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Resilience has been championed as important for mitigating stressors and challenges experienced by students during post-secondary education, as evidenced by the abundance of programs aimed at enhancing student resilience. Despite growing attention to resilience, there continues to be a lack of consensus about the definition or operationalization of the concept. Even less is known about how to foster resilience in the post-secondary context, especially for marginalized or underrepresented students, who are recognized to be at increased risk for negative mental health outcomes during their post-secondary education. To address these gaps, we employed qualitative methodology to explore marginalized or underrepresented students’ perceptions of resilience. Findings demonstrated that resilience arises from a complex and dynamic interplay between personal skills and attitudes and resources available within students’ communities. Post-secondary institutions are called to shift from individual student responsibility to a collective and shared responsibility for students’ wellbeing in the face of adversity.

Patient-oriented health research approaches are growing in popularity; however, there is a lack of literature describing how patient-oriented research is being utilized to enhance mental health programming for students. The current study reports on a participant-oriented approach to development and evaluation of an innovative, holistic, multi-disciplinary program designed to empower post-secondary students to actively maintain their health and well-being and support academic success. Results demonstrated significant increase in self-reported resilience and anxiety symptoms, but no change in depression symptoms. Prevention programs co-designed with intended users show promise as an effective approach to supporting students with sub-clinical mental health challenges.

Depression is associated with reduced flexibility in emotion regulation (ER). Diversity in the use of ER strategies is crucial for ER flexibility. In this study, we examined associations between depression and ER diversity and proposed a novel measure: the ER diversity index. Currently depressed (n= 58), remitted depressed (n= 65), and healthy control participants (n= 55) rated their use of nine ER strategies. Four ER measures were computed (diversity index, sum score, flexibility score, intraindividual standard deviation), and their association with diagnostic group was compared. The ER diversity index was associated with depression status more strongly than all other ER measures. Currently and remitted depressed individuals exhibited greater diversity in ER strategies overall and maladaptive ER strategies but less diversity in adaptive ER strategies compared with healthy individuals. Thus, the ER diversity index may be a valid measure of ER diversity, and ER diversity may have an important role in depression.

Objectives: The Working Mind is a program designed to reduce stigmatizing attitudes toward mental illness, improve resilience, and promote mental health in the general workplace. Previous research has revealed positive program effects in a variety of workplace settings. This study advances previous work in implementing randomization and a control group to assess the intervention’s efficacy.Methods: The program was evaluated using a cluster-randomized design, with pretest, posttest, and a 3-month follow-up in 2 implementation groups across 4 sites.Results: The Working Mind program was effective at decreasing mental health stigma and increasing self-reported resilience and coping skills at the pre–post assessment in both delivery groups. The program’s effects were maintained to the time of 3-month follow-up. Qualitative data provided further evidence that participants benefited from the program.Conclusions: This study represents an advancement over past research and provides further support for efficacy of the Working Mind program. Directions for future research, including replication using rigorous methodological procedures and examination of program effects over longer follow-up intervals, are discussed.

Stimulation adjustment is required to optimise outcomes of deep brain stimulation (DBS) for treatment-resistant depression, but controlled data for ideal stimulation parameters are poor or insufficient. We aimed to establish the efficacy and safety of short pulse width (SPW) and long pulse width (LPW) subcallosal cingulate DBS in depression.

Scant research has investigated emotion regulation strategies in somatization disorder, despite its high comorbidity with depression and the growing interest in this topic in depression. The present study investigated emotion regulation strategies in patients with major depression and somatization disorder using clinical samples to examine common vulnerability factors and to provide evidence for difficulties in emotion regulation as transdiagnostic factors in these disorders. Patients with major depressive disorder (n= 30) and patients with somatization disorder (n= 30) completed measures of putatively adaptive and maladaptive emotion regulation strategy use. Patients with somatization disorder showed higher scores on measures of regulatory strategies, as measured by the sum of adaptive strategies in the Cognitive Emotion Regulation Questionnaire as well as the following subscales: positive refocusing, positive reappraisal, and refocusing on a plan. After controlling for levels of current depression, the significant effects remained for positive refocusing. Depression symptom severity was significantly and negatively correlated with most adaptive strategies and positively correlated with most maladaptive strategies. The current results provide preliminary data for a similar pattern of adaptive and maladaptive emotion regulation strategies usage in these two disorders. The results also contribute to theories of psychopathology and our understanding of critical cognitive and emotional processes.

Background: Organizational characteristics and attributes are critical issues to consider when implementing and evaluating workplace training. This study was a qualitative examination of the organizational context as it pertained to the implementation of a workplace mental health program called Road to Mental Readiness (R2MR) in police organizations in Canada.Methods: We conducted a qualitative key informant study in 9 different policing organizations in Canada.Results: The central theme of “successful cultural uptake” emerged as key to R2MR’s implementation and the ability to facilitate broader culture change. Successful cultural uptake was enabled by several contextual factors, including organizational readiness, strong leadership support, ensuring good group dynamics, credibility of the trainers, implementing widely and thoroughly, and implementing R2MR as one piece of a larger puzzle. Successful cultural uptake was also described as enabling R2MR’s impact for broader cultural change within the organization. This enablement occurred through enhanced dialogue about mental health and the introduction of a common language, a supportive workplace culture, increased help seeking, and organizational momentum for additional mental health programming and policy initiatives.Conclusion: Successful uptake of R2MR has the potential to lead to promote change within policing organizations. The model derived from our research may function as a tool or roadmap to help guide other organizations in the process of or planning to implement R2MR or a similar intervention.

Objectives: This article describes a meta-analysis of The Working Mind, a program that was developed to address workplace mental health. The basic program addresses issues related to stigma in the workplace, the use of a mental health continuum model to evaluate signs and indicators of mental illness, and the development of coping skills. A manager version further addresses issues such as how to work with an employee who struggles with mental health issues, workplace accommodations, and overall management issues.Methods: A total of 8 replications evaluated program effects on stigma, self-reported resilience, and coping abilities.Results: The implementation of the program was associated with moderate reductions in stigma and increased self-reported resilience and coping abilities. These results were generally consistent across settings and showed nonsignificant differences when various potential moderators of the program were evaluated (e.g., employees versus managers, public versus private sector, gender, age). Qualitative comments collected at the end of the program suggested that many program participants found the program to be helpful and that the skills were being employed.Conclusions: Directions for future research, including the need for a randomized trial of The Working Mind, are discussed. Overall, the results suggest that the program is successful in its aims, but further inquiry is encouraged.

The Opening Minds Initiative of the Mental Health Commission of Canada has worked with many workplaces to implement and evaluate mental illness stigma reduction programs. This article describes the lessons learned from Opening Minds’ research and programming initiatives in the workplace target group and details some of the most valuable learnings from collaborating with workplace partners. These insights range from issues such as the recruitment of potential partners to the implementation of evaluation in the workplace. The lessons learned described here are not intended as the optimal ways of developing partnerships or conducting research in a workplace setting but are intended to highlight some of our experiences in implementing antistigma programming. These experiences are provided so that those who are in the same situation can draw from our learnings to make their efforts more efficient. To conclude, we discuss some of our thoughts in which the implementation of workplace mental illness stigma reduction programming should work towards in the future.

The Opening Minds Initiative of the Mental Health Commission of Canada has taken a novel approach to reducing the stigma of mental illness by targeting specific sectors. This first article describes Opening Minds’ research and programming initiatives in the workplace target group. This article describes the context of mental illness stigma in Canada and the development of the Opening Minds initiative of the Mental Health Commission of Canada, with a specific focus on the workplace sector. We outline the steps that were taken to develop an evidence-based approach to stigma reduction in the workplace, including reviews of the state of the art in this workplace antistigma programming, as well as the development of tools and measures to assess mental illness stigma in the workplace. Finally, 2 specific program examples (e.g., Road to Mental Readiness and The Working Mind) are used to highlight some of the procedural and logistical learnings for implementing antistigma and mental health initiatives within the workplace. In a second related article, we further examine the Opening Minds workplace initiative, with a discussion of the lessons learned from the implementation and evaluation of antistigma programming in the workplace.

Objectives: First-responder mental health, especially in Canada, has been a topic of increasing interest given the high incidence of poor mental health, mental illness, and suicide among this cohort. Although research generally suggests that resiliency and stigma reduction programs can directly and indirectly affect mental health, little research has examined this type of training in first responders. The current paper examines the efficacy of the Road to Mental Readiness for First Responders program (R2MR), a resiliency and anti-stigma program.Methods: The program was tested using a pre-post design with a 3-month follow-up in 5 first-responder groups across 16 sites.Results: A meta-analytic approach was used to estimate the overall effects of the program on resiliency and stigma reduction. Our results indicate that R2MR was effective at increasing participants’ perceptions of resiliency and decreasing stigmatizing attitudes at the pre-post review, which was mostly maintained at the 3-month follow-up.Conclusions: Both quantitative and qualitative data suggest that the program helped to shift workplace culture and increase support for others.

Background: Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP.Methods: An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures.Results: There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure.Interpretation: The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

In addition to the growing evidence‐based practice movement in psychology, psychological treatments are undergoing increasing adaptation and transportation to other countries and cultures around the world, prompting the need to evaluate treatments in these diverse settings. This article proposes the “benchmarking” strategy as a valuable approach to evaluate the effectiveness of culturally adapted or transported treatments and to promote the internationalization of evidence‐based practice. We first describe the benchmarking concept in clinical research, followed by considerations for the cultural adaptation and transportation of psychological treatments. We then explain how the benchmarking strategy may be used to validate culturally transported and adapted psychological treatments. The article concludes with a discussion of considerations, limitations, and challenges for conducting cross‐cultural benchmarking research.

Although cognitive behavioral therapy (CBT) is an effective treatment for depression, a substantial number of individuals experience relapse following treatment. It is possible that these individuals remain vulnerable due to personality characteristics such as self-critical perfectionism. This study examined the longitudinal association of depressive symptoms, stressful events, and self-critical perfectionism using post-treatment data from the Component Analysis of Cognitive-Behavioral Treatment for Depression study. The temporal relationship between depressive symptoms and stressful events (assessed at treatment termination and at 6-, 12-, 18-, and 24-month follow-ups) was evaluated using the Latent Difference Score (LDS) structural modelling framework. Four theoretical models (no association, stress generation, stress reactivity, transactional) were compared. Results supported the stress reactivity model, in which stressful events led to subsequent depression symptom change. Multigroup LDS analysis demonstrated that longitudinal stress reactivity occurred only for individuals experiencing high levels of self-critical perfectionism. The results suggest that maintenance of treatment gains following CBT is related to an individual's personality style and stress reactivity.

According to attentional control theory, high trait anxious individuals experience reduced attentional control as compared to low trait anxious individuals due to the imbalance between goal-directed and stimulus-driven attentional systems. One consequence is that high trait anxious individuals have difficulty resisting distraction, as compared to low trait anxious individuals. A separate line of research on individual differences in working memory capacity (WMC) has shown that individuals with higher WMC have better attentional control and thus are better able to resist distraction. The present study investigated the hypothesis that high WMC compensates for high trait anxiety in a task that evaluates the ability to resist distraction, the antisaccade task. Participants completed the State-Trait Anxiety Inventory to measure trait anxiety and the Operation Span and Reading Span tasks to measure WMC. As hypothesised, individuals who were high trait anxious exhibited increased attentional control on the antisaccade task when they had high WMC. Theoretical implications and directions for future research are discussed.

This article presents a panel discussion on the development of the therapeutic relationship element of collaborative empiricism in Beckian Cognitive Therapy, or Cognitive Behavior Therapy (CBT). The panel comprised experts in research and practice who had been invited as keynote presenters for the 7th International Congress of Cognitive Psychotherapy held in Istanbul, Turkey in 2011. The experts responded to questions about the definition of collaborative empiricism, the role for case conceptualization in collaborative empiricism, how collaborative empiricism contributes to central CBT change mechanisms, and what issues emerge in CBT training and supervision. Additional themes arising from the discussion concerned how the relational element of collaborative empiricism is embedded throughout the use of CBT techniques, and highlighted a need for process research on collaborative empiricism in CBT

The Center for Epidemiologic Studies Depression Scale (CES-D) is a widely used instrument in the measurement of depression symptoms. Unfortunately, and despite the ubiquity of depression in all regions of the world, the psychometric properties of the CES-D have never been examined in Egyptian samples. The present investigation examined the reliability and validity of the CES-D when used with a sample of Egyptian students.

Objective: No recent meta-analysis has examined the effects of cognitive-behavioural therapy (CBT) for adult depression. We decided to conduct such an updated meta-analysis.Methods: Studies were identified through systematic searches in bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane library). We included studies examining the effects of CBT, compared with control groups, other psychotherapies, and pharmacotherapy.Results: A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g= 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g= 0.53), and because the ES of higher-quality studies was significantly lower (g= 0.53) than for lower-quality studies (g= 0.90). The difference between high- and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone (g= 0.49).Conclusions: There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.

Objective: The Beck Depression Inventory (BDI) has been used more than any other self-report questionnaire in research on depression in cardiovascular disease. However, no studies have examined whether BDI scores may be influenced by somatic symptoms common after myocardial infarction (Ml) that may overlap with symptoms of depression. The objective of this study was to examine whether BDI scores of post-MI patients may be influenced by somatic symptoms that commonly occur after MI, but may not be related to depression.Method: Post-MI patients and psychiatric outpatients were matched on BDI cognitive-affective symptom scores, sex, and age, and their BDI somatic symptom scores were compared using independent samples ttests.Results: Somatic symptoms accounted for 57% of BDI total scores for 296 post-MI patients (mean total BDI = 8.8), compared with 50% for 296 matched psychiatric outpatients (mean total BDI = 7.6). Overall, BDI somatic scores of post-MI patients were 1.3 points higher than for psychiatric outpatients (95% CI 0.68 to 1.82; P< 0.001), equivalent to 14% of total scores of post-MI patients.Conclusions: The relative influence of somatic symptoms on BDI total scores was higher for post-MI patients than for psychiatric outpatients matched on cognitive-affective scores, sex, and age. This finding stands in contrast to that from a previous study that used similar methods and sample comparisons and found that post-MI and psychiatric outpatients did not differ in their endorsement of somatic symptoms on the BDI-II. The BDI-II may be preferable to the BDI in post-MI patients.

Patient characteristics may partly explain individual differences in long-term maintenance of treatment gains in response to cognitive and behavioral therapies (CBT). This study evaluated the relative contribution of negative cognitive style, behavioral activation, and personality patterns, measured at the end of treatment among treatment responders, towards the risk of relapse of major depressive disorder over a 2-year prospective follow-up. The sample included depressed adults who were randomized and received an adequate dose of one of three forms of CBT, who then fully responded and completed a 2-year prospective follow-up (N = 93) (Jacobson et al., 1996; Gortner, Gollan, Dobson and Jacobson, 1998). Cox regression analyses revealed that for treatment responders, self-devaluative depressogenic cognitive style did not predict relapse during the 2-year follow-up. Separate cox regression analyses indicated that without considering the contribution of personality patterns, it was important to distinguish the level of behavioral activation (e.g. frequency of pleasant events) from its associated pleasure in predicting relapse. With the introduction of personality patterns; however, an integrated model revealed that only dependent personality pattern was associated with hazard of relapse during the 2-year prospective follow-up. Dependent personality pattern may increase relapse through behavioral passivity.

Joiner (this issue) identifies erosive and self‐propogatory processes in depression. Here I argue that although these processes are important to discuss in the context of depression, and although his presentation offers an excellent starting point for a fulsome discussion of these issues, Joiner's analysis fails to fully develop the literature to the maximum extent possible. Several issues for further theory development are advanced: (1) the definition of chronicity and chronic processes in depression, (2) the definition and use of the concepts of erosive and self‐propogatory processes, (3) other factors that deserve attention, and (4) an encouragement for ongoing work emphasizing the multifacto‐rial prediction of depression.

This article responds to the commentary by Cardemil ([Cardemil, E. V., 2015]) on our original article (Spilka & Dobson, [Spilka, M. J., 2015]), in which we proposed the use of a benchmarking strategy to evaluate culturally adapted and transported treatments. We address Cardemil's assertion that a culturally embedded or bottom‐up approach to the development of models of psychopathology and treatment of disorders is optimal and argue that benchmarking provides an alternative model in which treatments may also be developed in one culture and exported, with appropriate adaptation and evaluation, to another. We discuss the circumstances in which benchmarking is likely to have enhanced benefit and argue that this issue should be addressed with research and evidence as part of the global efforts toward evidence‐based practice.

Though Likert-type scales are frequently employed in research, typically little systematic consideration is given to the process of identifying the number of response categories, selecting appropriate category labels or ensuring that the scale yields an acceptable level of measurement. Relatively little research has been performed to identify the category labels which yield scales with equidistant category points. Unidimensional ratings of category labels associated with the psychological dimensions of intensity, frequency, and similarity on 5-, 7-, and 9-point scales by 192 introductory psychology students yielded several scales with equidistant intervals. Researchers are encouraged to employ such Likert-type scales with interval levels of measurement and to validate them on the population being studied.

In an effort to evaluate the generalizability of past research that has examined the social responses to depressed targets, the interpersonal responses to normal, anxious, and depressed-anxious female undergraduate targets (n = 20 per cell) was assessed. As well, the targets' perceptions of the social responses they elicited was contrasted with the actual responses in order to identify potential distortions in how normal, anxious, and depressed-anxious targets perceive their interpersonal impact. The results showed that although the three groups of targets were responded to in essentially equal ways, the depressed-anxious and anxious targets believed they were more rejected. No differences in the targets' perceptions of induced mood or interpersonal impact were found. The implications of these results for Coyne's interpersonal model of depression and cognitive models of depression were discussed. Also, the relationship between anxiety and depression was highlighted, and it is suggested that the interpersonal responses to conditions other than depression warrant further investigation.

Recent efforts at measuring cognitions relevant to depression have yielded a number of measures. In the first part of this study a battery of cognitive assessment measures were contrasted using three subject groups (major depressed patients, nondepressed psychiatric, and nonpsychiatric hospital patients). The results strongly support the existence of a correlated set of cognitions specific to depression. Several measures of cognition during the depressive episode correlated uniformly with severity of depression, and for the most part scores of depressed subjects were significantly different from the two control groups. The second part of the study explored the stability of cognition in a sample of depressed inpatients. Using the battery of cognitive assessment methods, the results indicate marked stability of scores while the person remains depressed. With a sample of remitted patients, changes in cognition appeared for only a small number of measures. The results were seen as providing supportive evidence for the cognitive model of depression.

Past research has demonstrated that depressed individuals tend to distort their recall of positive feedback in a negative fashion. In the current study an attempt was made to replicate the finding and then to stop this negative distortion through a self-correction (reality-testing) procedure. Groups of depressed and nondepressed college students were randomly assigned to high positive (HP) or low positive (LP) feedback conditions. In the first half of the study, there was a replication of the cognitive distortion of HP feedback by the depressed group. The reality-testing procedure invoked in the second half of the study, however, made no impact on the cognitive distortions made by the depressed group under HP feedback conditions. Under conditions of LP feedback, the reality-testing procedure had the paradoxical effect of increasing the distortions shown by the depressed group. The implications of this study for therapy were elaborated upon and the utility of reality testing, as an isolated treatment component, was called into question.

The efficiency and style of problem solving for rules of varying difficulty was examined in a depressed college group. The depressed group and a control group of nondepressed students did not differ in the time required to solve conceptual problems. There were differences for the more difficult problems in the number of cards required for solution and problem-solving efficiency (defined as a strategy score).Both groups were able to improve their performance scores between problem (rule)learning and identification phases of the study. Expectations for and ratings of performance did not show a comparable pattern of results to the problem-solving measures; whereas the depressives had fixed perceptions of their performance, the nondepressed group altered their perception of performance in keeping with the improvement in the second phase of the study. The results implicated both a problem-solving deficit and a conservative problem-solving style in depression. The importance of the task difficulty as an intermediary variable in problem-solving studies was also discussed.

Although past theory and research implicate social problem- solving deficits in both depression and aggressive disorders, research examining carefully diagnosed groups of adolescent depressed and conduct- disordered groups had not previously been conducted. In the current study three groups of adolescents (major depression, conduct- disordered, and normal) were studied using two social problem- solving measures. Both the Means- Ends Problem- Solving task (MEPS) and the Social Situations Analysis measure (SSA) failed to show social problem- solving problem deficits in the depressed group relative to their normal age peers, but did provide corroborative evidence for social problem- solving deficits in the conduct- disordered sample. Relative to the other two groups, the conduct- disordered adolescents were found to generate fewer means to a social end, to anticipate fewer obstacles in the pursuit of solutions to interpersonal situations, and to generate fewer assertive behavioral solutions to difficult social situations. The results are discussed in relation to other work with depressed and aggressive youth, and directions for future research are given.

Researchers have typically used factor-analytic composite measures of coping, instead of individual scales, to predict rehabilitation outcome. There are, however, both advantages and disadvantages to using individual or composite scores. This study extended the findings of Jensen et al. (1992), by prospectively comparing the individual and composite scores of the Coping Strategies Questionnaire (CSQ) in the prediction of 4 types of adjustment to low back pain. Two-hundred patients completed the CSQ, the Oswestry Index, the SCL-90R, and 4 lifting tasks at admission and discharge from a multidisciplinary pain clinic. Return to work was determined at 9-month follow-up. The CSQ scales were factor-analyzed to devise composite indices, and the 3 resultant factors were compared to the individual scales in the prediction of pain and other outcomes. The results indicated that the relative predictive utility of the composite or individual scales depended on which outcome measure was used to define adjustment.

This article provides a commentary on the stage model for psychotherapy manual development proposed by Carroll and Nuro (this issue). We endorse the emphasis on the evolution of treatment manuals, dependent on their stage of development, research base, and intended audience. At the same time, we discuss some of the conceptual and practical challenges to the smooth and steady transition of treatment manuals from efficacy trials into clinical practice. These issues include incentives for researchers to conduct effectiveness trials, lack of funding for such research, skepticism in some quarters of the field about the utility of treatment manuals, issues of dissemination, and the general lack of feedback from the clinical community to the developers of treatment manuals about ways to make them flexible enough for use in clinical practice. We end with an encouragement of the template of a stage model for manual development.

The article focuses on the potential of mobile applications in psychological intervention studies, their benefits and the rise of effectiveness studies.

The article offers information on the clinical pathway for the treatment of depression developed by the Primary Care Networks, and Shared Mental Health Care program in Calgary, Alberta, Canada which used the Patient Health Questionnaire-9 (PHQ-9) as the key pathway tool.