Changes in threat-related cognitions and experiential avoidance in group-based transdiagnostic CBT for anxiety disorders.

Group-based Transdiagnostic Cognitive Behavioral Therapy (TCBT) for anxiety disorders aims to target common factors to produce beneficial effects on multiple anxiety disorders at once. While there is growing evidence that various anxiety disorders can be effectively treated by this approach, the common factors contributing to these treatment effects are not well delineated. In a sample of 48 Veterans who completed Group-based TCBT, the current study examined change in threat perception and change in experiential avoidance pre to post-treatment and as potential mediators of changes in negative affect and personalized fear ratings. Results indicated that both threat perception and experiential avoidance were significantly reduced during treatment. Additionally, reductions in both threat perception and experiential avoidance significantly predicted reductions in negative affect and fear ratings. When change in threat perception and change in experiential avoidance were examined simultaneously, both remained significant predictors of changes in negative affect though only experiential avoidance predicted changes in fear ratings. Thus, both reductions in threat perception and experiential avoidance may mediate the broad treatment effects observed in group-based TCBT. Directions for future research are discussed.

Engagement with a social networking intervention for cancer-related distress.

BACKGROUND: Understanding patterns and predictors of engagement could improve the efficacy of Internet interventions. PURPOSE: The purpose of the study was to characterize engagement in a multi-component Internet intervention for cancer survivors with distress. METHODS: Data were derived from 296 cancer survivors provided with access to the Internet intervention and included self-report measures and directly-measured engagement with each component of the intervention. RESULTS: Over 12 weeks, average total engagement was 7.3 h (sd = 11.7), and 42 % of participants spent >3 h on the website. Participants spent more time using social networking components than structured intervention content. Greater early and total engagement was associated with previous chemotherapy, being female, and being recruited via the Internet. Early engagement was associated with greater fatigue and more social constraints. CONCLUSIONS: For many users, engagement with an Internet intervention was quite high. Reducing attrition and tailoring content to better meet the needs of those who do not engage should be a focus of future efforts.

Representativeness of two sampling procedures for an internet intervention targeting cancer-related distress: a comparison of convenience and registry samples.

Internet interventions often rely on convenience sampling, yet convenience samples may differ in important ways from systematic recruitment approaches. The purpose of this study was to evaluate potential demographic, medical, and psychosocial differences between Internet-recruited and registry-recruited cancer survivors in an Internet-based intervention. Participants were recruited from a cancer registry (n = 80) and via broad Internet outreach efforts (n = 160). Participants completed a set of self-report questionnaires, and both samples were compared to a population-based sample of cancer survivors (n = 5,150). The Internet sample was younger, better educated, more likely to be female, had longer time since diagnosis, and had more advanced stage of disease (p's < .001), and the registry-sample was over-represented by men and those with prostate or other cancer types (p's < .001). The Internet sample also exhibited lower quality of life and social support and greater mood disturbance (p's < .001). Understanding how convenience and systematic samples differ has important implications for external validity and potential for dissemination of Internet-based interventions.

Internet-based interventions for cancer-related distress: exploring the experiences of those whose needs are not met.

OBJECTIVE: Low levels of engagement in Internet-based interventions are common. Understanding users' experiences with these interventions is a key to improving efficacy. Although qualitative methods are well-suited for this purpose, few qualitative studies have been conducted in this area. In the present study, we assessed experiences with an Internet-based intervention among cancer survivors who made minimal use of the intervention. METHODS: Semi-structured interviews were conducted with 25 cancer survivors who were minimally engaged (i.e., spent around 1 h total on website) with the online intervention, health-space.net. The intervention was a 12-week, facilitated support group with social and informational components. Interviews were analyzed using an interpretive descriptive design. RESULTS: Three broad categories, consisting of 18 specific themes, were identified from the interviews, which included connecting with similar others, individual expectations, and problems with the site (Κ = 0.88). The 'similar others' category reflected the significance of interacting with relatable survivors (i.e., same cancer type), the 'individual expectations' category reflected the significance of participants' expectations about using online interventions (i.e., personally relevant information), and the 'problems with the site' category reflected the significance of study procedures (i.e., website structure). CONCLUSIONS: The data indicate that minimally engaged participants have high variability regarding their needs and preferences for Internet-based interventions. Using qualitative methodologies to identify and incorporate these needs into the next generation of interventions has the potential to increase engagement and outcomes. The current study provides a foundation for future research to characterize survivors' needs and offer suggestions for better meeting these needs.

Hippocampal volumes in adolescents with and without a family history of alcoholism.

BACKGROUND AND OBJECTIVES: The hippocampus may be vulnerable to the effects of heavy alcohol use during adolescence, which is a time of continued neurodevelopment. However, differences in hippocampal volume may be due to risk factors such as a family history (FH) of alcoholism. We examined hippocampal volumes in youth with and without a FH of alcoholism prior to the initiation of alcohol use. METHODS: Participants were demographically matched adolescents (aged 12-14) with positive (n = 15; FHP) and negative (n = 15; FHN) FH of alcoholism. Each group consisted of 10 males and 5 females with minimal previous substance use. Manual hippocampal tracings were completed on high-resolution magnetic resonance images by reliable raters, and intracranial volumes were controlled in analyses. RESULTS: FH groups did not differ on memory or hippocampal volumes, but group x gender interactions (p < .05) indicated that FHP males had larger left hippocampi than FHN males. Females showed greater left versus right hippocampal asymmetry, while males showed larger right versus left asymmetry. For all adolescents, larger right hippocampal volumes predicted poorer delayed visual memory (p < .01). CONCLUSION AND SIGNIFICANCE: Alcoholism risk factors, such as family history of alcoholism, may differentially influence adolescent hippocampal development for boys as compared to girls. Results suggest that FH does not account for prior findings of reduced left hippocampal volumes in heavy drinking youth. Findings are preliminary, but suggest that future studies examining the effects of alcohol use on the adolescent brain should consider the influence of FH, especially among boys.