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There has been an increased number of international students attending universities in the United States, which has resulted in a growing number of international students in counseling programs. Cultural differences necessitate culturally appropriate supervision models for counselors and supervisors to utilize when working with international students. The authors identify and delineate the challenges and unique supervision needs of international counseling students and highlight the importance of mentoring as a culturally appropriate complementary supervision technique when supervising international counseling students. The authors propose the inclusion of mentoring with Bernard's discrimination model of supervision as a strategy to enhance the counseling skills of international students.

OBJECTIVE We estimated the cost-effectiveness of the Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to usual care (UC) and each other. RESEARCH DESIGN AND METHODS Data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year simulation time horizon from the health care sector and societal perspectives, discounting costs and benefits at 3% annually. Primary outcome was cost per quality-adjusted life-year (QALY) gained. RESULTS From the health care sector perspective, the EXER intervention strategy saved $313 (USD) per patient and produced 0.38 more QALY (cost saving), the CBT intervention strategy cost $596 more and gained 0.29 more QALY ($2,058/QALY), and the EXER+CBT intervention strategy cost $403 more and gained 0.69 more QALY ($585/QALY) compared with UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared with EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared with UC, the EXER intervention strategy saved $126 (cost saving), the CBT intervention strategy cost $2,838/QALY, and the EXER+CBT intervention strategy cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. In comparison with EXER, the EXER+CBT intervention strategy cost $3,021/QALY. Results were robust in sensitivity analyses. CONCLUSIONS All three Program ACTIVE II interventions represented a good value for money compared with UC. The EXER+CBT intervention was highly cost-effective or cost saving compared with the CBT or EXER interventions.

OBJECTIVE Depression (major depressive disorder [MDD]) in adults with type 2 diabetes mellitus (T2DM) is associated with worsened diabetes complications, increased health care costs, and early mortality. Program ACTIVE II was a randomized, controlled, multicenter treatment trial designed to test the comparative effectiveness of cognitive behavioral therapy (CBT) and/or community-based exercise (EXER) on diabetes and depression outcomes compared with usual care (UC). RESEARCH DESIGN AND METHODS Using a 2 × 2 factorial randomized controlled trial design, adults with T2DM for ≥1 year who met DSM-IV-TR criteria for MDD were randomized to CBT (10 sessions occurring over 12 weeks; N = 36), EXER (12 weeks of community-based exercise including six sessions with a personal trainer; N = 34), CBT+EXER (concurrent over a 12-week period; N = 34), and UC (N = 36). Primary outcomes were depression remission rate (assessed by psychiatric interviewers blind to assignment) and change in glycemic control (HbA1c). RESULTS The mean age was 56.0 years (SD 10.7). Participants were female (77%), white (71%), and married (52%). After controlling for education and antidepressant use, odds of achieving full MDD remission in the intervention groups were 5.0–6.8 times greater than UC (P < 0.0167). The CBT+EXER group demonstrated improved HbA1c compared with UC. For participants with a baseline HbA1c ≥7.0%, exploratory post hoc subgroup analysis showed that the CBT+EXER group had a 1.1% improvement in HbA1c (P < 0.0001) after controlling for covariates. CONCLUSIONS The Program ACTIVE behavioral treatment interventions demonstrated clinically meaningful improvements in depression outcomes in adults with T2DM and MDD. These community-based interventions are complementary to medical care and extend access to those in rural and urban areas.

Objective: Program ACTIVE II was a randomized controlled trial to assess the comparative effectiveness of cognitive behavioral therapy (CBT) and/or community-based exercise (EXER) individually and in combination (EXER+CBT) compared to usual care (UC) in adults with type 2 diabetes and major depression. We sought to estimate the cost-effectiveness of the three interventions relative to each other and to UC. Research Design and Methods: Empirical trial data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year time horizon from the healthcare sector and societal perspectives, discounting both costs and benefits at 3% annually. The primary outcome was costs per quality-adjusted life-year (QALY) gained. Results: From the healthcare sector perspective, compared to UC, the EXER intervention saved $313 per patient and produced 0.38 more QALY (cost-saving), the CBT intervention cost $596 more and gained 0.29 more QALY ($2,054/QALY), and the EXER+CBT intervention cost $403 more and gained 0.69 more QALY ($585/QALY). Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared to UC, the EXER intervention still saved $126, the CBT intervention cost $2,833/QALY, and the EXER+CBT intervention cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention cost $3,021/QALY. Results were robust in sensitivity analyses. Conclusions: All three Program ACTIVE II interventions represented a good value for money compared to UC. The EXER+CBT intervention was highly cost-effective or cost-saving compared to the EXER or CBT intervention. Disclosure S. Kuo: None. W. Ye: Research Support; Self; Bayer Healthcare Pharmaceuticals Inc. M. de Groot: Consultant; Self; Kenner Family Foundation, Inc., LifeScan Diabetes Institute. J.H. Shubrook: Advisory Panel; Self; Bayer U.S., Eli Lilly and Company, Novo Nordisk Inc., Sanofi US. W. Hornsby: None. Y. Pillay: None. K.J. Mather: Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. W.H. Herman: Consultant; Spouse/Partner; Nestlé. Other Relationship; Self; Merck Sharp & Dohme Corp. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK092765, R34DK071545)

OBJECTIVE: The 6 Minute Walk Test (6MWT) is a measure that is routinely used to assess a response to treatment for cardiopulmonary diseases such as pulmonary fibrosis and congestive heart failure. The measure has never been verified as a valid measure of exercise capacity in the highly prevalent patient population of type 2 diabetes (T2DM). This study investigated the correlation between the 6MWT and graded exercise testing (GXT) in an effort to validate the 6MWT as a quality tool for assessing exercise capacity in adults with T2DM. RESEARCH DESIGN AND METHOD: This is a secondary data analysis of Program ACTIVE II, a randomized controlled trial designed to assess the effectiveness of two behavioral interventions on depression and glycemic outcomes in adults with T2DM. The correlation of 6MWT and predicted VO2 max (PVO2M) using GXT was examined in a subsample of participants at the time of study enrollment and at post-intervention. RESULTS: PVO2M showed a significant correlation with 6MWT distance both at baseline (r=0.57, p=0.014) and post-intervention (r = 0.66, p = 0.037). The regression analysis of baseline data revealed that 6MWT distance alone explained 45% (F = 13.03, p = .0024) of the variability in PVO2M. When combined with the SF-12 physical health component score (PCS), 6MWT explained 66% (F = 13.62, p < .001) of the variance in PVO2M. After adjusting for PCS, 6MWT distance explained an additional 30% variability in PVO2M. CONCLUSIONS: Findings from this study indicate that the 6MWT and predicted exercise capacity are significantly correlated. The 6MWT can be used to estimate exercise capacity in adults with T2DM.

In the past two decades there has been an increase in the number of studies that have examined the psychological effects on counselors who provide counseling to clients with trauma experiences. However, little is known about the experiences of counselor trainees who provide counseling to their clients seeking counseling because of trauma. This qualitative study explored the experience of eight doctoral students in a counseling program who completed their master’s-level training in the United States. Three themes emerged from the inductive data analysis process, namely: (1) immediate reactions, (2) information processing, and (3) post-exposure development. Implications for counselors, counselor educators, and clinical supervisors are examined and recommendations to enhance counseling and supervision services are offered.

Responding to an increasingly globalized world, universities are training students to function in a multicultural environment through internationalization. Institutional culture can influence policies and practices for internationalization. Research in internationalization indicate that majority of the studies on the contributions of organizational cultures to internationalization across universities focused on the perspectives of faculty and university senior level administrative personnel and neglected the views of students. This qualitative case study explored students’ understanding of how organizational culture contributes to promote internationalization using international events that occur at two U.S universities. Semi-structured interviews were used for data collection. Purposeful and snowball sampling were employed to select domestic and international undergraduate and graduate students for the study. Findings indicate that integration into university family, community relationship, buffering, communication, symbols, and shared values and beliefs cultures are critical to promote higher education internationalization.

Few studies have evaluated the long-term comparative effects of behavioral treatments for major depressive disorder (MDD) on glycemic and psychological outcomes. Program ACTIVE II was a multi-state randomized controlled comparative effectiveness trial of cognitive behavioral therapy (CBT), community-based exercise (EXER), combination treatment (CBT+EXER) or usual care (UC) for adults with MDD and type 2 diabetes (T2DM). CBT+EXER had a lasting A1c benefit at 6-months (-1.27%; SE: 0.6; p=0.04) and 12 months (-1.42%; SE: 0.6; p=0.03) compared to UC in those with baseline A1c ≥ 7.0%, after controlling for baseline covariates. At 6-month (N=74) and 12-month (N=64) follow-up assessments, all groups had high rates of MDD full remission (range: 63-93%; NS) and minimal depressive symptoms (BDI total score range: 10.7-15.6; NS). At 6 months, CBT+EXER had significant improvements in diabetes-related distress regimen burden (p=0.05); and personal support for health (p=0.05) compared to UC. EXER had improvements in negative thoughts (p=0.005), community social support (p=0.005), diabetes-specific quality of life (DQoL; p=0.04) and satisfaction with T2DM (p=0.01) compared to UC. CBT had improvements over UC in personal support for health (p=0.04) and DQoL (p=0.047). At 12 months, all 3 treatment groups reported improved support from health care providers (p=0.03 CBT, EXER and CBT+EXER) compared to UC. CBT+EXER had improved SF-12 Physical Component Scores (p=0.04) compared to UC. The Program ACTIVE II CBT+EXER intervention had a sustained benefit for A1c beyond the effect of MDD full remission. All 3 behavioral interventions sustained improvements in psychological well-being over 1 year. These findings highlight durable benefits of community-based depression interventions delivered by behavioral health and exercise professionals, which could allow expanded access to depression treatment for T2DM patients in rural and urban areas. Disclosure M. de Groot: Consultant; Self; Johnson &Johnson Diabetes Institute, LLC., Eli Lilly and Company.W. Hornsby: None.C.K. Saha: None.Z. Yang: None.Y. Pillay: None.K.M. Fitzpatrick: None. K.J. Mather: Research Support; Self; Merck &Co., Inc., Sanofi-Aventis, Novo Nordisk A/S, Abbott. Advisory Panel; Self; Merck & Co., Inc.J.H. Shubrook: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk Inc., Intarcia Therapeutics, Inc..

Objective Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to conduct a cost-effectiveness analysis of predicted incidence of cardiovascular complications across groups. Methods The study is a 2-by-2 factorial randomized controlled trial consisting of 4 treatment groups: CBT alone, EXER alone, combination of CBT and EXER, and UC. Adults with T2DM for > 1 year and who meet DSM-IVTR criteria for Major Depressive Disorder (MDD) are eligible to participate at two rural Appalachian sites (southeastern Ohio and West Virginia) and one urban site (Indianapolis). This type II behavioral translation study uses a community-engaged research (CEnR) approach by incorporating community fitness centers and mental health practices as interventionists. Conclusions This is the first study to evaluate the comparative effectiveness of combined CBT and exercise in the treatment of depression using community-based intervention delivery. This approach may serve as a national model for expanding depression treatment for patients with T2DM.

‘Perspectives’ is a special feature included in this issue of Journal of Creativity in Mental Health that provides mental health professionals with an opportunity to discuss their positions on a variety of creativity-related topics. In this column, Yegan Pillay shares his perspective on the roles of the Black church and barbershops/beauty salons and the use of digital technology as resources to support African American persons living with HIV/AIDS. Yegan Pillay is a South African who has worked as a researcher/mental health practitioner in Botswana and South Africa and is the current director of the HIV/AIDS in Africa Education Program. He incorporates into his research, writing, and practice creative and innovative nontraditional strategies that enhance the psychological well-being of people. The Centers for Disease Control and Prevention (2010) reports that approximately 1 million people in the United States are living with HIV. African Americans comprise 12% of the population yet account for approximat...

Technological advances have impinged on every aspect of contemporary phenomenological experiences, including counseling and psychotherapy. The author explores the intersection of narrative therapy, specifically the traditional memory book, with the advances in information technology in the formulation of the digital memory book. The digital memory book is examined relative to the underpinnings of humanistic psychology and the postmodern paradigm that accentuate that people essentially construct their reality and inherently have the potential to influence their well-being. The potential for the digital memory book to complement therapeutic interventions is posited, and implications for counseling and psychotherapy are highlighted.

Inasmuch as psychology references a conscious questioning of what it is to be self, or what it is to say "I," it can be considered to be as old as civilization itself. Yet it is a relative neophyte within the paradigm of Western/Eurocentric scientific disciplines. Contemporary mainstream psychology traces its origins to the late nineteenth century for its disciplinary status and to the Greeks for its philosophical underpinnings. However, the lines of influence may not be as narrow and clear-cut, and the fact of the matter may well be that civilizations that existed earlier, and elsewhere, have played a decisive and formative role in shaping the very fundamentals of contemporary psychology. India (and perhaps "the East" in general) may well be such a case in point. Archaeological sources suggest that the genesis of modern-day psychology can be traced to civilizations that existed around 3000 BCE and earlier. According to Gardner Murphy and Joseph K. Kovach (1972), it was the forces from the Persian uplands who invaded India, "borrowed" from her culture, and produced influential philosophical treatises such as the Upanisads and the Bhagavad Gita. In the period 500 BCE the psychological systems of Buddha, Confucius, and Laotsu emerged, and concomitantly during this era Greek systematic philosophy began its evolution - which arguably was the point of conception of Western psychological systems. Klaus K. Klostermaier (1994) asserts that there is evidence to support the presence of Indian religious and philosophical thought in ancient Athens and comments on its possible influence on early and classical Greek philosophy. If it is so that India contributed significantly to the Greeks, who in turn provided the ontological and epistemological foundation for contemporary psychology in the West, the irony is that psychology is now exported to countries, including India, wholly devoid of any acknowledgment or recognition of such multifaceted, multiregioned, and multicultural intellectual origins. Anand C. Paranjpe (1988) asserts that the contemporary psychology taught at most Asian universities bears the hallmark of European intellectual heritage of philosophers such as Plato, Aristotle, and Descartes, rather than that of Buddha, Confucius, or Sankara. Several writers such as

This study examined racial identity attitudes, acculturation, and gender as predictors of psychological health in a sample of African American college students. The participants were 136 undergraduate students who attended a predominantly White midwestern university. Hierarchical regression analysis indicated that gender was a significant predictor and contributed to 3.5% of the variance in psychological health. Acculturation was a significant predictor above and beyond that accounted for by gender and contributed to 3.7% of the variance in psychological health. Finally, racial identity was a significant predictor of psychological health above and beyond that accounted for by both gender and acculturation and contributed to 20.7% of the variance in psychological health. Limitations of the study and recommendations for future research are offered.

Objective Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to conduct a cost-effectiveness analysis of predicted incidence of cardiovascular complications across groups.

This study investigated how colonial culture impacted on the identity formation of seven individuals from southern Africa. Iographies focussed on factors participants believed impacted on their identity. Results indicated that: (1) participants were forced into a particular racial/cultural identity because of colonialism; (2) separation of individuals on racial lines prevented a collective anti-colonial/oppression identity from evolving; (3) participants experienced a sense of limited worthiness and/or of being more worthy than others because of their race; (4) participants' identities included an anti-colonial component; (5) white individuals who did not wish to participate in the colonial system were considered by some whites as unworthy and were mistrusted by some nonwhites; (6) participants' identity shifted over time. Implications for counselling are provided. Keywords: apartheid, Bulhan's developmental stages, counselling, psychological experiences, race, southern Africa Journal of Psychology in Africa 2005, 15(1): 41–51