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19-12-2022 | Original Article

Mediators and Moderators of Therapeutic Change in the Unified Protocol for Women Experiencing Homelessness

Auteurs: Sara Rodriguez-Moreno, Ana I. Guillén, Julianne W. Tirpak, Carolina Marín, Nicole D. Cardona, Elizabeth H. Eustis, Todd J. Farchione, David H. Barlow, Sonia Panadero

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 2/2023

Abstract

Background

The general aim of the study was to examine potential mediators and moderators in an adaptation of the Unified Protocol for Homeless Women (UPHW).

Methods

We conducted a secondary analysis in a sample of 80 homeless women participated in the study: 37 in the UPHW and 43 in the waitlist control condition. The assessment before and after the program included primary outcomes (anxiety and depression) and secondary outcomes, including different mediators (positive and negative affect, well-being, and social support) and moderators (demographics, homelessness, physical function, drug and alcohol abuse).

Results

The UPHW showed significant improvements on anxiety and depression outcomes at post-intervention compared to waitlist control condition. Negative affect was the only significant mediator of the relationship between the UPHW and reductions in anxiety and depression symptoms. Physical functioning was the only significant moderator of the relationship between the UPHW and depression symptoms.

Conclusion

To our knowledge this is the first study examining potential mediators and moderators of change in an evidence-based psychological treatment in a population experiencing homelessness. Findings suggest that transdiagnostic protocols may be a promising approach to improving psychological outcomes in this population.

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Amore, K., Baker, M., & Howden-Chapman, P. (2011). The ETHOS definition and classification of homelessness: An analysis.European Journal of Homelessness, 5(2)

Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35(2), 205–230. https://doi.org/10.1016/S0005-7894(04)80036-4CrossRef

Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Conklin, L. R., Boswell, J. F., Ametaj, A., Carl, J. R., Boettcher, H. T., & Cassiello-Robbins, C. (2017). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74(9), 875–884. https://doi.org/10.1001/jamapsychiatry.2017.2164CrossRefPubMedPubMedCentral

Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). Guilford Press

Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011). The unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. Oxford University Press

Beck, A., & Steer, R. (1993). Beck anxiety inventory manual. Psychological Corporation

Beck, A., Steer, R., & Brown, G. (1990). Manual for the Beck Depression Inventory-II. Psychological Corporation

Bentley, K. H., Sauer-Zavala, S., Cassiello-Robbins, C. F., Conklin, L. R., Vento, S., & Homer, D. (2017). Treating suicidal thoughts and behaviors within an emotional disorders framework: Acceptability and feasibility of the Unified Protocol in an inpatient setting. Behavior Modification, 41(4), 529–557. https://doi.org/10.1177/0145445516689661CrossRefPubMed

Boswell, J. F., Sauer-Zavala, S. E., Gallagher, M. W., Delgado, N. K., & Barlow, D. H. (2012). Readiness to change as a moderator of outcome in transdiagnostic treatment. Psychotherapy Research, 22(5), 570–578. https://doi.org/10.1080/10503307.2012.688884CrossRefPubMedPubMedCentral

Brown, T. A., Dinardo, P. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule adult version: Client interview schedule. Oxford University Press

Bullis, J. R., Boettcher, H., Sauer-Zavala, S., Farchione, T. J., & Barlow, D. H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. Clinical Psychology: Science and Practice, 26(2), 19. https://doi.org/10.1111/cpsp.12278CrossRef

Bullis, J. R., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Carl, J. R., & Barlow, D. H. (2015). The unified protocol for transdiagnostic treatment of emotional disorders: Preliminary exploration of effectiveness for group delivery. Behavior Modification, 39(2), 295–321. https://doi.org/10.1177/0145445514553094CrossRefPubMed

Busseri, M. A. (2018). Examining the structure of subjective well-being through meta-analysis of the associations among positive affect, negative affect, and life satisfaction. Personality and Individual Differences, 122, 68–71. https://doi.org/10.1016/j.paid.2017.10.003CrossRef

Carr, A., Cullen, K., Keeney, C., Canning, C., Mooney, O., Chinseallaigh, E., & O’Dowd, A. (2020). Effectiveness of positive psychology interventions: A systematic review and meta-analysis. Journal of Positive Psychology, 1–21. https://doi.org/10.1080/17439760.2020.1818807

Cassiello-Robbins, C., Southward, M. W., Tirpak, J. W., & Sauer-Zavala, S. (2020). A systematic review of Unified Protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review, 78, 101852. https://doi.org/10.1016/j.cpr.2020.101852CrossRefPubMed

Castonguay, L. G., Constantino, M. J., & Holtforth, M. (2006). The working alliance: Where are we and where should we go? Psychotherapy: Theory Research Practice Training, 43(3), 271. https://doi.org/10.1037/0033-3204.43.3.271CrossRef

Chakhssi, F., Kraiss, J. T., Sommers-Spijkerman, M., & Bohlmeijer, E. T. (2018). The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: A systematic review and meta-analysis. Bmc Psychiatry, 18(1), 1–17. https://doi.org/10.1186/s12888-018-1739-2CrossRef

Chondraki, P., Madianos, M. G., Dragioti, E., & Papadimitriou, G. N. (2014). Homeless mentally ill in Athens area: A cross-sectional study on unmet needs and helpseeking. International Journal of Social Psychiatry, 60(6), 544–553. https://doi.org/10.1177/0020764013503150CrossRefPubMed

Conklin, L. R., Cassiello-Robbins, C., Brake, C. A., Sauer-Zavala, S., Farchione, T. J., Ciraulo, D. A., & Barlow, D. H. (2015). Relationships among adaptive and maladaptive emotion regulation strategies and psychopathology during the treatment of comorbid anxiety and alcohol use disorders. Behaviour Research and Therapy, 73, 124–130. https://doi.org/10.1016/j.brat.2015.08.001CrossRefPubMedPubMedCentral

Cuijpers, P., Driessen, E., Hollon, S. D., van Oppen, P., Barth, J., & Andersson, G. (2012). The efficacy of non-directive supportive therapy for adult depression: A meta-analysis. Clinical Psychology Review, 32(4), 280–291. https://doi.org/10.1016/j.cpr.2012.01.003CrossRefPubMed

de Vries, S., Juhnke, G., & Keene, C. (2018). PTSD, Complex PTSD, and childhood abuse: Gender differences among a homeless sample.Journal for Social Action in Counseling & Psychology, 10(2)

Eustis, E. H., Cardona, N., Nauphal, M., Sauer-Zavala, S., Rosellini, A. J., Farchione, T. J., & Barlow, D. H. (2020). Experiential avoidance as a mechanism of change across cognitive-behavioral therapy in a sample of participants with heterogeneous anxiety disorders. Cognitive Therapy and Research, 44(2), 275–286. https://doi.org/10.1007/s10608-019-10063-6CrossRef

Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., Gallagher, M. W., & Barlow, D. H. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behavior Therapy, 43(3), 666–678. https://doi.org/10.1016/j.beth.2012.01.001CrossRefPubMedPubMedCentral

Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in Western countries: Systematic review and meta-regression analysis. PLoS Medicine, 5(12), e225. https://doi.org/10.1371/journal.pmed.0050225CrossRefPubMedPubMedCentral

Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in highincome countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529–1540. https://doi.org/10.1016/S0140-6736(14)61132-6CrossRef

FEANTSA (2017). Extent and profile of homelessness in European Member States: A statistical update.

First, M., Spitzer, R., Gibbon, M., & Williams, J. (1996). Structured clinical interview for DSM-IV axis I disorders research version (SCID-I). New York State Psychiatric Institute: Biometrics Research

Freeman, D., & Freeman, J. (2013). The stressed sex: Uncovering the truth about men, women & mental health. Oxford University Press

Fritz, M. S., & Mackinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological science, 18(3), 233–239. https://doi.org/10.1111/j.1467-9280.2007.01882.xCrossRefPubMed

Furukawa, T. A., Noma, H., Caldwell, D. M., Honyashiki, M., Shinohara, K., Imai, H., & Churchill, R. (2014). Waiting list may be a nocebo condition in psychotherapy trials: A contribution from network meta-analysis. Acta Psychiatrica Scandinavica, 130(3), 181–192. https://doi.org/10.1111/acps.12275CrossRefPubMed

Gallagher, M. W., Long, L. J., Richardson, A., D’Souza, J., Boswell, J. F., Farchione, T. J., & Barlow, D. H. (2020). Examining hope as a transdiagnostic mechanism of change across anxiety disorders and CBT treatment protocols. Behavior Therapy, 51(1), 190–202. https://doi.org/10.1016/j.beth.2019.06.001CrossRefPubMed

Geschwind, N., Bosgraaf, E., Bannink, F., & Peeters, F. (2020). Positivity pays off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression. Psychotherapy, 57(3), 366–378. https://doi.org/10.1037/pst0000288CrossRefPubMed

Griffith, J. W., Zinbarg, R. E., Craske, M. G., Mineka, S., Rose, R. D., Waters, A. M., & Sutton, J. M. (2010). Neuroticism as a common dimension in the internalizing disorders. Psychological Medicine, 40(7), 1125–1136. https://doi.org/10.1017/S0033291709991449CrossRefPubMed

Guillén, A. I., Marín, C., Panadero, S., & Vázquez, J. J. (2020). Substance use, stressful life events and mental health: A longitudinal study among homeless women in Madrid (Spain). Addictive Behaviors, 103, 106246. https://doi.org/10.1016/j.addbeh.2019.106246CrossRefPubMed

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2014). Multivariate Data Analysis, 7th edition. Pearson-Prentice Hall International Edition

Hamburg, M. A., & Collins, F. S. (2010). The path to personalized medicine. New England Journal of Medicine, 363(4), 301–304. https://doi.org/10.1056/nejmp1006304CrossRefPubMed

Hayes, A. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford publications

Hervás, G., & Vázquez, C. (2013). Construction and validation of a measure of integrative well-being in seven languages: The Pemberton Happiness Index. Health and Quality of Life Outcomes, 11(1), 1–13. https://doi.org/10.1186/1477-7525-11-66CrossRef

Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29(5), 409–416. https://doi.org/10.1002/da.21888CrossRefPubMed

Hosogoshi, H., Takebayashi, Y., Ito, M., Fujisato, H., Kato, N., Nakajima, S., Oe, Y., Miyamae, M., Kanie, A., & Horikoshi, M. (2020). Expressive suppression of emotion is a moderator of anxiety in a unified protocol for transdiagnostic treatment of anxiety and depressive disorders: A secondary analysis. Journal of Affective Disorders, 277, 1–4. https://doi.org/10.1016/j.jad.2020.07.132CrossRefPubMed

Hwang, S. W., Kirst, M. J., Chiu, S., Tolomiczenko, G., Kiss, A., Cowan, L., & Levinson, W. (2009). Multidimensional social support and the health of homeless individuals. Journal of Urban Health, 86(5), 791–803. https://doi.org/10.1007/s11524-009-9388-xCrossRefPubMedPubMedCentral

Kanter, J., Manos, R., Bowe, W., Baruch, D., Busch, A., & Rusch, L. (2010). What is behavioral activation?: A review of the empirical literature. Clinical Psychology Review, 30(6), 608–620. https://doi.org/10.1016/j.cpr.2010.04.001CrossRefPubMed

Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3(1), 1–27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432CrossRefPubMed

Kazdin, A. E. (2009). Understanding how and why psychotherapy leads to change. Psychotherapy Research, 19(4–5), 418–428. https://doi.org/10.1080/10503300802448899CrossRefPubMed

Khakpoor, S., Saed, O., & Armani Kian, A. (2019). Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: Double-blind randomized clinical trial. Trends in Psychiatry and Psychotherapy, 41(3), 227–236. https://doi.org/10.1590/2237-6089-2018-0074CrossRefPubMed

López-Gómez, I., Hervás, G., & Vázquez, C. (2015). Adaptación de las “Escalas de afecto positivo y negativo” (PANAS) en una muestra general española. Psicología Conductual, 23(3), 529–548

Magán, I., Sanz, J., & Garcia-Vera, M. P. (2008). Psychometric properties of a Spanish version of the Beck Anxiety Inventory (BAI) in general population. The Spanish Journal of Psychology, 11(2), 626–640. https://doi.org/10.1017/S1138741600004637CrossRefPubMed

Marín, C., Guillén, A., Rodriguez-Moreno, S., Diéguez, S., Panadero, S., & Farchione, T. (2021). Application of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders among homeless women: A feasibility study. Psychotherapy. https://doi.org/10.1037/pst0000357CrossRefPubMed

Martínez-López, Z., Páramo, M. F., Guisande, M. A., Tinajero, C., da Silva, L., & Rodríguez, M. S. (2014). Social support in Spanish first year university students: Psychometrics properties of the Social Support Questionnaire-Short Form and the Social Provisions Scale. Revista Latinoamericana de Psicología, 46(2), 102–110. https://doi.org/10.1016/S0120-0534(14)70013-5CrossRef

McPherson, P., Krotofil, J., & Killaspy, H. (2018). Mental health supported accommodation services: A systematic review of mental health and psychosocial outcomes. Bmc Psychiatry, 18(1), 128. https://doi.org/10.1186/s12888-018-1725-8CrossRefPubMedPubMedCentral

Mejia-Lancheros, C., Lachaud, J., O’Campo, P., Wiens, K., Nisenbaum, R., Wang, R., Hwang, S. W., & Stergiopoulos, V. (2020). Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PloS One, 15(2), e0229385. https://doi.org/10.1371/journal.pone.0229385CrossRefPubMedPubMedCentral

Nilsson, S., Laursen, T. M., Hjorthøj, C., & Nordentoft, M. (2018). Homelessness as a predictor of mortality: An 11-year register-based cohort study. Social Psychiatry and Psychiatric Epidemiology, 53(1), 63–75. https://doi.org/10.1007/s00127-017-1456-zCrossRef

Norton, P. J., Barrera, T. L., Mathew, A. R., Chamberlain, L. D., Szafranski, D. D., Reddy, R., & Smith, A. H. (2013). Effect of transdiagnostic cbt for anxiety disorders on comorbid diagnoses. Depression and Anxiety, 30(2), 168–173. https://doi.org/10.1002/da.22018CrossRefPubMed

Nusselder, W. J., Slockers, M. T., Krol, L., Slockers, C. T., Looman, C. W. N., & van Beeck, E. F. (2013). Mortality and life expectancy in homeless men and women in Rotterdam: 2001–2010. PLoS One, 8(10), e73979. https://doi.org/10.1371/journal.pone.0073979CrossRefPubMedPubMedCentral

Osma, J., Delgado, E. C., & Garcia-Palacios, A. (2015). The unified protocol for transdiagnostic treatment of emotional disorders in group format in a Spanish public mental health setting. Behavioral Psychology, 23(3), 447–466

Oudshoorn, A., Forchuk, C., Hall, J., Smith-Carrier, T., & Van Berkum, A. (2018). An evaluation of a Housing First program for chronically homeless women. Journal of Social Inclusion, 9(2), 34. https://doi.org/10.36251/josi.136CrossRef

Panadero, S., Martín, R., & Vázquez, J. J. (2018). Suicide attempts and stressful life events among homeless people in Madrid (Spain). Journal of Community & Applied Social Psychology, 28(4), 200–212. https://doi.org/10.1002/casp.2351CrossRef

Panadero, S., Vázquez, J. J., Guillén, A. I., Martín, R. M., & Cabrera, H. (2013). Diferencias en felicidad general entre las personas sin hogar en Madrid (España) [Differences in General Happiness between Homeless People in Madrid]. Revista de Psicología, 22(2), 63. https://doi.org/10.5354/0719-0581.2013.30853CrossRef

Paul, G. (1969). Behavior modification research: Design and tactics.Behavior Therapy: Appraisal and Status,29–62

Pérez, B., García, L., De Vicente, M. P., Oliveras, M. A., & Lahoz, M. (2010). Spanish Validation of the Drug Abuse Screening Test (DAST-20 y DAST-10). Health and Addictions, 10(1), 35–50. https://doi.org/10.21134/haaj.v10i1.35CrossRef

Phipps, M., Dalton, L., Maxwell, H., & Cleary, M. (2019). Women and homelessness, a complex multidimensional issue: Findings from a scoping review. Journal of Social Distress and the Homeless, 28(1), 1–13. https://doi.org/10.1080/10530789.2018.1534427CrossRef

Pressman, S. D., & Cohen, S. (2005). Does Positive Affect Influence Health? Psychological Bulletin, 131(6), 925. https://doi.org/10.1037/0033-2909.131.6.925CrossRefPubMed

Reinholt, N., Aharoni, R., Winding, C., Rosenberg, N., Rosenbaum, B., & Arnfred, S. (2017). Transdiagnostic group CBT for anxiety disorders: The unified protocol in mental health services. Cognitive Behaviour Therapy, 46(1), 29–43. https://doi.org/10.1080/16506073.2016.1227360CrossRefPubMed

Roca, P., Vazquez, C., Diez, G., Brito-Pons, G., & McNally, R. J. (2021). Not all types of meditation are the same: Mediators of change in mindfulness and compassion meditation interventions. Journal of Affective Disorders, 283, 354–362. https://doi.org/10.1016/j.jad.2021.01.070CrossRefPubMed

Rodriguez-Moreno, S., Farchione, T. J., Roca, P., Marín, C., Guillén, A. I., & Panadero, S. (2020). Initial effectiveness evaluation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for homeless women. Behavior Modification, 1–23. https://doi.org/10.1177/0145445520982562

Rubio, V., Bermejo, V., Caballero, S., & Santo-Domingo, C. (1998). Validation of the alcohol use disorders identification test (AUDIT) in primary care. Revista Clínica Española, 198(1), 11–14

Sakiris, N., & Berle, D. (2019). A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clinical Psychology Review, 72, 101751. https://doi.org/10.1016/j.cpr.2019.101751CrossRefPubMed

Sanz, J., Navarro, M., & Vázquez, C. (2003). Adaptación española del Inventario para la Depresión de Beck-II (BDI-II): Propiedades psicométricas en estudiantes universitarios. Análisis y Modificación de Conducta, 29, 239–288

Sarason, I. G., Sarason, B. R., Shearin, E. N., & Pierce, G. R. (1987). A brief measure of social support: Practical and theoretical implications. Journal of Social and Personal Relationships, 4(4), 497–510. https://doi.org/10.1177/0265407587044007CrossRef

Sauer-Zavala, S., Ametaj, A. A., Wilner, J. G., Bentley, K. H., Marquez, S., Patrick, K. A., Starks, B., Shtasel, D., & Marques, L. (2019). Evaluating transdiagnostic, evidence-based mental health care in a safety-net setting serving homeless individuals. Psychotherapy, 56(1), 100–114. https://doi.org/10.1037/pst0000187CrossRefPubMed

Sauer-Zavala, S., Boswell, J. F., Bentley, K. H., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2018). Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: An investigation of mediation. Cognitive Therapy and Research, 42(2), 135–145. https://doi.org/10.1007/s10608-017-9855-8CrossRefPubMed

Sauer-Zavala, S., Boswell, J. F., Gallagher, M. W., Bentley, K. H., Ametaj, A., & Barlow, D. H. (2012). The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders. Behaviour Research and Therapy, 50(9), 551–557. https://doi.org/10.1016/j.brat.2012.05.005CrossRefPubMedPubMedCentral

Sauer-Zavala, S., Tirpak, J. W., Eustis, E. H., Woods, B. K., & Russell, K. (2020). Unified Protocol for the Transdiagnostic Prevention of Emotional Disorders: Evaluation of a brief, online course for College Freshmen. Behavior Therapy. https://doi.org/10.1016/j.beth.2020.01.010CrossRefPubMedPubMedCentral

Saunders, J. B., Aasland, O. G., Babor, T. F., De la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful Alcohol consumption-II. Addiction, 88(6), 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.xCrossRefPubMed

Simon, G. E., & Perlis, R. H. (2010). Personalized medicine for depression: Can we match patients with treatments? American Journal of Psychiatry, 167(12), 1445–1455. https://doi.org/10.1176/appi.ajp.2010.09111680CrossRefPubMed

Skinner, H. A. (1982). The drug abuse screening test. Addictive Behaviors, 7(4), 363–371. https://doi.org/10.1016/0306-4603(82)90005-3CrossRefPubMed

Stevens, N. R., Gerhart, J., Goldsmith, R. E., Heath, N. M., Chesney, S. A., & Hobfoll, S. E. (2013). Emotion regulation difficulties, low social support, and interpersonal violence mediate the link between childhood abuse and posttraumatic stress symptoms. Behavior Therapy, 44(1), 152–161. https://doi.org/10.1016/j.beth.2012.09.003CrossRefPubMed

Sun, Y., Lin, S., & Chung, K. (2020). Does emotional well-being mediate between the association of peer support and depressive symptoms in university students during COVID-19 pandemic? https://doi.org/10.31234/osf.io/k5wms

Talkovsky, A. M., & Norton, P. J. (2018). Negative affect and intolerance of uncertainty as potential mediators of change in comorbid depression in transdiagnostic CBT for anxiety. Journal of Affective Disorders, 236, 259–265. https://doi.org/10.1016/j.jad.2018.04.104CrossRefPubMed

Teesson, M., Hodder, T., & Buhrich, N. (2004). Psychiatric disorders in homeless men and women in Sydney. Australian & New Zealand Journal of Psychiatry, 38(3), 162–168. https://doi.org/10.1080/j.1440-1614.2004.01322.xCrossRef

Tinland, A., Boyer, L., Loubière, S., Greacen, T., Girard, V., Boucekine, M., Fond, G., & Auquier, P. (2018). Victimization and posttraumatic stress disorder in homeless women with mental illness are associated with depression, suicide, and quality of life. Neuropsychiatric Disease and Treatment, 14, 2269–2279. https://doi.org/10.2147/NDT.S161377CrossRefPubMedPubMedCentral

Torchalla, I., Strehlau, V., Li, K., Linden, I. A., Noel, F., & Krausz, M. (2014). Posttraumatic stress disorder and substance use disorder comorbidity in homeless adults: Prevalence, correlates, and sex differences. Psychology of Addictive Behaviors, 28(2), 443–452. https://doi.org/10.1037/a0033674CrossRefPubMed

Vilagut, G., Valderas, J., Ferrer, M., Garin, O., López-García, E., & Alonso, J. (2008). Interpretación de los cuestionarios de salud SF-36 y SF-12 en España: componentes físico y mental. Medicina Clínica, 130(19), 726–735. https://doi.org/10.1157/13121076CrossRefPubMed

Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity.Medical Care,220–233

Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070CrossRefPubMed

Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., Daleiden, E. L., Ugueto, A. M., Ho, A., Martin, J., Gray, J., Alleyne, A., Langer, D. A., Southam-Gerow, M. A., Gibbons, R. D., Glisson, C., Green, E. P., Hoagwood, K. E., Kelleher, K., & Mayberg, S. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry, 69(3), 274–282. https://doi.org/10.1001/archgenpsychiatry.2011.147CrossRefPubMed

Winetrobe, H., Wenzel, S., Rhoades, H., Henwood, B., Rice, E., & Harris, T. (2017). Differences in health and social support between homeless men and women entering permanent supportive housing. Women’s Health Issues, 27(3), 286–293. https://doi.org/10.1016/j.whi.2016.12.011CrossRefPubMedPubMedCentral

Titel: Mediators and Moderators of Therapeutic Change in the Unified Protocol for Women Experiencing Homelessness
Auteurs: Sara Rodriguez-Moreno
Ana I. Guillén
Julianne W. Tirpak
Carolina Marín
Nicole D. Cardona
Elizabeth H. Eustis
Todd J. Farchione
David H. Barlow
Sonia Panadero
Publicatiedatum: 19-12-2022
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 2/2023
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-022-10335-8

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Stress-Related Exhaustion, Polygenic Cognitive Potential, and Cognitive Test Performance – A General Population Study

Is Future Mental Imagery Associated with Reduced Impact of the COVID-19 Pandemic on Negative Affect and Anhedonic Symptoms in Young People?

Development of a Forced Choice Assessment of Appearance Importance: The Appearance Preference Task (APT)

Sleep-Directed Hypnosis Improves Subjective Sleep Quality but not Extinction Memory After Exposure to Analog Trauma

Acceptability and Outcomes of Transdiagnostic Guided Self-help Bibliotherapy for Internalizing Disorder Symptoms in Adults: A Fully Remote Nationwide Open Trial

Antidepressant Medication Status as a Moderator of Winter Depression Recurrence Following Cognitive-Behavioral Therapy and Light Therapy: Is There Evidence of an Iatrogenic Effect?