Faculty Bibliography

The Pittsburgh Sleep Quality Index (PSQI) is a widely used, comprehensive self-report measure of sleep quality and impairment, which has demonstrated good psychometric properties within various populations, including older adults. However, the psychometric properties of the PSQI and its component scores have not been evaluated for older adults with generalized anxiety disorder (GAD). Additionally, changes in PSQI global or component scores have not been reported following cognitive-behavioral treatment (CBT) of late-life GAD. This study examined (1) the psychometric properties of the PSQI within a sample of 216 elderly primary care patients age 60 or older with GAD who were referred for treatment of worry and/or anxiety; as well as (2) response to CBT, relative to usual care, for 134 patients with principal or coprincipal GAD. The PSQI demonstrated good internal consistency reliability and adequate evidence of construct validity. Those receiving CBT experienced greater reductions in PSQI global scores at post-treatment, relative to those receiving usual care. Further, PSQI global and component scores pertaining to sleep quality and difficulties falling asleep (i.e., sleep latency and sleep disturbances) demonstrated response to treatment over a 12-month follow-up period. Overall, results highlight the usefulness of the PSQI global and component scores for use in older adults with GAD.

Cognitive-behavioral therapy (CBT) for the treatment of Social Anxiety Disorder (SAD) has demonstrated efficacy in numerous randomized trials. However, few studies specifically examine the applicability of such treatment for ethnic minority clients. Thus, the purpose of this article is to present two case studies examining the utility of individualized CBT for SAD with two clients who immigrated to the United States, one from Central America and one from China, for whom English was not their primary language. Both clients demonstrated improvement on a semi-structured interview and self-report measures. Necessary adaptations were modest, suggesting that therapy could be conducted in a culturally sensitive manner without much deviation from the treatment protocol. Results are discussed in terms of adapting treatment to enhance acceptability for and better fitting the needs of ethnic minority clients and non-native speakers of English. Implications for treating ethnic minority clients, as well as the practice of culturally sensitive treatment, are discussed.

This preliminary study examined the nature of worry content of lesbians, gay men, and bisexual individuals and the relationship between worry related to sexual orientation and mental health. A community sample of 54 individuals identifying as sexual minorities was recruited from two cities in the Great Plains to complete a packet of questionnaires, including a modified Worry Domains Questionnaire (WDQ; Tallis, Eysenck, & Mathews, 1992) with additional items constructed to assess worry over discrimination related to sexual orientation, and participate in a worry induction and verbalization task. The content of self-reported worries was consistent with those reported in prior investigations of worry content, and worry related to sexual orientation was not found to be elevated compared to other topics. However, degree of worry related to sexual orientation was significantly associated with increased negative affect, depressive symptoms, and internalized homophobia and decreased quality of life and positive affect. Implications of these findings, limitations, and future research issues are discussed.

Many studies support the effectiveness of paraprofessionals in administering psychotherapy. However, no review has compared the utility/efficacy of paraprofessionals versus professionals in administering cognitive-behavioral therapies (CBT). This article systematically reviews published trials comparing outcomes of paraprofessional to professional therapists using CBT to treat anxiety and depressive symptoms. Four studies met inclusion criteria and are critiqued using evidence-based quality parameters. The authors conclude that paraprofessionals can be effective in delivering CBT to these patients, with outcomes comparable to those of professionals.

A meta-analysis of 22 studies evaluating the relation of different assessments of IQ and intervention response did not support the hypothesis that IQ is an important predictor of response to instruction. We found an R(2) of .03 in models with IQ and the autoregressor as predictors and a unique lower estimated R(2) of .006 and a higher estimated R(2) of .013 in models with IQ, the autoregressor, and additional covariates as predictors. There was no evidence that these aggregated effect sizes were moderated by variables such as the type of IQ measure, outcome, age, or intervention. In simulations of the capacity of variables with effect sizes of .03 and .001 for predicting response to intervention, we found little evidence of practical significance.

The current study was conducted to assess courage, defined as behavioral approach despite the experience of fear, in an effort to better understand its relationship with anxiety, fear, and behavioral approach. Thirty-two participants who completed a measure of courage and reported elevated spider fears during an earlier screening participated in a Behavioral Approach Test where they were shown a display of four taxidermied tarantulas and asked to move their hand as close to the spiders as they felt comfortable doing. After controlling for scores on measures of spider fears, courage scores were significantly associated with approach distance to the spiders, such that participants with greater courage moved closer to the spiders. This study advances knowledge about the relationship between courage and fear. Based on our findings, future studies can explore the extent to which (a) courage mediates willingness to engage in therapeutic exposure in treatment, and (b) whether courage can be augmented in treatment prior to implementing exposure therapy.

BACKGROUND:The Generalized Anxiety Disorder Severity Scale (GADSS) is an interview rating scale designed specifically for assessing symptom severity of generalized anxiety disorder (GAD), which has demonstrated positive psychometric data in a sample of adult primary care patients with GAD and panic disorder. However, the psychometric properties of the GADSS have not been evaluated for older adults. METHODS:This study evaluated the psychometric properties of the GADSS, administered via telephone, with a sample of older primary care patients (n=223) referred for treatment of worry and/or anxiety. RESULTS:The GADSS demonstrated adequate internal consistency, strong inter-rater reliability, adequate convergent validity, poor diagnostic accuracy, and mixed discriminant validity. CONCLUSIONS:Results provide mixed preliminary support for use of the GADSS with older adults.