due to a lack of primary studies we were mostly unable to analyse the effects on performance and absenteeism. Although we found a large heterogeneity in the hypothesized relationships, additional moderator analyses of study quality, age, gender, duration and intention of intervention yielded no significant effects. We discuss limitations and implications for practice and for future research.

Effects of Group Functional Behavior-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Behavior in a Youth With Autism Spectrum Disorder

ABSTRACTIndividuals with Autism Spectrum Disorder (ASD) often present with comorbid Obsessive Compulsive Behaviors (OCBs), but little research exists on effective intervention for OCBs. Using a single-case experimental design, this study highlights the efficacy of a Group Functional Behavior-based Cognitive-Behavior Therapy (Fb-CBT) to reduce OCBs in an 11-year-old youth with ASD. Tailored to the individual needs of this youth, Fb-CBT included traditional CBT components (e.g., psychoeducation, cognitive-behavioral skills training, and exposure and response prevention) coupled with functional behavior assessment and intervention. Time-series parent report data and standardized measures showed clinically significant decreases in OCBs, an increase in psychosocial functioning, and high consumer satisfaction.

Evaluation of an Evidence-Based Weight Loss Trial for Urban African American Adolescents and Caregivers

Rates of obesity are among the highest for African American adolescents in the US. However, African American adolescents benefit the least from evidence-based weight loss interventions, often experiencing poor treatment retention and low motivation. Participant evaluations provide key information for future development of family-based weight loss interventions able to address these barriers. The purpose of this study was to examine the experiences of African American adolescent and caregivers participating in the FIT Families trial for program satisfaction and content palatability. Content analysis was used to analyze semi-structured exit interviews from 136 African American adolescents [median age 14 years, 69% female] and caregiver pairs [primarily mothers] participating in a family-based 6-month behavioral weight loss intervention that was delivered either in the home or in an office setting. Participants reported most program practices [location, parent involvement, interpersonal relationship with weight loss counselors] and intervention content [cognitive behavioral skills training, motivational interviewing, contingency management] were helpful. Many adolescents [49%] and their caregivers [47%] reported that the program was acceptable overall, however noted that areas for refinement did exist. Participants reported that managing the logistics of weekly sessions was hard. Families expressed a desire for more engaging skills-based learning and the inclusion of exercise sessions and additional tailoring to needs and interests. Individualization, active learning, and support around parenting continues to be beneficial when designing interventions.

Evaluation of an Evidence-Based Weight Loss Trial for Urban African American Adolescents and Caregivers

Rates of obesity are among the highest for African American adolescents in the US. However, African American adolescents benefit the least from evidence-based weight loss interventions, often experiencing poor treatment retention and low motivation. Participant evaluations provide key information for future development of family-based weight loss interventions able to address these barriers. The purpose of this study was to examine the experiences of African American adolescent and caregivers participating in the FIT Families trial for program satisfaction and content palatability. Content analysis was used to analyze semi-structured exit interviews from 136 African American adolescents [median age 14 years, 69% female] and caregiver pairs [primarily mothers] participating in a family-based 6-month behavioral weight loss intervention that was delivered either in the home or in an office setting. Participants reported most program practices [location, parent involvement, interpersonal relationship with weight loss counselors] and intervention content [cognitive behavioral skills training, motivational interviewing, contingency management] were helpful. Many adolescents [49%] and their caregivers [47%] reported that the program was acceptable overall, however noted that areas for refinement did exist. Participants reported that managing the logistics of weekly sessions was hard. Families expressed a desire for more engaging skills-based learning and the inclusion of exercise sessions and additional tailoring to needs and interests. Individualization, active learning, and support around parenting continues to be beneficial when designing interventions.

“Just Take a Moment and Breathe and Think”: Young Women with Depression Talk about the Development of an Ecological Momentary Intervention to Reduce Their Sexual Risk

Study ObjectiveDepressed young women are at increased risk for adverse outcomes related to sexual behavior, including unintended pregnancy, HIV, and other sexually transmitted infections. Brief sexual risk reduction interventions have not targeted depressed young women's specific needs for affect management and impulse control. Design, Setting, Participants, Interventions, and Main Outcome MeasuresWe interviewed depressed young women ages 15-23 years engaging in sexual risk behavior about a proposed intervention approach. The approach was described as in-person counseling and cognitive-behavioral skills training, followed by an ecological momentary intervention (EMI) delivered via smartphone application for 4 weeks. The EMI would include reporting multiple times a day on affective states, self-efficacy for safer sex behavior, and sexual behavior, and receiving responsive messages to provide support and prompt use of cognitive-behavioral skills. Participants provided their perspectives on comfort, usability, burden, confidentiality, and potential efficacy of the EMI and recommended message content. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. ResultsThematic saturation was reached with 16 interviews. Participants expressed positive opinions about the EMI. They believed that reporting at random times would help them to recognize their feelings, receiving the messages would be reassuring, and overall the smartphone application would be experienced as therapeutic. They desired a high degree of personalization of the message quality, style, and voice, and provided a wide variety of message content. ConclusionDepressed young women believed that a flexible, personalized approach to mobile momentary intervention for addressing the link between their symptoms and behavior would be acceptable, supportive, and effective in reducing sexual risk.

Training Trainers

Cognitive behavioral strategies (CBS) have shown to be an effective way to increase physical activity (PA); however, many kinesiology students are not trained to deliver such strategies (Brawley, 2013) PURPOSE: The purpose of this project was to explore if training students to use cognitive behavioral skills training (CBST) when working with clients was an effective way for increasing PA level of clients. This study also aimed at investigating changes in clients’ self-efficacy (SE) to be physically active as well as students’ self-efficacy to deliver these cognitive behavioral strategies. METHODS: 28 students (age: 23.5±2.4) received CBST as part of an upper division kinesiology class. All students were matched with a client (N=27, 25.0±11.1) who was seeking to increase their PA. Students met with their clients for a minimum of 5 visits over the course of 6 weeks. At the first and last meeting with students and clients, clients’ levels of SE were measured using a multidimensional SE scale consisting of three subscales (task, coping, and planning SE; Roger et al., 2008). Clients’ physical activity was assessed using Godin Leisure Time Exercise Questionnaire (Godin & Shephard, 1985). Students’ SE was measured using a 10-item measure developed for this study. Paired t-tests were performed to compare differences between pre and post scores. RESULTS: There was a significant increase in PA levels of clients (p=.01). Clients’ scheduling SE also significantly increased from pre intervention levels (p=.012) whereas client’s coping SE showed a positive trend that did not reach significance (p=.077). Students SE to deliver cognitive behavioral strategies also increased significantly during the course of the class (p=.003). CONCLUSIONS: These findings provide preliminary evidence that CBST may be an effective way to increase clients’ PA and scheduling SE along with students’ SE to deliver CBS.