Publications (12)29.04 Total impact
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Article: A Pilot Study Investigating Behavioral Prescriptions for Depression
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ABSTRACT: Depression is a prevalent and expensive condition. Many patients are seeking and receiving treatment for depression in the primary care setting where pharmaceutical interventions prevail as the predominant treatment. While psychotropic medications can certainly help ameliorate mental and behavioral problems, all medical interventions carry with them certain risks and side effects. A natural multiple-baseline (across participants), single-case experimental design was used in a pilot study to evaluate the feasibility of “behavioral prescriptions” for cognitive-behavioral bibliotherapy with five depressed patients in a primary care setting. Results indicated that final depression self-report scores were lower than baseline and pre-treatment reports for every participant. At three month follow-up, three out of five participants reported no symptoms of depression, one participant reported minimal symptoms of depression, and one participant reported mild symptoms of depression. Behavioral prescriptions for cognitive bibliotherapy warrant further controlled research and may offer a cost-effective and practical treatment alternative to the pharmaceutical intervention of depression in primary care.Journal of Clinical Psychology in Medical Settings 04/2012; 14(2):152-159. · 1.49 Impact Factor -
Article: Does acceptance and relationship focused behavior therapy contribute to bupropion outcomes? A randomized controlled trial of functional analytic psychotherapy and acceptance and commitment therapy for smoking cessation.
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ABSTRACT: This study evaluated a treatment combining bupropion with a novel acceptance and relationship focused behavioral intervention based on the acceptance and relationship context (ARC) model. Three hundred and three smokers from a community sample were randomly assigned to bupropion, a widely used smoking cessation medication, or bupropion plus functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT). Objective measures of smoking outcomes and self-report measures of acceptance and relationship processes were taken at pretreatment, posttreatment, 6-month, and 1-year follow-up. The combined treatment was significantly better than bupropion alone at 1-year follow-up with 7-day point prevalence quit rates of 31.6% in the combined condition versus 17.5% in the medication-alone condition. Acceptance and the therapeutic relationship at posttreatment statistically mediated 12-month outcomes. Bupropion outcomes were enhanced with an acceptance and relationship focused behavioral treatment.Behavior therapy 12/2011; 42(4):700-15. · 2.85 Impact Factor -
Article: Bibliotherapy as a treatment for depression in primary care.
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ABSTRACT: This study was designed to determine whether a physician-delivered bibliotherapy prescription would compare favorably with the prevailing usual care treatment for depression in primary care (that often involves medication) and potentially offer an alternative. Six family physicians were trained to write and deliver prescriptions for cognitive-behavioral bibliotherapy. Thirty-eight patients were randomly assigned to receive either usual care or a behavioral prescription to read the self-help book, Feeling Good (Burns, D. D. (1999). Feeling good: The new mood therapy. New York: HarperCollins). The treatment groups did not differ in terms of overall outcome variables. Patients in both treatment groups reported statistically significant decreases in depression symptoms, decreases in dysfunctional attitudes, and increases in quality of life. Although not statistically significant, the mean net medical expenses in the behavioral prescription group were substantially less. This study provided empirical evidence that a behavioral prescription for Feeling Good may be as effective as standard care, which commonly involves an antidepressant prescription.Journal of Clinical Psychology in Medical Settings 09/2010; 17(3):258-71. · 1.49 Impact Factor -
Article: Corporate funding and conflicts of interest: a primer for psychologists.
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ABSTRACT: A presidential task force on external funding was established by the American Psychological Association (APA) in 2003 to review APA policies, procedures, and practices regarding the acceptance of funding and support from private corporations for educational and training programs; continuing education offerings; research projects; publications; advertising; scientific and professional meetings and conferences; and consulting, practice, and advocacy relationships. This article, based on the Executive Summary of the APA Task Force on External Funding Final Report, presents the findings and unanimous recommendations of the task force in the areas of association income, annual convention, research and journals, continuing education, education, practice, and conflicts of interest and ethics. The task force concluded that it is important for both APA and individual psychologists to become familiar with the challenges that corporate funding can pose to their integrity. The nature and extent of those challenges led the task force to recommend that APA develop explicit policies, educational materials, and continuing education programs to preserve the independence of psychological science, practice, and education.American Psychologist 01/2008; 62(9):1005-15. · 6.87 Impact Factor -
Article: Psychology in the prescription era: building a firewall between marketing and science.
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ABSTRACT: The pharmaceutical industry has contributed to many life-saving innovations in medicine and has become one of the most successful industries in the world. As a result, pharmaceutical industry financial and marketing influences extend to federal regulatory agencies, professional organizations, medical journals, continuing medical education, scientific researchers, media experts, and consumer advocacy organizations. These extensive influences have created conflicts of interest that have undermined the credibility of medical research and education. As professional psychology pursues and achieves prescription privileges, it will likely be faced with increasing influences from the industry. To preserve the integrity of psychological science, the authors propose an aspirational "firewall" designed to separate industry marketing from the science of psychology.American Psychologist 01/2004; 58(12):1028-43. · 6.87 Impact Factor -
Article: Penetrating the blind in a study of an SSRI.
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ABSTRACT: We assessed blind integrity in a double-blinded study comparing paroxetine 20 mg with inert placebo in 20 volunteer subjects who were attempting to stop using methamphetamines. At the end of the study, the blinded clinicians reviewed subject charts and attempted to identify the assigned conditions for the 13 subjects who completed two or more weeks of the study. The three subjects who completed the entire study also attempted to identify their conditions on a questionnaire. We conclude that the blind may unwittingly be broken when the treatments under study are placebo and the selective serotonin reuptake inhibitor (SSRI) paroxetine. The integrity of the blind should be tested in all double-blind SSRI studies.Journal of Behavior Therapy and Experimental Psychiatry 07/2002; 33(2):67-71. · 1.86 Impact Factor -
Article: Antidepressants: A triumph of marketing over science?
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ABSTRACT: Posted July 15, 2002. In a meta-analysis of the Food and Drug Administration (FDA) database of controlled trials used in the initial approval for the most popular antidepressants, I. Kirsch, T. J. Moore, A. Scoboria, and S. S. Nicholls (2002) found that antidepressants demonstrated a clinically negligible advantage over inert placebo. These results are surprising, because they come from studies underwritten by the drug manufacturers. This analysis probably overestimates the antidepressant effect because placebo washout strategies, penetration of the blind, reliance on clinician ratings, use of sedative medication, and replacement of nonresponders may penalize the placebo condition or boost the drug condition. These findings do not appear to justify the popularity of antidepressants, which may have been fueled in part by publication bias and outstanding marketing. Psychotherapy may offer an effective alternative with fewer medical risks. (PsycINFO Database Record (c) 2012 APA, all rights reserved)06/2002; 5(1):No Pagination SpecifiedArticle 25. -
Article: Psychotherapy versus medication for depression: Challenging the conventional wisdom with data.
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ABSTRACT: Antidepressant medications are the most popular treatment for unipolar depression in the US, although there may be safer alternatives that are equally or more effective. This article reviews a wide range of well-controlled studies comparing psychological and pharmacological treatments for depression. The evidence suggests that the psychological interventions, particularly cognitive behavioral therapy, are at least as effective as medication in the treatment of depression, even if severe. These conclusions hold for both vegetative and social adjustment symptoms, especially when patient-rated measures are used and long-term follow-up is considered. Some aspirational guidelines for the treatment of depression are proposed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)Professional Psychology Research and Practice 11/1995; 26(6):574-585. · 1.34 Impact Factor -
Article: Acceptance-based treatment for smoking cessation
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ABSTRACT: This pilot study applied a theoretically derived model of acceptance-based treatment process to smoking cessation, and compared it to a pharmacological treatment based on a medical dependence model. Seventy-six nicotine-dependent smokers were randomly assigned to one of two treatments: Nicotine Replacement Treatment (NRT), or a smoking-focused version of Acceptance and Commitment Therapy (ACT). There were no differences between conditions at posttreatment; however, participants in the ACT condition had better long-term smoking outcomes at 1-year follow-up. As predicted by the acceptance process model, ACT outcomes at 1 year were mediated by improvements in acceptance-related skills. Withdrawal symptoms and negative affect neither differed between conditions nor predicted outcomes. Results were consistent with the functional acceptance-based treatment model.Behavior Therapy. -
Article: Corporate Funding and Conflicts of Interest
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Article: A cost-effectiveness analysis of cognitive behavior therapy and fluoxetine (prozac) in the treatment of depression
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ABSTRACT: Depression affects at least 11 million Americans per year and costs the U.S. economy an estimated 44 billion dollars annually. Comprehensive review of the existing scientific evidence suggests that psychotherapy, particularly cognitive behavior therapy (CBT), is at least as effective as medication in the treatment of depression, even if severe (Antonuccio, Danton, & DeNelsky, 1995). These conclusions hold for both vegetative and social adjustment symptoms, especially when patient-rated measures are used and long-term follow-up is considered. In addition, several well-controlled studies with long-term follow-up (Evans et al., 1992; Shea et al., 1992; Simons, Murphy, Levine, & Wetzel, 1986) suggest that CBT may be more effective than drug treatment at preventing relapse. The relative effectiveness of psychotherapy for depression, particularly CBT, has been reinforced by meta-analyses reported in both psychiatry (Hollon, Shelton, & Loosen, 1991; Wexler & Cicchetti, 1992) and psychology journals (Dobson, 1989; Robinson, Berman, & Neimeyer, 1990; Steinbrueck, Maxwell, & Howard, 1983). In the era of managed care, it is not enough to be effective; treatments must be cost-effective. This paper considers the outcome studies as the basis for a cost-effectiveness comparison of drugs and psychotherapy in the treatment of unipolar depression. The analysis shows that over a 2-year period, fluoxetine alone may result in 33% higher expected costs than individual CBT treatment and the combination treatment may result in 23% higher costs than CBT alone. Supplemental analysis shows that group CBT may only result in a 2% ($596) cost savings as compared to individual treatment.Behavior Therapy. -
Article: Suitability of bupropion SR for nicotine-dependent smokers: problems in a practice setting.
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ABSTRACT: Bupropion SR (Zyban) has been shown in randomized controlled trials to be an efficacious pharmacological aid for smoking cessation; however, recent reports have raised serious concerns about the breadth of its applicability without complications or contraindications. We examined this issue in a well-documented medical population, i.e. veterans volunteering to participate in a smoking cessation treatment research program involving the use of bupropion SR. Overall, 22% of the 78 subjects who met the study criteria were appropriate for and completed the course of medication. Thus, bupropion SR in nicotine-dependent veterans may not be broadly applicable when conservative prescribing guidelines are carefully followed.Psychotherapy and Psychosomatics 73(4):252-4. · 6.28 Impact Factor
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Institutions
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2004–2012
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University of Nevada School of Medicine
Reno, NV, USA
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