A randomized controlled trial of cognitive-behavioral treatment for depression versus relaxation training for alcohol-dependent individuals with elevated depressive symptoms.

OBJECTIVE: A previous pilot study found positive outcomes among alcohol-dependent individuals with elevated depressive symptoms who received cognitive-behavioral treatment for depression (CBT-D; n = 19) compared with a relaxation training control (RTC; n = 16). The current study represents a replication of this pilot study using a larger sample size and a longer follow-up assessment period. METHOD: Patients entering a partial hospital drug and alcohol treatment program who met criteria for alcohol dependence and elevated depressive symptoms (Beck Depression Inventory score ≥ 15) were recruited and randomly assigned to receive eight individual sessions of CBT-D (n = 81) or RTC (n = 84). RESULTS: There were significant improvements in depressive and alcohol use outcomes over time for all participants.Compared with RTC, the CBT-D condition had significantly lower levels of depressive symptoms, as measured by the Beck Depression Inventory, at the 6-week follow-up. However, this effect was inconsistent because there were no differences in the Modified Hamilton Rating Scale for Depression between conditions at that time point and there were no significant differences at any other follow-up. No significant between-group differences on alcohol use outcomes were found. CONCLUSIONS: The current findings did not replicate the positive outcomes observed in the CBT-D condition in our previous pilot study. Possible explanations for why these findings were not replicated are discussed, as are theoretical and clinical implications of using CBT-D in alcohol treatment.

The Florida Clergy End-of-Life Education Enhancement Project: a description and evaluation.

The Florida Clergy End-of-Life Education Enhancement Project was a model program developed to provide an interdenominational and statewide model of clergy education on loss, grief dying, and death. The authors describe the project including materials and curriculum as well as present data from the project's evaluation. Clergy and their partners in ministry responded enthusiastically to the project. As a whole, they reported higher levels of knowledge on end-of-life (EOL) issues at the conclusion of the training. Clergy and their ministerial teams also reported that they were better informed about the technical, procedural, medical, and legal issues that arise at the end of life and expressed the desire for subsequent training. The project indicates that clergy both recognize the need for additional training and are anxious to improve their abilities to minister to the dying and bereaved. The model presented here could easily be applied to local organizations such as hospices or denominational training.

Adolescents' responses to the gender valence of cigarette advertising imagery: the role of affect and the self-concept.

The studies presented in this manuscript evaluated the role that affect and the self-concept play in adolescent never smokers' reactions to the gender valence of cigarette advertising imagery. Study 1 (n=29; 59% female) revealed that adolescent females have more positive affective reactions to female-valenced cigarette advertising imagery compared to male-valenced cigarette advertising imagery. Study 2 (n=101; 56% female) revealed that adolescent females viewed female-valenced cigarette advertising imagery as more relevant to their self-concepts compared to male-valenced cigarette advertising imagery. Across both studies, male adolescents did not respond differently as a function of the gender valence of cigarette advertising imagery. Thus, female-valenced cigarette advertising imagery may have specific effects on never smoking female adolescents by enhancing positive affect and suggesting that women who smoke hold the same characteristics as do the young women themselves.

Motivational enhancement and coping skills training for cocaine abusers: effects on substance use outcomes.

AIMS: This clinical trial investigated effects of motivational enhancement treatment (MET) and group coping-skills training (CST) tailored for cocaine dependence. Effects of MET were hypothesized to be greater with CST and for less motivated patients. DESIGN AND INTERVENTIONS: A 2 x 2 design investigated two individual sessions of MET compared to meditation-relaxation (MRT), followed by four group sessions of CST versus drug education (ED), as daily adjuncts to intensive treatment. SETTING: The substance abuse program provided full-day treatment with a learning-theory and 12-Step orientation. PARTICIPANTS: Cocaine-dependent patients were recruited. MEASUREMENTS: Assessment included treatment retention; change in cocaine-related urge, self-efficacy, pros and cons, and motivation; substance use and problems during 12-month follow-up. Findings Of 165 patients, follow-up status is known for 90% (n = 149). Patients in MET with low initial motivation to change reported less cocaine and alcohol relapse and use days and fewer alcohol problems than MET patients with higher initial motivation. MET produced more employment improvement than MRT, with no other significant benefit for MET. Patients with higher motivation had more cocaine use and alcohol problems after MET than MRT. Group CST reduced cocaine and alcohol use during follow-up for women only and reduced alcohol relapse for men and women. CONCLUSIONS: MET is more beneficial for patients with lower initial motivation than for patients with high initial motivation. CST reduced cocaine and alcohol use for women only and reduced alcohol relapses, in contrast to results with lengthier individual CST.

Who am I? The role of self-conflict in adolescents' responses to cigarette advertising.

Cigarette advertising may be partly responsible for adolescent smoking initiation, but few studies have investigated the advertising and individual difference factors that may be responsible. This study evaluated whether individual differences in the number of self-conflicts (i.e., conflicts between personality attributes experienced as part of self-concept development) interacts with stage of development (early versus middle adolescence) to predict responses to cigarette advertising imagery. One hundred and one never smoking adolescents judged the self-relevance of various cigarette advertisements. As predicted, self-conflict was related to judgments of self-relevance for early adolescents only; early adolescents who are having the most difficulty defining themselves are more likely to look to the powerful images displayed by cigarette advertisements for help. These results have implications for understanding the impact of cigarette advertising on smoking initiation for some adolescents.

Adolescents' reactions to the imagery displayed in smoking and antismoking advertisements.

This study compared adolescents' unbiased perceptions of the images displayed in smoking and antismoking advertising. Twenty-nine adolescents (ages 11-17) were shown images taken from both advertising types; all images were digitally edited so that no product information appeared in them. Participants described each image in a free-response format and rated each image on self-report dimensions. Content analyses of free-response descriptions and analyses of self-reports revealed that adolescents viewed images taken from cigarette advertisements more positively compared with images taken from antismoking advertisements. These findings suggest that I reason for the potency of cigarette advertising, compared with antismoking advertising, is the inherent positive appeal of the images displayed. Antismoking advertising may be more effective at limiting adolescent smoking if the images displayed have a more positive valence.