Clinical Psychology

Adele Hayes

		Associate Professor Director of Clinical Training Ph.D., State University of New York-Stony Brook Research Interests Recent Publications Representative Publications Vita -MS Word file ahayes@psych.udel.edu Office: 121 Wolf Hall (302) 831-0484 (302) 831-3645 -fax Lab: (302) 831-2215 Preferred contact method - email

Research Interests

Process of change in psychotherapies for depression and Anxiety disorders; treatment development and prevention research

My research focuses on identifying principles of change in cognitive behavioral treatments for depression and anxiety disorders.  More specifically, I am interested in the roles of experiential avoidance and rumination as inhibitors of change and cognitive/emotional processing as a facilitator of change. I am developing a therapy for depression that is based on exposure principles that are used effectively in the treatment of anxiety disorders. My research on mindfulness focuses on understanding and measuring the conceptual opposite of experiential avoidance and rumination.

The general foundation from which I study change is dynamical systems theory from other sciences. A common principle across a number of sciences and systems is that periods of disturbance can herald system transition and that the study of these nonlinear discontinuities can reveal factors that underlie change. In a recent special issue of Clinical Psychology Review, Debra Hope and I present a collection of papers that demonstrate how these principles can be applied to the study of change in psychotherapy.

Three ongoing projects are related to this work:

Exposure-Based Cognitive Therapy for Depression: Treatment Development Research

In this line of research, I am developing an exposure-based cognitive therapy (EBCT) for depression. My research team and I have completed the first open trial of this therapy to examine its efficacy, and the results are promising (Hayes et al., 2005; Hayes, Feldman, Beevers, Laurenceau, & Cardaciotto, 2007). Exposure-based techniques coupled with cognitive analysis are methods of creating disturbance and increasing flexibility and openness for change in those suffering from chronic avoidance, rumination, and hopelessness, all of which inhibit change. Using growth curve modeling, we demonstrated that, as in treatment of anxiety disorders and in dynamic systems models of change, the shape of symptom change in EBCT was cubic. There was an initial decrease in symptoms that was followed by a period of increased disturbance (transient spikes in depression) during the exposure phase, and then another decrease in depressive symptoms.

Applying the principles of dynamic systems modeling, we studied patient changes that occurred at the discontinuities in the course of symptom change (Hayes, Laurenceau, Feldman, Strauss, & Cardaciotto, 2007). Two patterns that predicted treatment response were a rapid early decrease in depression symptoms and a transient period of symptom exacerbation (depression spike). To study what might be changing at these points of transition, we coded the content of weekly essays that patients wrote about their depression each week across the course of therapy. The CHANGE, an observational coding system that my colleagues and I developed to study therapeutic change processes (Hayes, Feldman, & Goldfried, 2006), was used to examine the roles of hope, avoidance, and cognitive/emotional processing as predictors of change. Hope was associated with the early rapid response pattern. Avoidance was associated with overall worse outcomes and with less cognitive\emotional processing. Processing, on the other hand, predicted better outcomes and occurred in the vicinity of the depression spikes. Thus, it appears in this initial study that exposure principles can be applied to the treatment of depression and that the pattern of change looks similar to that in exposure-based therapies for anxiety disorders. A combination of cognitive and emotional processing, the theorized mechanism of change in exposure therapies for anxiety disorders, might also play an important role in treating depression.

In the next stage of this program of research, we are examining the extent to which attentional control, emotional processing, and cognitive reactivity change with EBCT. We are including psychophysiological measures to study more carefully the role of arousal in the change process.

Extreme Avoidance and Rumination: The Study of Change in Cognitive Therapy for Personality Disorders

In this NIMH-funded project, we coded the content of therapy sessions from the first open trial of cognitive therapy (CT) for avoidant and obsessive-compulsive personality disorders, using the CHANGE observational coding system (Hayes et al., 2006). The study of these personality disorders, which are highly comorbid with depression and anxiety disorders, provides a unique context to examine extreme levels of avoidance and rumination that are pervasive and rigidly maintained. Cognitive therapy can be conceptualized as a method of increasing perturbation and inducing system change. It therefore provides an opportunity to study how avoidance and rumination decrease and to identify predictors of change. As in our research on exposure-based cognitive therapy for depression, the pattern of symptom change in CT for personality disorders was cubic, indicating an initial reduction in symptoms, followed by a period of increased distress and then symptom reduction (Hayes, Laurenceau, Feldman, et al., 2007). Cognitive/emotional processing during this spike in distress was a strong predictor of improvement in personality symptoms and also in depression and anxiety symptoms. Exposure to corrective information preceded this processing. In contrast, avoidance and rumination seemed to inhibit movement toward processing. We found a similar discontinuous pattern in patient ratings of the therapeutic alliance, which appeared as a transient worsening and then improvement in the therapeutic alliance. This pattern predicted treatment response beyond early levels of alliance and early symptom reduction (Strauss, Hayes, Johnson, Newman, Brown, Barber, Laurenceau, & Beck, 2006). Dr. Aaron T. Beck at the Beck Institute of Cognitive Therapy and Research and Dr. Cory Newman of the Center for Cognitive Therapy at the University of Pennsylvania are our collaborators on this project.

The Study of Change in Post-Traumatic Stress Disorder and Depression in Trauma-Focused Cognitive-Behavioral Therapy for Maltreated Children and Adolescents:

This ongoing study piggybacks on a SAMHSA-funded project to disseminate Trauma-Focused Cognitive Behavior Therapy (TF-CBT) for children and adolescents who have experienced trauma (physical and sexual abuse, violence) to mental health facilities across the state of Delaware. We will examine change in PTSD and depression symptoms in this population that is at especially high risk for developing chronic depression. To study the process of change, we are using the CHANGE coding system (Hayes et al., 2006) to examine avoidance, poor early alliance, and rumination as predictors of early dropout and poor treatment response, and emotional arousal, cognitive/emotional processing, and corrective information as predictors of positive treatment response. We are also adding acoustic startle assessment at pre and posttreatment and psychophysiological measurement across the course of therapy. Consistent with our previous research, we predict a nonlinear pattern of symptom change and a period of disturbance that is characterized by physiological arousal and more cognitive\emotional processing. We will assess acoustic startle response to assess the extent to which general reactivity to stressors changes over the course of therapy. We are collaborating with Dr. Charles Webb at the Delaware Department of Children, Youth and Families, Dr. Esther Deblinger of the New Jersey Child Abuse Research Education and Service Institute, and Dr. Robert Simons in the Psychology Department of Psychology at the University of Delaware.

Recent Publications

Hayes, A. M., Laurenceau, J.-P., & Cardaciotto, L. Methods for studying the process of change.

(2007). In A. M. Nezu and C. M. Nezu (Eds.). Evidence-based outcome research: A practical guide to conducting randomized clinical trials for psychosocial interventions. (pp 335-358). Oxford University Press.

Hayes, A. M., Feldman, G., Beevers, C., Laurenceau, J-P., & Cardaciotto, L. (2007). Discontinuities and cognitive changes in exposure-based cognitive therapy. In R. Ingram (Ed.) Special section: Cognitive processes and psychotherapy. Journal of Consulting and Clinical Psychology, 75,  409-421.

Feldman, G.C., Hayes, A.M., Kumar, S., Greeson, J., & Laurenceau, J-P (2007). Development, factor structure, and initial validation of the Cognitive and Affective Mindfulness Scale. Journal of Psychopathology and Behavioral Assessment, 29, 177-190.

Hayes, A. M., Laurenceau, J-P, & Feldman, G. C., Strauss, J. L., & Cardaciotto, L.A. (2007). Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27, 715-724.  

Laurenceau, J-P, Hayes, A. M., & Feldman, G. C.  (2007). Statistical and methodological issues in the study of change in psychotherapy. Clinical Psychology Review, 27, 682-695.

Hayes, A. M., Hope, D. A. & Hayes, S. (2007) Toward an understanding of the process and mechanisms of change in cognitive-behavioral therapy: Linking innovative methodology with fundamental questions. Introduction to co-edited special issue, D. A. Hope & A. M. Hayes (Eds.). Clinical Psychology Review, 27,679-681.

Hayes, A. M., Goldfried, M. R., & Feldman, G. C. (2006). The Change and Growth Experiences Scale (CHANGE): A measure of insight and emotional processing. In L. G. Castonguay & C. Hill (Eds.) Insight in psychotherapy. (pp. 231-253). Washington, DC: APA.  

Strauss, J.L, Hayes, A.M., Johnson, S.L, Newman, C.R., Brown, G.K., Barber, J.P, Laurenceau, J-P., & Beck, A.T.(2006). Early alliance, alliance ruptures, and symptom change in a non-randomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74, 337-345.

Wolfsdorf, B. A., Hayes, A. M., Carver, C. S., Gulliver, S. B., & Perlman, C. A. (2006). Identification and evaluation of cognitive affect-regulation strategies: Development of a self-report measure. Cognitive Therapy and Research, 30, 227-262.

Feldman, G.C. & Hayes, A. M. (2005). Preparing for problems:  A measure of anticipatory coping processes. Journal of Research in Personality.

Hayes, A. M., Beevers, C., Feldman, G., Laurenceau, J-P., & Perlman, C. A. (2005). Avoidance and emotional processing as predictors of symptom change and positive growth in an integrative therapy for depression. Ironson, G., Lundberg, U., & Powell, L. H. (Eds.) Special issue: Positive Psychology. International Journal of Behavioral Medicine, 111-122.

Hayes, A. M. & Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Science and Practice, 11 (3), 255-262.

Hayes, A. M., Harris, M. S., & Carver, C. S. (2004). Predictors of self-esteem variability. Cognitive Therapy and Research, 28 (3), 369-385. 

Representative Publications

Hayes, A. M., Laurenceau, J.-P., & Cardaciotto, L. Methods for studying the process of change. (2007). In A. M. Nezu and C. M. Nezu (Eds.). Evidence-based outcome research: A practical guide to conducting randomized clinical trials for psychosocial interventions. (pp 335-358). Oxford University Press.

Hayes, A. M., Feldman, G., Beevers, C., Laurenceau, J-P., & Cardaciotto, L. (2007). Discontinuities and cognitive changes in exposure-based cognitive therapy. In R. Ingram (Ed.) Special section: Cognitive processes and psychotherapy. Journal of Consulting and Clinical Psychology, 75,  409-421.

Feldman, G.C., Hayes, A.M., Kumar, S., Greeson, J., & Laurenceau, J-P (2007). Development, factor structure, and initial validation of the Cognitive and Affective Mindfulness Scale. Journal of Psychopathology and Behavioral Assessment, 29, 177-190.

Hayes, A. M., Laurenceau, J-P, & Feldman, G. C., Strauss, J. L., & Cardaciotto, L.A. (2007). Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27, 715-724.  

Hayes, A. M., Goldfried, M. R., & Feldman, G. C. (2006). The Change and Growth Experiences Scale (CHANGE): A measure of insight and emotional processing. In L. G. Castonguay & C. Hill (Eds.) Insight in psychotherapy. (pp. 231-253). Washington, DC: APA.  

Strauss, J.L, Hayes, A.M., Johnson, S.L, Newman, C.R., Brown, G.K., Barber, J.P, Laurenceau, J-P., & Beck, A.T.(2006). Early alliance, alliance ruptures, and symptom change in a non-randomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74, 337-345.

Hayes, A. M., Beevers, C., Feldman, G., Laurenceau, J-P., & Perlman, C. A. (2005). Avoidance and emotional processing as predictors of symptom change and positive growth in an integrative therapy for depression. Ironson, G., Lundberg, U., & Powell, L. H. (Eds.) Special issue: Positive Psychology. International Journal of Behavioral Medicine, 111-122.

Hayes, A. M. & Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Science and Practice, 11 (3), 255-262.

Hayes, A. M., & Strauss, J.  (1998).  Dynamic systems theory as a paradigm for the study of change in psychotherapy:  An application to cognitive therapy for depression.  Journal of Consulting and Clinical Psychology, 66, 6, 939-947.

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