Journal of Consulting and Clinical Psychology

Objective: To investigate if Sessions 1–4 Patient Health Questionnaire–9 (PHQ-9) scores are associated with treatment outcome and if there is a differential effect between person-centered experiential therapy (PCET) and cognitive behavioral therapy (CBT). Method: A secondary data analysis of a prospectively registered and ethically approved pragmatic, noninferiority randomized controlled trial comparing PCET and CBT for the treatment of moderate or severe depression. Latent growth curve modeling was applied to data from 274 patients who received ≥ five sessions of therapy to investigate the association between change in Sessions 1–4 PHQ-9 scores on a binary end-of-treatment outcome (i.e., reliable and clinically significant improvement; RCSI) and on final-session PHQ-9 scores. Estimated power was 80%. Results: Change in Sessions 1–4 PHQ-9 scores was significantly associated with the probability of RCSI in the PCET condition (p = .002) but not the CBT condition (p = .156). Specifically, greater early treatment improvement and higher PHQ-9 scores at Session 1 were significantly associated with obtaining RCSI in PCET, but not in CBT; this relationship differed significantly between conditions (p = .007). Greater early treatment improvement was also significantly associated with lower final-session PHQ-9 scores (p < .001), but this relationship did not significantly differ across conditions (p = .121). Conclusions: Early session scores are associated with final-session depression scores, though PCET and CBT manifest distinctively different trajectories for patients achieving RCSI.

Objective: In this commentary, we outline conceptual and methodological concerns we have with a recent randomized trial of two group-delivered transdiagnostic eating disorder treatments (Stice et al., 2023), particularly regarding the description, implementation, and labeling of the comparison condition. Method: We discuss the selection of a control condition in comparative psychotherapy trials; the distinction between adaptations and other types of intervention modifications; the need for processes to ensure that an intervention is developmentally and diagnostically appropriate; and the provision of detailed descriptions of interventions in articles and supplementary materials, as well as making manuals publicly available, to ensure that reviewers and readers can understand the interventions delivered and can accurately interpret the results. Results: We highlight the potential downstream implications of mislabeling an intervention and conclude that the comparison condition in Stice et al.’s (2023) article should be reclassified to avoid misinterpretation. Conclusions: There are published frameworks and guidelines available that promote more detail, precision, and transparency about interventions being tested in clinical trials. We believe it is time for journals to implement these guidelines to ensure that reviewers and readers can fully understand what interventions were tested to draw informed conclusions from the study, replicate research findings, and reliably deliver these interventions in clinical practice.

Objective: Inhibitory learning models emphasize the central role of threat expectancy violation during exposure therapy. However, exposure is often implemented alongside cognitive restructuring, which reduces threat expectancies before exposure, reducing the potential for expectancy violation. This study examined whether the timing of expectancy violation (before/during exposure) and magnitude of expectancy change impact the efficacy of exposure therapy. Method: A total of 249 adults (range 18–59 years old, M = 21.19, SD = 6.89) with elevated public speaking anxiety completed an intensive exposure session. Participants were randomly allocated to receive exposure based on (a) behavioral experiments (BE; i.e., maximizing expectancy violation and emphasizing prediction error following exposure); (b) cognitive restructuring before exposure (CR + EXP; i.e., threat expectancies reduced before exposure, thus reducing expectancy violation during exposure tasks); or (c) exposure without explicit processing of threat expectancies or expectancy violation. Change in symptoms was assessed pre–post exposure session and at 1-week follow-up. Results: The BE and CR + EXP groups showed superior anxiety reduction (primary outcome) and threat expectancy change (secondary outcome) compared to exposure without explicit processing of threat expectancies or expectancy violation. There was a nonsignificant small effect size difference in anxiety reduction favoring BE over CR + EXP. There was greater expectancy change in the BE group compared to the CR + EXP group and shorter treatment duration. Greater threat expectancy change during exposure tasks was associated with greater anxiety reduction. Conclusions: Threat expectancy change facilitates anxiety reduction during exposure therapy, and there may be modest advantages to challenging threat expectancies after exposure (BE) compared to before exposure (CR + EXP).

Objective: The growing demand for emergency department (ED) care for suicidal ideation and attempts in adolescents calls for effective interventions preventing post-ED recurrence of suicidal crises. Parents are tasked with implementing postdischarge suicide prevention recommendations, often with little support. To address this need, this study examined a parent-facing texting intervention targeting parental engagement in suicide prevention activities to lower youth suicide risk after discharge. Method: A pilot randomized controlled trial was conducted with 120 parents (83.3% mothers) and their adolescents (ages 13–17, 65.8% female, 75.0% White) presenting to an ED with suicide risk concerns. Parents were randomized to a control group or a 6-week intervention providing parents with daily adolescent-centered text messages encouraging post-ED parental engagement in recommended suicide prevention activities with or without added parent-centered texts intended to support parents’ own well-being. Proposed mechanisms (parental self-efficacy, engagement in suicide prevention activities) were assessed at 2, 6, and 12 weeks. This trial is registered with https://clinicaltrials.gov (NCT05058664). Results: The text-based intervention was feasible and acceptable. In exploratory analyses, relative to control, the text-based intervention was associated with greater parental engagement in suicide prevention activities postintervention at 6 (d = 0.48, p = .027) and 12 weeks (d = 0.53, p = .019) and lower youth suicide attempts at 12 weeks (hazard ratio = 0.23, CI [0.06, 0.96], p = .044), regardless of whether parents received additional parent-centered texts. Conclusions: Warranting further study in a fully powered trial, findings suggest this parent-facing texting intervention intended to promote youth safety was acceptable and may offer a promising strategy to lower post-ED youth suicide risk.

Objective: Depression is an ongoing public health issue impacting over 5 million American adolescents. Although prevention has been shown to be an effective strategy in reducing the incidence of depressive symptoms, depression prevention programs have been developed and tested in largely White populations. Thus, the effects of such programs in diverse groups are understudied, though research shows adapted versions are more beneficial for diverse populations than nonadapted programs. In this study, we sought to examine the effects of depression prevention in Black and White American youth. Method: Informed by youth focus groups, we adapted and implemented a program which previously benefited mainly White samples to benefit Black and White American inner-city high school students. Of the 425 youth who participated, 57.2% identified as Black and 42.8% identified as White. We randomized youth into two conditions—prevention and nonprevention control—and measured depressive symptoms over three semesters. Results: We found differential effects of prevention on Black and White American youth. For Black American youth, there was no difference between the two conditions at any of the waves of data collection. For White American youth, however, the prevention program worked as intended. Conclusions: Given our findings and past research, it is essential to investigate possible causes for the differential effects of prevention to increase understanding and ensure positive effects of prevention for all youth. Additional ramifications and recommendations for future research and practice are discussed.

Objective: To explore which cognitive behavioral therapy (CBT) self-help app usage predicted depression during a selective prevention trial. Method: A recent controlled trial (ECoWeB-PREVENT) randomized young people aged 16–22, at increased risk for depression because of elevated worry/rumination, negative appraisals, and/or rejection sensitivity but without past or current history of major depression, to apps that provided self-monitoring, self-monitoring plus CBT self-help, or self-monitoring plus emotional competency self-help. Self-help included coping strategies for moment-by-moment use (Tools) and self-learning/planning exercises (Challenges). On the primary outcome (depression, Patient Health Questionnaire-9 [PHQ-9]) at 3-months follow-up (primary endpoint), only the CBT app outperformed self-monitoring. In this secondary analysis, only data from participants who used the CBT or self-monitoring apps at least once were analyzed to test what app use predicted change in depression from baseline to 3 months. Results: Of the original 1,262 participants (79% female), 558 were included (CBT, baseline, n = 273, PHQ-9: M = 7.48, SD = 3.9; 3 months, N = 163, PHQ-9: M = 8.83, SD = 4.92; self-monitoring, baseline, n = 285, PHQ-9: M = 7.45, SD = 4.26; 3 months, N = 183, PHQ-9: M = 7.48, SD = 3.9). Neither total app use, self-monitoring, nor use of Tools predicted change in depression (all ps > .05). Frequency of use of Challenges predicted lower depression symptoms and caseness at 3 months (β = −0.28, 95% CI [−0.53, −0.03], p = .029). Specifically, the use of behavioral activation challenges mediated the effects of the CBT app on depression over 3 months (β = −0.59, 95% CI [−1.13, −0.05], p = .03). Conclusions: Brief psychoeducation about behavioral activation principles in an app may protect young people from depression over 3 months, even when only used once.

Objective: Depression and anxiety are major mental health concerns for college students, and accessible, low-cost interventions are urgently needed. Although traditional treatments focus on negative emotions, there is growing support for the efficacy of positive emotion-focused interventions. We extended this prior work by developing a peer-delivered brief promoting positive emotion (BPPE) intervention that aims to enhance positive valence systems processes and reduce internalizing risk in college students. The goal of this study was to examine the feasibility, acceptability, and initial mental health outcomes of BPPE. Method: In this pilot randomized controlled trial, 92 unselected college students (Mage = 19.44, SD = 1.15) completed measures of depressive and social anxiety symptoms, perceived stress, well-being, and positive and negative affect before being randomized to the BPPE intervention (n = 47) or a comparison study skills instruction (n = 45). Participants repeated the affect measure immediately after the intervention and repeated the rest of the measures 1 month later (n = 66). Intention-to-treat linear mixed-effect models were used to examine group differences. Results: We found that BPPE can be delivered with high fidelity by peer-trained skills coaches and was rated as highly satisfactory by participants. Positive affect increased pre- to immediately postintervention in the BPPE group. Significant group by time interactions were observed for depression, social anxiety, and perceived stress across the 1-month follow-up, such that BPPE appeared to buffer against worsening symptoms across time. Conclusion: Our findings provide preliminary support for a brief, scalable, preventive intervention targeting positive valence systems functions among college students. Future studies warrant a fully powered randomized controlled trial to test the efficacy of the intervention.

Objective: Young adults in college engage in risky drinking that results in alcohol-related harms. Most evidence-based prevention interventions recommended for this population rely on correcting exaggerated drinking norms via personalized normative feedback (PNF). Informed by an extensive literature linking alcohol attitudes and drinking behavior, we adapted a brief counter-attitudinal advocacy (CAA) task to the alcohol prevention context. The goal of this study is to evaluate the ability of CAA in changing drinking and related consequences and to explore the comparative efficacy of CAA versus PNF. Method: This two-site randomized controlled trial had two experimental conditions (CAA and PNF) and an assessment-only control condition. Participants were 585 students who reported heavy episodic drinking and ≥2 alcohol-related negative consequences. Alcohol outcomes were assessed at 1-, 3-, and 6-month follow-ups to test hypotheses that the CAA and PNF manipulations will decrease drinks per week, typical drinks per day, peak blood alcohol concentration, and alcohol consequences, relative to control. Results: Participants reported reductions in drinks per week, typical drinks, and alcohol consequences. Those who received PNF reported significantly fewer drinks per week than controls, whereas those who received CAA reported significantly fewer consequences than controls. The CAA and PNF conditions did not differ from one another. Conclusions: This study demonstrates an application of attitude change theory and CAA methods to the alcohol prevention context, across demographically different settings. The novel CAA task had a harm reduction effect on consequences but not consumption.

Several researchers who have evaluated Interpersonal Psychotherapy (IPT) wrote a commentary arguing that the group-delivered IPT treatment for eating disorders that we adapted and used in a recent trial (Stice, Rohde, et al., 2023) was less effective than the new dissonance-based eating disorder treatment (Body Project Treatment) because the group-delivered IPT did not contain all core elements, was not developmentally appropriate, was not tailored for people with eating disorders, and because our team lacked sufficient IPT expertise. In response, we note that the group-delivered IPT that we evaluated produced higher abstinence from binge eating and compensatory weight control behaviors (40%) than did individually delivered IPT in the only trial that also evaluated this treatment with a broad range of eating disorders (33%; Fairburn et al., 2015). The fact that the group-delivered IPT produced a higher abstinence rate than individually delivered IPT for a similar spectrum of patients appears to refute the stated concerns regarding the group-delivered version of IPT because it was not less effective than individually delivered IPT. We argue it is critical to establish that a treatment significantly outperforms alternative treatments with a distinct intervention target because only an active comparator controls for the potential confounds that can drive improvement in trials, including expectancies, demand characteristics, and nonspecific therapeutic effects. We also note that IPT for the treatment of eating disorders has not significantly outperformed three alternative treatments and that the evidence base for IPT may thus be driven by expectancies, demand characteristics, and nonspecific effects.

Objective: This article presents primary outcomes from the Community Study of Outcome Monitoring for Emotional Disorders in Teens, a two-site, randomized controlled trial comparing the effectiveness of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Adolescents plus measurement-based care (UP-A), measurement-based care alone (TAU+), and treatment as usual (TAU) in community mental health clinics. Method: A total of 174 clinicians were randomized to implement TAU (n = 49), TAU plus an MBC measure (TAU+; n = 63), or UP-A plus MBC (UP-A; n = 62). In addition, 196 adolescents were randomized to receive 16 weeks of either TAU (n = 68), TAU+ (n = 60), or UP-A (n = 68). Independent evaluator-, self-, and caregiver-reported adolescent anxiety and depression symptoms were measured at baseline and Weeks 8, 16, and 28 postenrollment. Results: Adolescents in all groups showed improvement over time, and compared with TAU, adolescents receiving TAU+ and UP-A conditions improved more quickly on adolescent-report measures only. There were no treatment group differences observed on independent evaluator (primary outcome) or caregiver-report measures. In post hoc analyses, moderators of treatment response included treatment duration and complexity of symptom presentation. Conclusions: In one of the largest adolescent-focused, community-located psychotherapy trials conducted in the United States, transdiagnostic treatment plus measurement-based care and measurement-based care alone conferred some adolescent-reported symptom benefits compared with treatment as usual, although adolescents in all conditions exhibited improvements in anxiety and depression. Future directions for subsequent adolescent psychotherapy effectiveness trials for anxiety and depression are discussed.

Objective: Early identification of failing psychological treatments could be of high clinical value, but therapists themselves have been found to be bad at predicting who will benefit or not. Previous research has some methodological limitations, and therapists’ predictive accuracy has never been examined in internet-delivered treatments. Method: Therapists providing internet-delivered cognitive behavior therapy for depression, social anxiety disorder, and panic disorder in routine psychiatric care made outcome predictions for 897 patients during the fourth week of treatment. Therapists’ accuracies were also compared to the accuracy of a simple statistical model and benchmarks for clinically acceptable/useful levels of accuracy from previous research. Results: Therapists were more accurate than chance, but their balanced accuracy was on average nine percentage points lower than the balanced accuracy of the statistical model (though confidence intervals often overlapped) and only in one case did the predictions reach the clinical acceptance and utility benchmarks. Therapists could predict on average 16% of the variance in outcome. Therapists were overly optimistic, predicting positive outcomes on average twice as often as they occurred. They differed in confidence in their predictions, though this did not affect how correct they were. Conclusions: Internet-delivered cognitive behavior therapy-therapists can often predict treatment outcomes better than chance, but generally not as well as the statistical model, and probably not accurately enough that they would be willing to act on their predictions, or that they could be used in an adaptive treatment strategy. Our previous findings suggest that patients would benefit from statistical monitoring and prediction tools in clinical settings.

Objectives: Evidence-based psychosocial treatments for the early stages of mood or psychotic spectrum disorders are difficult to find in public health settings, and the efficacy of these treatments is limited by inconsistent behavioral skill practice among youth between sessions. Treatments can be made more accessible and efficacious when delivered through a group format that makes use of mobile applications to remind users to practice skills. Method: We conducted a 9-week, randomized controlled trial of the unified protocol (UP) for cognitive behavioral therapy (CBT) delivered via telehealth in a group format, comparing an app-enhanced version of the treatment (AppUP) to standard UP for adolescents with mood and psychotic spectrum conditions. The app was designed to help participants review session content, practice treatment skills, and log their psychiatric symptoms. Study assessors evaluated adolescents for psychiatric symptom severity and psychosocial functioning prior to treatment, at posttreatment, and 3 months posttreatment. Results: Sixty adolescents (Mage = 15.0, SD = 1.3) initiated the trial (30 were randomly assigned to each condition) with 49 retained at posttreatment (9 weeks) and 48 retained at 3 months posttreatment. Adolescents in AppUP showed greater improvements in psychosocial functioning over the 5-month study compared with those in standard UP. AppUP was also associated with greater reductions in depression severity among youth with more self-reported skill practice compared to those in standard UP. Conclusions: This study supports the benefits of transdiagnostic CBT for youth with mood and psychotic symptoms. An adjunctive app appears to improve psychosocial functioning and mood among these youth, especially among those who practice behavioral skills regularly.

Objective: Cognitive control impairments are frequently observed after remission from depression. There is evidence to show that cognitive control training (CCT) can reduce such impairments and related risk for recurrent episodes. However, it is currently unclear how many CCT sessions are required for short- and long-term effects. Method: This randomized controlled trial investigates the dose–response relationship of CCT in a sample of individuals with remitted depression (n = 216). Participants were randomly assigned to one of six arms, each receiving a different amount of training sessions (zero, one, five, 10, 15, or 20 sessions) over the course of 4 weeks, with each session lasting 15 min. Depressive symptoms and other cognitive and emotional transfer effects were examined shortly after training, as well as at 3- and 6-month follow-up. Results: We found task-specific, but no near cognitive transfer. Mixed-effects models showed that a minimum of 10 training sessions was required for a significant decrease in depressive symptoms shortly after training with medium effect sizes, but this was not maintained at 3- or 6-month follow-up. We observed reductions in perseverative thinking in all groups receiving 10 or more CCT sessions, which remained present until 6-month follow-up. Conclusions: A minimum of 10 CCT sessions is required for beneficial effects on depressive symptoms and perseverative thinking. Where perseverative thinking remained decreased long-term, this was not the case for depressive symptoms, indicating the need for continued training or the use of booster sessions to maintain training-related improvement.

Objective: Rising rates of mental illness in young people over recent decades are a trend that represents a wake-up call across the globe. The causes of this increase are not known. We also know little about effective interventions or implementation strategies to prevent depression in either youth or adults. The need for the prevention of mental ill health represents an outstanding research opportunity for our field. Method: This conceptual article identifies current challenges in our field, provides potential solutions, and suggests the most promising avenues for future solutions and how we might investigate them. Results: Key challenges include the following: poor implementation with low fidelity; methodological challenges related to appropriate sampling, time frames, interventions, and active controls; and lack of fit between interventions and their context. Potential solutions include the following: supplementing trials with evidence from large-scale epidemiological studies, establishing prevention models that work at scale including those that address social determinants and show effectiveness in low- and middle-income countries, building capacity in methods, and strengthening geographically dispersed networks of prevention researchers and practitioners. Conclusions: There are major challenges in conducting prevention research and demonstrating effects. New perspectives and collaborations are needed to overcome existing barriers.

Objective: Despite the prevalence of depressive disorders among youth, there is no health system model to address the prevention of these disorders. Method: With the goal of creating effective, tolerable, and scalable interventions for the prevention of adolescent depression, we have fielded three randomized clinical trials, centered in health care delivery organizations that use a whole-of-society approach: (a) Path 2 Purpose (N = 664), comparing the Competent Adulthood Transition with Cognitive Behavioral, Humanistic, and Interpersonal Training (CATCH-IT; B. W. Van Voorhees et al., 2015), guided digital health intervention to a synchronous mental health specialist-led group cognitive behavioral intervention, Coping with Depression Course–Adolescent; (b) PATHway (N = 400), examining the efficacy of the CATCH-IT components; and (c) Behavioral Health Stratified Treatment (N = 780), which examines the feasibility and potential benefit of a coordinated care, risk stratification, and intervention matching approach for adolescents with intellectual and developmental disabilities using both CATCH-IT (lower risk) and the Coping with Depression Course–Adolescent (higher risk). Results: The study samples for all three trials include youth from traditionally underrepresented groups (71.8%) with some economic distress (47.6%). Intervention utilization was moderate across trials. Feedback from study teams reveals general barriers to implementation and challenges specific to the pandemic. Conclusions: We review these trials, report preliminary data on demographics and intervention utilization, and provide feedback from study teams on implementation challenges encountered.

Objective: Veterans returning from deployment have high rates of posttraumatic stress disorder (PTSD) and co-occurring alcohol use disorder (AUD). Current treatments for PTSD and AUD report high dropout rates, and many veterans report alcohol misuse to cope with symptoms of PTSD. The present study is a pilot randomized controlled trial in which veterans (N = 201) were randomized to receive a mobile mindfulness-based intervention enhanced with brief alcohol intervention content (Mind Guide) or an active stress management program. Method: To be eligible for the study, veterans had to have served after September 11, 2001 (post-9/11 veteran) and screen positive for PTSD and AUD. All participants were asked to complete a baseline and four monthly follow-up assessments (two during treatment phase and two posttreatment phase). Primary outcomes were PTSD symptoms, frequency of alcohol use, and alcohol use consequences. Results: Engagement with Mind Guide was excellent (averages of over 31 logins and 5 hr of app usage). Those assigned to Mind Guide showed significant reductions in PTSD symptoms (d = -0.36; 16-week follow-up). No differences emerged for frequency of alcohol use (d = -0.12; 16-week follow-up) or consequences (d = -0.12; 16-week follow-up). Conclusions: Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. Further development of Mind Guide may enhance efficacy at reducing alcohol use and consequences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: This study applied a machine-learning-based skill assessment system to investigate the association between supportive counseling skills (empathy, open questions, and reflections) and treatment outcomes. We hypothesized that higher empathy and higher use of open questions and reflections would be associated with greater symptom reduction. Method: We used a data set with 2,974 sessions, 610 clients, and 48 therapists collected from a university counseling center, which included 845,953 rated therapist statements. Client outcome was routinely monitored by the Counseling Center Assessment of Psychological Symptoms Instruments. Therapists' skills were measured via computer by a bidirectional-long-short-term-memory-based system that rated use of supportive counseling skills. We used multilevel modeling to separate the between-therapist and the within-therapist associations of the skills and outcome. Results: Use of open questions and reflections was associated with client symptom reduction between therapists but not within therapists. We did not find significant associations between therapist empathy and client symptom reduction but found that empathy was negatively associated with clients' baseline symptom level within therapists. Conclusions: Therapist exploration of clients' experience and expression of understanding may be important skills that are associated with clients' better outcomes. This study highlights the importance of support counseling skills, as well as the potential of machine-learning-based measures in psychotherapy research. We discuss the limitations of the study, including the limitations related to the speaker recognition system and potential reasons for the lack of association between empathy and client outcome. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Despite decades of policy emphasizing the role of evidence in guiding services, few studies have sought to improve the degree to which evidence is used in supervision and treatment. This study reports supervisor and therapist outcomes from the Reaching Families multisite cluster-randomized controlled trial, which tested the effects of a coordinated knowledge system (CKS) against practice guidelines (PG) on the use of evidence in supervision and treatment targeting low treatment engagement in publicly funded youth community mental health organizations located in two geographically distinct, underresourced communities where service inequities are common. Method: The sample included 121 mental health professionals (92.6% female; 81.0% Black, Indigenous, and people of color1) randomly assigned to a CKS or PG control condition. We recorded, transcribed, and coded 430 supervision and 208 treatment sessions involving 221 youth (Mage = 13.1 years, 46.2% female; 78.7% Black, Indigenous, and people of color) and/or their caregivers who reported engagement concerns during therapy. Results: CKS dyads showed uniformly greater use of evidence focused on specific client needs relative to dyads in the PG condition, with large effect sizes and no differences in the effect of condition across the sites. Secondary analyses showed that tools in the CKS condition were perceived significantly more positively than those in the PG condition in terms of effort and effectiveness, and supervisory workload was the same across both conditions. Conclusions: In routine clinical care delivered within highly representative community settings, a strategically designed knowledge resource can improve evidence-based reasoning and action and be perceived as easy to use and useful without negatively impacting workload. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Therapists report a lack of confidence and competence in teletherapy compared to in-person therapy. Training focusing on teletherapy skills is scarce. This study reports on (a) the development of a training workshop for facilitative interpersonal skills (FIS) in teletherapy (tele-FIRST) and (b) a randomized controlled trial assessing the efficacy of tele-FIRST. Tele-FIRST is a 2-hr online synchronous training workshop that incorporates didactics, deliberate practice, simulation of teletherapy challenges, modeling, and discussion. Method: A set of tele-FIS stimulus clips that depict four types of teletherapy challenges (e.g., emotional disconnection, distraction) was used to evaluate and train therapists’ teletherapy skills. A total of 182 licensed therapists and trainees were randomized into either the tele-FIRST or a waitlist group. Of these, 153 participants completed baseline assessment and were included in the final analyses (tele-FIRST: n = 82; waitlist: n = 71). At baseline, posttraining, and follow-up, participants were assessed on their observer-rated FIS for teletherapy, self-reported FIS, teletherapy skills, acceptance of teletherapy, and self-efficacy. Results: Therapists demonstrated increased teletherapy skills following the tele-FIRST workshop. After controlling for baseline scores, the tele-FIRST group demonstrated significantly higher observer-rated tele-FIS (ηp² = .134), self-reported FIS (ηp² = .106), teletherapy skills (ηp² = .037), acceptance of teletherapy technology (ηp² = .082), and self-efficacy (ηp² = .036) compared to the waitlist group at posttraining. Conclusion: The tele-FIRST demonstrated significant short-term effects on enhancing therapists’ teletherapy skills as rated by both independent observers and therapists themselves. Tele-FIRST may improve the quality of teletherapy, though more research is needed to investigate its long-term effects.

Objective: Specific modifiable factors (e.g., screen time [ST], sleep duration, physical activity, or social connections) are targets for reducing depression risk in adults. However, research in adolescents lacks causal inference implementations, as prevention trials are costly and often prohibitive. Emulating randomized trials with observational data enables inference regarding hypothetical interventions on modifiable factors that reduce depression risk, in general and at-risk populations. Method: Data from the Adolescent Brain Cognitive Development (N = 8,699) and the Generation R (N = 3,739) studies were leveraged for modifiable factors (age 10) and internalizing symptoms (age 12–14). We (a) tested prospective associations of each modifiable factor with internalizing symptoms under target trial emulation (TTE) and (b) used G-formula to estimate the potential effects on internalizing symptoms if hypothetical interventions were implemented. Analyses were conducted in the full sample (universal prevention setting) and at-risk youth (selective and indicated prevention setting). Results: First, under TTE, only ST associated with internalizing symptoms. Second, in the universal prevention setting, adhering to more stringent ST guidelines (0–1 hr) decreased internalizing symptoms by 0.10–0.16 SDs while following more lenient guidelines (3–4 hr) increased them by 0.07–0.09 SDs, compared to existing guidelines (2 hr). Such changes were greater in the indicated (subclinical symptom) prevention settings and robust to residual confounding. Restricting physical activity reduced internalizing risk in the indicated setting, but findings were not robust. Conclusions: With a causally informed strategy, we demonstrated the potential effects of numerous hypothetical interventions on modifiable factors for depression risk reduction, across multiple preventive settings.

Objective: This study described therapists’ delivery of six child mental health evidence-based practices (EBPs) over 33 months during the sustainment phase of a system-driven implementation aimed at improving access to EBPs in community settings. Method: Seven hundred seventy-seven therapists and 162 program leaders delivering at least one of six EBPs of interest completed surveys, and these data were matched to therapist administrative claims data. Survival analyses examined (a) therapists’ discontinuation of delivery of all Los Angeles County Department of Mental Health direct client services (i.e., turnover) and (b) therapists’ discontinuation of a specific EBP while continuing to provide psychotherapy services. Results: A majority of therapists (58.3%) were observed to discontinue providing any direct client services over the 33-month period, and discontinuation rates for specific EBPs ranged from 100% of therapists (Cognitive Behavioral Intervention for Trauma in Schools) to 76.4% (Managing and Adapting Practice). Different factors predicted the discontinuation of all service delivery compared to the discontinuation of a specific EBP. Greater therapist emotional exhaustion predicted higher likelihood of discontinuation of all direct client services. For EBP discontinuation, EBP-level factors (e.g., EBPs that required ongoing consultation), therapist-level factors (e.g., ability to provide services in a language other than English), and agency-level factors (e.g., more positive program leader perceptions of the EBP) predicted lower likelihood of discontinuation of the specific EBP. Conclusions: Different factors contribute to the risk of therapists leaving the service system versus discontinuing the delivery of specific EBPs.

Objective: The therapeutic alliance is one of the most stable predictors of symptom burden over the course of therapy. So far, this effect has only been examined on the basis of sessions. Continuous-time models (CTM) allow this relationship to be modeled as a continuous process in which the actual time interval between measurements is considered. The aim of the present study was to compare the fit of discrete-time models (DTM) of the alliance–symptom relationship with CTM using different time variables (sessions vs. actual time interval). Method: Data from 1,413 patients at a university psychotherapy outpatient clinic were analyzed. The alliance and symptom burden were assessed each session with the Bernese Session Report and the Hopkins Symptom Checklist-Short-Form, respectively. Different DTM and CTM were estimated using the R-package ctsem and compared in their fit via the Akaike information criterion. Results: CTMs with session as the time unit fitted the data best. Significant negative within-person effects of alliance and symptom burden were found. These effects showed a significant positive correlation, implying that individuals with a stronger effect of the alliance on symptom severity also showed a stronger effect of symptom severity on the alliance. Conclusions: When modeling the relationship of symptom severity and alliance, it seems to be of more importance to capture the fact that a session occurred than to capture the exact time intervals between sessions. Future studies should examine this finding for other psychotherapeutic factors. Interpersonal factors might explain the positive association of the reciprocal alliance–symptom effects.

Objective: The present study assessed two theory-driven mediators of the effects of a family group cognitive-behavioral (FGCB) preventive intervention for youth of parents with a history of major depressive disorder (MDD) or dysthymia on long-term youth psychopathology symptoms and diagnoses. Method: Sample included 180 parents (Mage = 41.9, 89% female, 82% White, non-Hispanic) and one of their children/adolescents ages 9–15 years (Mage = 11.4, 49% female, 74% White, non-Hispanic). Changes in the hypothesized mediators, observations of positive parenting (Iowa Family Interaction Rating Scales) and youth secondary control coping (SCC) skills (Responses to Stress Questionnaire), were assessed at 6 months. Changes in youth psychopathology symptoms were assessed on the Child Behavior Checklist and Youth Self-Report at 18- and 24-month follow-ups and MDD diagnoses with the Kiddie Schedule for Affective Disorders and Schizophrenia at 12 and 24 months. Results: Changes in youth SCC skills (e.g., acceptance, reappraisal) after the intervention mediated the effects of the FGCB program on changes in youth internalizing and externalizing symptoms at 18- and 24-month follow-ups. Effects for changes in positive parenting behaviors as a mediator were more limited. SCC skills were further shown to mediate the effects of the FGCB intervention on MDD diagnoses from 12 to 24 months. Conclusions: This study provides clear and strong evidence that changes in youth SCC skills mediated the long-term effects of preventive intervention for families of depressed parents.