Our Research



eCBT Study

Major depression is a common yet highly debilitating form of mood disorder which puts a substantial burden on sufferers and their families. Cognitive-behavioral therapy (CBT) has been shown to be a highly effective treatment for depression, but without regular maintenance, estimates of relapse rates range anywhere from 15-80%. One of the key components of CBT is homework, therapeutic “assignments” that are negotiated in therapy sessions for clients to complete at home. However, it can be difficult for clients engaged in therapy to give their homework assignments the attention they require for the activities to be effective. Innovations that focus on personalizing homework assignments so that they are more achievable, practiced more often, and aid clients in gathering evidence to bring to future sessions could greatly improve the therapeutic process as well as depression outcomes. The major goal of the electronic mobile CBT – eCBT – project is to present a next generationadvance in our ability to personalize, tailor, and contextualize the delivery of homework assignments on CBT processes and outcomes creating and evaluating a mobile therapy system that will augment traditional CBT approaches to treating depression using a digital smartphone.

Nearly everyone these days has almost constant access to computers, cell phones, and other communications and information technology devices. Recent technological advances in micro-computing and cellular communications now allow mobile tools, like smartphones, palmtop computers, and handheld digital assistants, to be personalized to individuals and their unique social contexts. The ability of mobile devices such as cell phones to work as minicomputers enable researchers to use them to help monitor the interaction of people with their environments and to deliver therapeutic content, such as reminders and assignments, to increase the efficiency of CBT. Individuals who participate in the eCBT project will receive a mobile therapy smartphone system in addition to their regular meetings with their therapist for treatment of their depression. The mobile therapy system will be personalized by programming it to track client behaviors and automatically detect where a client is (home, work) and who else is there (social context, e.g., spouse, children, supervisors). Based on this information, the eCBT device will deliver situation-appropriate strategies for coping with stressful situations in these contexts. Using client and therapist input, the eCBT device will prompt and encourage clients to engage in certain behaviors when the eCBT device detects relevant settings (e.g., near a mall, favorite location) or social opportunities (e.g., with friend, at social events). The eCBT device can further personalize treatment by how often the prompts are made and the content that is delivered based on the individual client’s needs.

The aims of this project are to compare the eCBT system with standard CBT for depression in terms of reaching treatment milestones and the number of sessions required before ending therapy. We will also compare standard CBT and e CBT for depression in terms of clients’ reports of depression, negative mood, negative thinking, and distressing interpersonal interactions in everyday life. Finally, we will examine the effects of eCBT on adherence to and quality of homework, the intra/interpersonal and contextual experiences of automatic thinking patterns, and CBT knowledge and skill. We expect that the e CBT system will be superior to traditional CBT in terms of efficiency of treatment, reduction of depressive symptoms, as well as client and therapist satisfaction with treatment.

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Heart Matters Study

Heart Matters Study

Can your personality really be hazardous to your health? Researchers have been studying the effects of individual personality styles on heart disease and other health risks for more than 50 years, and current headlines still draw our attention to the ways in which our attitudes and emotions might be affecting our heart. Although it is generally agreed that people who are especially high strung, quick-tempered, or fall into the Type A personality category are at increased risk for heart troubles, there is still much to be learned about the pathways from behavioral quirks to cardiac arrest. One of those pathways may be related to a person’s degree of heart rate variability (HRV). Many people who are at increased risk of heart disease have diminished HRV. Another group of people who often have decreased HRV are people who are very high in trait hostility. Although hostility has long been shown to increase the risk of heart disease and other cardiac health problems, descriptions of the behavioral and affective correlates of trait hostility are almost exclusively based on observations made under artificial laboratory conditions, or ask people to rate their “typical” feelings, moods, and activities on a survey.

In developing the Heart Matters study, we hypothesized that at least part of the link between hostility and heart disease is due to how hostile individuals behave in their everyday lives and how they interact with others. To examine this relationship, participants in the Heart Matters study spend five days wearing an ambulatory heart monitor, which records their heart rate continuously while they go about their normal, everyday activities – going to work, school, spending time with their family and friends, and sleeping. Additionally, participants are signaled by a personal digital assistant repeatedly throughout the study period, and answer questions about their activities, mood, feelings, and interactions with others in real time. We are then able to link variations in their heart rate pattern with the kinds of activities that were going on at that time – particularly how participants described their interactions with the people around them. We hope that the results of the Heart Matters study will enable us to evaluate the degree to which diminished heart rate variability provides a pathway from hostility to heart disease and identify the behavioral and interpersonal processes contributing to that relationship.

Here are some articles that discuss the relationship between hostility, heart rate variability, and heart disease in more detail, as well as some preliminary results of the Heart Matters study.

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MASH Study

Project MASH Study

Most of what we know about teenagers’ habits and activities comes from what they choose to tell us. Project MASH (Monitoring Adolescent Stress & Health) was a longitudinal study of teenagers’ health and risk behaviors – particularly cigarette smoking – as well as their moods, activities, social interactions, and mental health. Project MASH was conducted over a period of seven years, between 1998 and 2004, and involved the participation of over 500 high school students in the Orange County area. What really sets Project MASH apart from other studies of adolescent health is that rather than using one-time surveys to collect information from the students each year, participants were asked to carry an electronic diary, on a personal digital assistant, and respond to questions repeatedly throughout the day for a period of four days. Participating students took part in the four-day electronic monitoring sessions twice a year, in the fall and spring, for each of their four years of high school, providing us with thousands of data points for each adolescent. The electronic diary system allows us to get a glimpse of the daily life of these adolescents – how they are feeling, what kind of activities they are involved in, how often they eat, drink, smoke, and use alcohol, when they sleep, when they exercise, how much time they spend with their family and friends – in real time, rather than asking participants to estimate how much time they spend doing these things. The information on the diary was augmented by physiological data collected through saliva samples, heart rate and blood pressure monitoring, and for some students, actigraphy – a measure of how much and often the body moves.

The information collected through Project MASH allows us to answer a huge array of questions about adolescent daily life and health. Some of the analyses that have come out of Project MASH include:

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Repressive Coping

If you’re sick, a little denial CAN be healthy – avoidant coping styles can be adaptive for certain aspects of chronic disease, such as reducing the distress associated with acute disease crises. However, in general, avoidant strategies predict poorer adjustment in the long term. People who always avoid active coping with stress, such as those who have a repressive coping style, may be more likely to develop a health problem, and may also have more serious illnesses than individuals who approach their health problems head on. Repressive coping, or the repressive adaptive style, was first described by Weinberger and colleagues (1979). Repressive copers are individuals who report very low psychological distress, even while enduring acute physical pain or chronic illness (Phipps & Steele, 2002). Dr. Jamner has had a long history of studying the repressive coping phenomenon, and has written a number of seminal papers on repression and its neurophysiological underpinnings, its relationship to pain, affiliation and bonding, and general health functioning.

Assessing "adaptive style" involves the measurement of two constructs - trait anxiety, often measured using the Taylor Manifest Anxiety Scale (Taylor, 1953), and defensiveness, often measured using the Marlowe-Crowne Social Desirability Scale (Crowne & Marlowe, 1960). Individuals are then placed in one of four categories: true low anxious (low anxiety, low defensiveness), true high anxious (high anxiety, low defensiveness), defensive-high anxious, and repressor (low anxiety, high defensiveness). The repressive style seems to be the most distinct; repressors are not simply denying their distress level but appear to actually believe that they are content, controlled, and well-adjusted. They do not express much, if any, negative emotion. However, on objective physiological measures of illness or distress, repressors often fare very poorly (Jamner, Schwartz, & Leigh, 1988). The repressive coping style may have neurophysiological and neurohormonal implications that can negatively impact health. Negative health outcomes abound for this population (Cooke, Myers, & Derakshan, 2002; Jamner, Schwartz, & Leigh, 1988), and in the long term, it is unlikely that the repressive style is adaptive.

At the CIHS, we have a wealth of data from the instruments used to assess the repressive coping style – in both adults and adolescents – in conjunction with many other measures of personality, mental and physical health functioning, daily activities, and health behaviors such as substance use, physical activity, and cardiovascular activity.

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