Catherine Stanger

Geisel School of Medicine at Dartmouth | DMS · Department of Psychiatry

Seasonal variations in glycemic trends remain largely unstudied despite the growing prevalence of diabetes. To address this gap, our objective is to investigate temporal changes in glycemic trends by analyzing intensively sampled blood glucose data from 137 patients (ages 2 to 76, primarily type 1 diabetes) over the course of 9 months to 4.5 years....

Objective digital data is scarce yet needed in many domains to enable research that can transform the standard of healthcare. While data from consumer-grade wearables and smartphones is more accessible, there is critical need for similar data from clinical-grade devices used by patients with a diagnosed condition. The prevalence of wearable medical...

Sequential Multiple-Assignment Randomized Trials (SMARTs) play an increasingly important role in psychological and behavioral health research. This experimental approach enables researchers to answer scientific questions about how to sequence and match interventions to the unique, changing needs of individuals. A variety of sample size planning res...

Background: Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD. Objective: The aim is to examine patient enga...

Objective digital data is scarce yet needed in many domains to enable research that can transform the standard of healthcare. While data from consumer-grade wearables and smartphones is more accessible, there is critical need for similar data from clinical-grade devices used by patients with a diagnosed condition. The prevalence of wearable medical...

BACKGROUND Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD. OBJECTIVE The aim is to examine patient engageme...

Background Cannabis misuse in young adults is a major public health concern. An important predictor of continued use is cannabis craving. Due to the time-varying nature of cravings, brief momentary interventions delivered while cravings are elevated may improve the use of strategies to cope with cravings and reduce cannabis use. Objective The goal...

UNSTRUCTURED Cannabis misuse in young adults is a major public health concern. An important predictor of continued use is cannabis craving. Due to the time-varying nature of craving, brief momentary interventions delivered while cravings are elevated may improve use of strategies to cope with cravings and reduce cannabis use. The goal of this manus...

Introduction: Across the U.S., the prevalence of opioid use disorder (OUD) and the rates of opioid overdoses have risen precipitously in recent years. Several effective medications for OUD (MOUD) exist and have been shown to be life-saving. A large volume of research has identified a confluence of factors that predict attrition and continued subst...

Background Prior studies suggest that mobile health physical activity programs that provide only weekly or daily text-based health coaching evidence limit the efficacy in improving physical activity in adolescents with overweight or obesity. It is possible that incentives, combined with health coaching and daily feedback on goal success, may increa...

[This corrects the article DOI: 10.3389/fpubh.2021.625640.].

Sequential Multiple-Assignment Randomized Trials (SMARTs) play an increasingly important role in psychological and behavioral health research. This experimental approach enables researchers to answer scientific questions about how best to sequence and match interventions to the unique and changing needs of individuals. A variety of sample size calc...

Background: The current COVID-19 coronavirus pandemic is an emergency on a global scale, with huge swathes of the population required to remain indoors for prolonged periods to tackle the virus. In this new context, individuals' health-promoting routines are under greater strain, contributing to poorer mental and physical health. Additionally, indi...

BACKGROUND Prior studies suggest that mobile health physical activity programs that provide only weekly or daily text-based health coaching evidence limit the efficacy in improving physical activity in adolescents with overweight or obesity. It is possible that incentives, combined with health coaching and daily feedback on goal success, may increa...

Background Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to their medical regimen and fail to achieve target range glycemic control. Few interventions, however, have been developed specifically for this age group. Objective In this randomized trial, we will provide a mobile app (SweetGoals) to al...

Background: Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of...

Hintergrund: Erfolgreiches Management chronischer Krankheiten erfordert eine vertrauensvolle Zusammenarbeit zwischen Fachpersonen, Betroffenen und deren Familienmitglieder. Chatbots können Fachpersonen unterstützen, indem sie Gesundheitskompetenz und-verhalten im Alltag von Betroffenen fördern. Allerdings ist unklar, ob Chatbots in dieser Rolle akz...

BACKGROUND Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to their medical regimen and fail to achieve target range glycemic control. Few interventions, however, have been developed specifically for this age group. OBJECTIVE In this randomized trial, we will provide a mobile app (SweetGoals) to al...

How to treat adults and adolescents with a Cannabis Use Disorder is a burgeoning research area. This article reviews the empirical literature pertaining to the several psychosocial approaches (cognitive-behavior therapy, motivational enhancement and contingency management), all of which are associated with favorable outcomes. We also review the eme...

BACKGROUND Successful management of chronic diseases requires a trustful collaboration between healthcare professionals, patients, and family members. Scalable conversational agents (CAs), designed to assist healthcare professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out into the everyday liv...

For type 1 diabetes management, the role of attentional bias remains unclear. This secondary analysis examined type 1 diabetes attentional bias and adolescent type 1 diabetes management prior to and during a cognitive and behavioral intervention. Youth with type 1 diabetes and above target glycemic control were assigned to intervention or usual car...

The application of digital technologies to better assess, understand, and treat substance use disorders (SUDs) is a particularly promising and vibrant area of scientific research. The National Drug Abuse Treatment Clinical Trials Network (CTN), launched in 1999 by the U.S. National Institute on Drug Abuse, has supported a growing line of research t...

The health care field has integrated advances into digital technology at an accelerating pace to improve health behavior, health care delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges to the fi...

This special issue of Psychology of Addictive Behaviors honors the life and work of a beloved friend, colleague, and mentor, Dr. Nancy M. Petry, who died on July 17, 2018 of breast cancer. At the time of her death, Dr. Petry was the editor of this journal. We were gratified to receive many submissions for this issue, resulting in an outstanding set...

Background Self-regulation deficits expressed through a decreased ability to value future rewards (delay discounting (DD)) and impaired emotion regulation (negative urgency (NU), cannabis coping motives (CCM), and anxiety sensitivity (AS)) relate to more frequent or problematic cannabis use. However, there is a need to better understand how self-re...

Multiple interventions for treating adolescents with substance use disorders have demonstrated efficacy, but most teens do not show an enduring positive response to these treatments. Contingency management (CM)-based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM models cont...

UNSTRUCTURED The healthcare field has integrated advances in digital technology at an accelerating pace to improve health behavior, healthcare delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges...

Background: Asthma is one of the most common chronic conditions worldwide. Successful asthma management requires knowledge about the condition, treatment adherence, and behavioral skills. In addition, when treating children with asthma, a trustful and empathetic collaboration between healthcare providers, patients and their family is necessary for...

Adolescent drug misuse represents a major risk factor for long-term drug use disorders. However, wide individual differences in responses to first-line behavioral therapies targeting adolescent drug misuse limit critical early intervention. Identifying the neural signatures of those adolescents most likely to respond to an intervention would potent...

The purpose of this sequential multiple-assignment randomization treatment pilot study was to examine if (a) adding working memory training to contingency management (CM) for youth with cannabis use disorder (CUD) and (b) switching nonresponding youth to higher magnitude CM incentives boosts outcomes. In Phase 1, youth with CUD (n = 59, M age = 16,...

Prevalence of cannabis use in the United States continues to rise, and 30% of cannabis users eventually meet criteria for Cannabis Use Disorder (CUD). One response to this problem is to develop decision-making constructs that indicate vulnerability to CUD that might not be gleaned from diagnostic criteria. Unfortunately, there is limited evidence t...

Tobacco smoking among those seeking treatment for cannabis use disorder (CUD) is common and is a negative predictor of cannabis outcomes. Quitting tobacco may be beneficial for those seeking to quit cannabis use. This initial proof of concept, controlled trial was designed to compare a simultaneous versus sequential tobacco intervention among those...

Adolescents with type 1 diabetes may be at elevated risk for somatic problems. This study used cross‐sectional, baseline data from an intervention to examine if problems with executive function (EF) were associated with greater somatic problems independent of poor adherence and disease severity in adolescents with type 1 diabetes and above target g...

Objective: We previously tested via randomized controlled trial a novel intervention for adolescents with type 1 diabetes and above-target glycemic control that combined web-delivered incentives for self-monitoring of blood glucose (SMBG) and brief web counseling with working memory training and parental contingency contracting training. Results s...

Introduction: Many young adults with type 1 diabetes (T1D) face challenges in adherence to self-management practices and have above-target HbA1c. Poorer decision-making skills, indicated by greater delay discounting, may be linked to these factors. Methods: An online survey using social media ads targeted young adults aged 18-26 with T1D. Partic...

This chapter provides an overview of the research-based clinical literature on the efficacy and effectiveness of interventions for those with a cannabis use disorder. The discussion focuses on recently published review articles of controlled studies on psychosocial and pharmacological interventions for adult and adolescent populations, as a number...

Background Type 1 diabetes is associated with significant mortality and economic cost. Management of type 1 diabetes involves completing multiple daily adherence behaviors, and many adolescents struggle with self-management and show poor glycemic control. Purpose The purpose was to conduct an unblinded pilot randomized controlled parallel-group st...

In a sample of adolescents with poorly controlled type 1 diabetes, this study examined if delay discounting, the extent to which individuals prefer immediate over delayed rewards, was associated with severity of non-adherence and poor glycemic control, and if parental monitoring of diabetes management moderated those associations. Sixty-one adolesc...

Cannabis is one of the most commonly used psychoactive substances among adolescents in the United States. Adolescent cannabis use has multiple consequences including academic, health, and psychiatric problems. The Marijuana Adolescent Problem Inventory (MAPI) is a 23-item scale adapted from the Rutgers Alcohol Problem Index and used in the current...

Objective: This study explored the associations between problems with self-regulation and glycemic control (HbA1c) in teens experiencing challenges with managing type 1 diabetes by examining greater diabetes-related family conflict and poorer adherence as serial mediators of the link between greater problems with self-regulation and higher HbA1c....

The purpose of this study was to conduct a randomized test of clinic- and home-based incentives plus parent training for adolescent problem alcohol use. Adolescents (N = 75) with alcohol misuse, with or without other substance misuse, were enrolled. All youth received individual Motivational Enhancement Therapy/Cognitive Behavior Therapy and weekly...

Multiple interventions for treating adolescents with substance use disorders have demonstrated efficacy, but a majority of teens do not show an enduring positive response to these treatments. Contingency management (CM)-based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM mo...

Objective . The purpose of this study was to examine the feasibility and effectiveness of a web-delivered multicomponent behavioral and family-based intervention targeting self-regulation and self-monitoring of blood glucose levels (SMBG) and glycemic control (HbA1c) in teens with type 1 diabetes (T1DM) living in rural US. Methods . 15 teens with p...

Introduction: Outpatient treatments for adolescent substance use demonstrate clinically meaningful reductions in substance use, but effect sizes are often low, relapse rates are high, and response to treatment is heterogeneous across participants. The present study utilized cluster analysis to identify subgroups of treatment response among adolesce...

Introduction: Outpatient treatments for adolescent substance use demonstrate clinically meaningful reductions in substance use, but effect sizes are often low, relapse rates are high, and response to treatment is heterogeneous across participants. The present study utilized cluster analysis to identify subgroups of treatment response among adolesc...

Cannabis users frequently report concurrent tobacco use, and tobacco use is associated with poorer outcomes during treatment for cannabis use disorders (CUD). Interventions that simultaneously target both tobacco and cannabis use disorders may enhance cessation outcomes for either or both substances. This study evaluated an intervention integrating...

Computer-assisted behavioral treatments hold promise for enhancing access to and reducing costs of treatments for substance use disorders. This study assessed the efficacy of a computer-assisted version of an efficacious, multicomponent treatment for cannabis use disorders (CUD), that is, motivational enhancement therapy, cognitive-behavioral thera...

The aim of this study was to conduct a randomized test comparing 2 multicomponent, contingency management interventions, 1 with and 1 without a full parent training curriculum, and an individual treatment for adolescent cannabis use disorders. A total of 153 adolescents who met DSM-IV criteria for cannabis abuse or dependence were randomized to mot...

Delay discounting is associated with problematic substance use and poorer treatment outcomes in adolescents and adults with substance use disorders. Although some research has addressed delay discounting among individuals with cannabis use disorders (CUDs), results have been equivocal, and no study has examined whether discounting rates differ betw...

Overall, adolescents (i.e., youth ages 12–18) in treatment for substance abuse have better outcomes than those not in treatment, and multiple types of behavioral interventions hold promise (Tanner-Smith et al., 2013). Treatments with empirical support from well-designed, randomized clinical trials (RCTs) include individual-, group-, and family-base...

Approximately 50% of individuals seeking treatment for cannabis use disorders (CUD) also smoke tobacco, and tobacco smoking is a predictor of poor outcomes for those in treatment for CUD. Quitting tobacco is associated with long-term abstinence from alcohol and illicit drugs, yet there are no established treatments for CUD that also target tobacco...

Many adolescents with substance use problems show poor response to evidence-based treatments. Treatment outcome has been associated with individual differences in impulsive decision making as reflected by delay discounting (DD) rates (preference for immediate rewards). Adolescents with higher rates of DD were expected to show greater neural activat...

Objective: To adapt and pilot test a multicomponent motivational intervention that includes family-based contingency management (CM) for adolescents with poorly controlled type 1 diabetes. Methods: A total of 17 adolescents, age 12-17 years (M = 14.8, SD = 1.5), with type 1 diabetes (duration M = 6.2 years, SD = 4.5) and mean HbA1c of 11.6% (SD...

The current study examined the impact of disruptive behavior disorder (DBD) on substance use outcomes in an adolescent sample. Sixty-eight adolescents and their caregivers were randomized to one of two fourteen-week, outpatient treatments: Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT)+Parent Management Training+Contingency M...

This study assessed the time to initiation of marijuana abstinence in an adolescent treatment-seeking sample, and identified variables that were predictive of abstinence. Adolescents (N=69), ages 14 to 18 were randomly assigned to one of two 14-week behavioral treatments. Abstinence was measured with twice-weekly urine toxicology plus teen and pare...

This paper provides a developmental overview of relevant theory and research on delay discounting and neuroeconomics, and their implications for contingency management (CM) approaches to treatment. Recent advances in the neuroscience of decision making have the potential to inform treatment development for adolescent substance use in general, and C...

The present study: (1) examined relations between parent psychopathology and adolescent internalizing problems, externalizing problems, and substance use in substance-abusing families; and (2) tested family functioning problems as mediators of these relations. Structural equation modeling was used to estimate the independent effects of parent psych...

The purpose of the current study was to identify predictors of delay discounting among adolescents receiving treatment for marijuana abuse or dependence, and to test delay discounting as a predictor of treatment outcome. Participants for this study were 165 adolescents (88% male) between the ages of 12 and 18 (mean age = 15.8 years; standard deviat...

Children of substance abusers are at risk for behavioral/emotional problems. To improve outcomes for these children, we developed and tested an intervention that integrated a novel contingency management (CM) program designed to enhance compliance with an empirically-validated parent training curriculum. CM provided incentives for daily monitoring...

The most potent outcomes for cannabis use disorders have been observed with a combination of three evidence-based interventions, motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), and abstinence-based contingency-management (CM). Access to this intervention remains limited because of cost and service availability issues. Th...

To test the association between the catechol-O-methyltransferase (COMT) Val158Met polymorphism and both aggressive behavior and attention problems in youth. We hypothesized that youth carrying a Met allele would have greater average aggressive behavior scores, and that youth exhibiting Val-homozygosity would have greater average attention problems...

The addition of contingency management (CM) to the menu of effective treatments for adolescent substance abuse has generated excitement in the research and treatment communities. CM interventions are based on extensive basic science and clinical research evidence demonstrating that drug use is sensitive to systematically applied consequences. This...

OBJETIVO: A cannabis continua sendo a substância ilegal mais amplamente utilizada na maioria dos países desenvolvidos. Seu potencial aditivo foi estabelecido e a necessidade de intervenções em problemas relacionados à cannabis se tornou clara. Este artigo faz uma revisão sobre as pesquisas que avaliam os tratamentos potenciais para transtornos por...

Cannabis remains the most widely used illicit substance in most developed countries. Its addictive potential has been established and the need for interventions for cannabis-related problems has become apparent. This article provides a review of the research evaluating potential treatments for cannabis use disorders. A search of publication databas...

An initial efficacy test of an innovative behavioral outpatient treatment model for adolescents with problematic use of marijuana enrolled 69 adolescents, aged 14–18, and randomly assigned them to one of two treatment conditions. Both conditions received individualized Motivational Enhancement and Cognitive Behavioral Therapy (MET/CBT) and a twice-...

Serial neuropsychological examinations were made of an eight‐year‐old girl following diagnosis and treatment of a pineocytoma. The tumor was resected and she received intensive radiation therapy to the entire neuraxis, with a boost to the pineal region. A battery of neuropsychological tests was administered every six to eight weeks, beginning befor...

Models of stress-induced hyperalgesia state that exposure to stress can exaggerate subsequent pain experiences. Studies using both animal and human subjects have shown evidence for hyperalgesia as a function of stress [e.g., Jorum E. Analgesia or hyperalgesia following stress correlates with emotional behavior in rats. Pain 1988;32:341-48; Peckerma...

Reports of adolescents' coping with recurrent pain, symptoms of anxiety/depression, and somatic complaints were obtained from a sample of 164 adolescents with recurrent abdominal pain and their parents. Confirmatory factor analysis revealed that coping consisted of 3 nonorthogonal factors: Primary Control Engagement Coping (problem solving, emotion...

Family-based treatments for adolescent substance abuse demonstrate efficacy and are becoming a treatment of choice. Family risk factors for substance abuse may present barriers to or suggest targets for modification during treatment. The sample included 149 adolescents presenting for substance abuse treatment and their parents. Structural equation...

This manuscript by Connell and Frye (Infant Child Dev 2006; 15(6): 609–621) provides a clear example of the application of latent growth mixture models (LGMM) to the development of antisocial behaviour in adolescence. The LGMM approach is discussed in the context of this example, and factors influencing the results achieved with these methods are h...

Few studies of temperament have tested goodness-of-fit theories of child behavior problems. In this study, we test the hypothesis that interactions between child and parent temperament dimensions predict levels of child psychopathology after controlling for the effects of these dimensions individually. Temperament and psychopathology were assessed...

Previous studies have looked at the structure of attention-deficit/hyperactivity disorder (ADHD) using latent class analysis (LCA) of Child Behavior Checklist (CBCL) or Diagnostic and Statistical Manual of Mental Disorders (DSM) symptom structure. These studies have identified distinct classes of children with inattentive, hyperactive, or combined...

A structural model accounting for child internalizing problems in substance-abusing families was tested. Parents receiving substance abuse treatment (N = 242) completed forms about children between the ages of 6 and 18 who resided in their home. The effects of parent gender, child gender, and child age were controlled. Negative parenting was examin...

To test whether children with recurrent abdominal pain (RAP) exhibit subliminal (nonconscious) and supraliminal (conscious) attentional biases to pain-related words, and to determine correlates of these biases. Previous research indicates that individuals attend to disorder-relevant threat words, and in this study, attentional biases to disorder-re...

The purpose of this study was to determine a score on the Obsessive Compulsive Scale (OCS) from the Child Behavior Checklist (CBCL) to screen for obsessive compulsive disorder (OCD) in children and to rigorously test the specificity and sensitivity of a single cutpoint. A receiver operating characteristic (ROC) curve analysis was applied to data fr...

Studies of individuals with an increased tendency to experience negative emotions such as fear, sadness, and anger have documented links between this temperamental trait and anxiety disorders. There exists debate, however, concerning the degree to which high levels of a temperamental trait are a necessary and/or sufficient component of a DSM diagno...

The prevalence of heroin and other opioid use has markedly increased among adolescents in the last decade; however, virtually no research has been conducted to identify effective treatments for this population. To evaluate the relative efficacy of 2 pharmacotherapies, the partial opioid agonist buprenorphine hydrochloride and the centrally active a...

To describe an innovative treatment for adolescent marijuana abuse and provide initial information about its feasibility, acceptability, and potential efficacy. Provided an intervention composed of (1) a clinic-administered, abstinence-based incentive program; (2) parent-directed contingency management targeting substance use and conduct problems;...

A valid cannabis withdrawal syndrome has been demonstrated in controlled studies with adult marijuana abusers, yet few published reports have examined cannabis withdrawal among adolescents. Adolescents presenting for outpatient substance abuse treatment, whose primary substance of abuse was cannabis, completed a questionnaire reporting the presence...

This study investigated associations between child temperament and DSM-IV disorders in children. A total of 156 probands (97 boys, 59 girls; mean age = 10.78 years) and 154 randomly selected siblings were assessed using the Junior Temperament and Character Inventory (JTCI) and a structured DSM-IV interview. Subjects were placed in nonoverlapping gr...

This study examines the diagnostic accuracy of the CBCL syndrome AS scales for predicting DSM-IV Attention Deficit-Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder with or without Conduct Disorder (ODD/CD). The sample included 370 children (187 probands and 183 siblings) participating in a family genetic study of attention and aggres...