Psychophysiologic effects of applied tension on the emotional fainting response to blood and injury

OBJECTIVE: The present study was designed to investigate the psychophysiologic effects of "Applied Tension" (AT) on the emotional fainting response to blood and injury in a controlled experiment. METHOD: Twenty-two persons reporting to generally feel faint or to have fainted at the sight of blood or injury and 22 participants classified as Non-Fainters were randomly allocated to a treatment or control condition. Psychophysiologic responses were continuously monitored while individuals watched a video depicting open-heart surgery and a control film. Prior to the surgery film, participants in the treatment condition were instructed in the use of AT. RESULTS: All participants classified as Fainters showed a diphasic response pattern while watching the surgery film. This response, however, was significantly attenuated in Fainters in the treatment condition. CONCLUSIONS: These results suggest that AT provides an effective treatment strategy for the prevention of fainting responses in persons with a fear of blood and injury.     

A randomized trial to evaluate the course of effects of a program to prevent adolescent depressive symptoms over 12 months

Although few prevention studies have been designed to investigate the course of prevention effects over time, it seems that the effects on depressive symptoms increase from post-intervention to 6-month follow-up but then decrease with longer lags to follow-up. Furthermore, previous prevention studies have found differential intervention effects for boys and girls without testing possible explanations for this effect. The present randomized control group study with 301 8th-grade students examined the effects of a depression prevention program from baseline until 12-month follow-up. As expected, while positive intervention effects were found on girls’ depressive symptoms, no such effects were found on boys’ depressive symptoms. Further, the positive intervention effects on girls’ depressive symptoms increased to the 6-month follow-up and remained stable through the 12-month follow-up, while depression symptoms in control-group girls increased from 6-month to 12-month follow-up. Further exploratory analyses revealed that neither baseline conduct problems nor cognitive or social knowledge of the prevention program at 12-month follow-up alone explained the sex effect. However, some limited evidence was found indicating that total knowledge (cognitive and social) might partially explain the effect but there was significant variability remaining to be explained.     

The effects of outcome expectations and satisfaction on weight loss and maintenance: correlational and experimental analyses--a randomized trial.

This study examines the hypothesis that highly favorable outcome expectations promote weight loss and hinder weight maintenance. To investigate the effects of outcome expectations and satisfaction with treatment outcomes on weight loss, 349 adults were randomly assigned to 1 of 2 weight loss programs that emphasize either (a) an "optimistic" message, focusing exclusively on the positive aspects of weight loss, or (b) a "balanced" message, giving equal time to positive and negative aspects of weight loss. Participants changed their weight loss cognitions in response to the intervention, but there was no significant difference between the intervention treatment groups in short-term or long-term (18-month) weight loss. Independent of treatment message, positive outcome expectations and satisfaction were both associated with weight loss.     

Reduced ADHD symptoms in adults with ADHD after structured skills training group: results from a randomized controlled trial

Objective

Feasibility, acceptability, and efficacy of a Dialectical Behavioral Therapy (DBT) -based method developed in Germany were evaluated in a Swedish outpatient psychiatric context.

Method

Fifty-one adults with ADHD on stable medical treatment or on no medication were randomized to the DBT-based skills training (n = 26) or a parallel loosely structured discussion group (n = 25). Self-rating scales were administered before randomization and after the treatment.

Results

Feasibility and participant satisfaction were good in both groups while skills training was perceived as more logical and effective for ADHD-related problems. The analyses of the individuals who completed the treatment and remained stable with regard to medication (n = 19 in skills training; n = 18 in control group) showed a significant reduction in ADHD symptoms in the skills training group, but not in the control group. No reduction of comorbidity was observed in any of the groups.

Conclusions

The treatment was feasible in an outpatient psychiatric context, well tolerated, and significantly reduced ADHD symptoms in on-treatment individuals who remained stable regarding medication status.     

Long-term effects from a randomized trial of two public health preventive interventions for parental depression.

This article presents long-term effects of a randomized trial evaluating 2 standardized, manual-based prevention strategies for families with parental mood disorder: informational lectures and a brief, clinician-based approach including child assessment and a family meeting. A sample of 105 families, in which at least 1 parent suffered from a mood disorder and at least 1 nondepressed child was within the 8- to 15-year age range, was recruited. Parents and children were assessed separately at baseline and every 9 to 12 months thereafter on behavioral functioning, psychopathology, and response to intervention. Both interventions produced sustained effects through the 6th assessment point, approximately 4.5 years after enrollment, with relatively small sample loss of families (<14%). Clinician-based families had significantly more gains in parental child-related behaviors and attitudes and in child-reported understanding of parental disorder. Child and parent family functioning increased for both groups and internalizing symptoms decreased for both groups, with no significant group differences. These findings demonstrate that brief, family-centered preventive interventions for parental depression may contribute to long-term, sustained improvements in family functioning.     

Prevention of pathological gambling: a randomized controlled trial

Although the gambling industry is expanding rapidly throughout North America and around the world, there are only a few empirically evaluated programs aimed at the prevention of pathological gambling (PG). The purpose of this study was to measure the effectiveness of a new prevention program aimed at PG. The Stop & Think! program was designed to teach at-risk video lottery terminal (VLT) gamblers cognitive restructuring and problem-solving skills that may help to prevent the development of PG. These skills were taught through a variety of methods - including an automated educational presentation, video and text vignettes, audio training tapes, and skill rehearsal. The program was evaluated using a randomized, 2-group experimental design with a wait-list control group and pre-, post-, and follow-up measures. Results indicated that, compared with the control group, the experimental group was less at risk for developing a gambling problem after the program. The experimental group endorsed fewer gambling-related cognitive distortions, engaged in less VLT gambling, and had lower scores on a measure of PG. The results of this study provide the basis for the implementation of the Stop & Think! program in the province of Prince Edward Island, Canada, and perhaps other jurisdictions too.     

The effects of attrition on baseline comparability in randomized experiments in education: a meta-analysis

Using meta-analysis, randomized experiments in education that either clearly did or clearly did not experience student attrition were examined for the baseline comparability of groups. Results from 35 studies suggested that after attrition, the observed measures of baseline comparability of groups did not differ more than would be expected given sampling error. The degree of either overall or differential attrition did not relate to baseline comparability, a finding that held under sensitivity analyses. Also, both overall and differential attrition rates were unrelated to posttest effect sizes. All of these analyses, however, lacked sufficient statistical power to detect small but potentially meaningful effects. Results suggest caution is warranted when applying quality scales and other blanket rules pertaining to attrition that are meant to either serve as inclusion-exclusion criteria or in scoring study quality. Much greater attention is needed to both the reporting of attrition in primary studies and to the development of conceptual and empirical models of the attrition process. These developments would aid further investigation of the relation between attrition and study outcomes.     

Applied tension, applied relaxation, and the combination in the treatment of blood phobia

Thirty patients with phobia for blood, wounds and injuries were treated individually with applied tension, applied relaxation, or the combination of these two methods for 5, 9 and 10 sessions, respectively. They were assessed on self-report, behavioral and physiological measures before and after treatment, and at a 6-month follow-up. All groups improved significantly on 11/12 measures, and the improvements were maintained at follow-up. Applying stringent criteria, 73% of the patients were clinically improved at the end of treatment and 77% were so at follow-up. Despite a failure to find between-group differences, on many measures there was a trend favoring applied tension. Since this method is as effective as the other treatments in only half the time, applied tension should clinically be the treatment of choice for blood phobia.     

Investigator ratings of ADHD symptoms during a randomized, placebo-controlled trial of atomoxetine: a comparison of parents and teachers as informants

This study compared investigator ratings of ADHD symptoms based on interviews with parents and teachers during a doubleblind, placebo-controlled study of atomoxetine. Investigators completed the ADHD Rating Scale: Investigator (ADHDRS-I) based on separate semistructured interviews with the primary caretaker and teacher of the participant. Interviews were conducted at Visits 2 to 7 during a double-blind treatment protocol comparing atomoxetine (N= 10) and placebo (N= 6). Both parent and teacher-based ratings were sensitive to change in ADHD symptoms with atomoxetine treatment. Parent-based assessment differentiated significantly between treatment with atomoxetine and placebo, whereas teacher-based assessment was less sensitive to change. Parents and teachers showed good agreement on change in ADHDRS-I scores. Investigator ratings based on parent- and teacher-report were sensitive to change in symptoms of ADHD during treatment with atomoxetine. Despite good agreement between parent- and teacher-based ratings of symptom change, parent-based ADHD symptom ratings are more sensitive to symptom change.     

A randomized controlled trial of a coping group intervention for adults with HIV who are AIDS bereaved: longitudinal effects on grief.

The authors sought to study the longitudinal effects of a cognitive-behavioral group intervention for coping with AIDS bereavement among a diverse sample of adults who were HIV positive. Participants (N = 267) were randomly assigned to receive the 12-week intervention or individual therapy upon request. Measures were administered at baseline, postintervention, and 4-, 8-, and 12-month follow-ups. Longitudinal data were analyzed with linear mixed models to examine change in grief by condition across the study period and the effect of the intervention on grief through its interaction with psychiatric distress. The authors used the Grief Reaction Index to assess grief and the Symptom Checklist-90-Revised to assess global psychiatric distress. Participants in both conditions reported decreases in grief severity. However, among those with higher levels of psychiatric distress, participants in the group intervention had significantly lower grief severity scores compared with participants in the individual therapy condition. The long-term effectiveness of this AIDS-bereavement intervention for psychiatrically distressed people with HIV/AIDS supports the need for tailored interventions among those at risk for complicated grief responses.     

Evidence that implementation intentions reduce dietary fat intake: a randomized trial.

This study evaluates the effectiveness of an intervention based on the concept of implementation intentions for reducing dietary fat intake. Participants (n=264) completed questionnaires on their motivation to eat a low-fat diet before being randomized to either an experimental condition, which required them to form an implementation intention, or a control condition. Results showed that, after 1 month, fat intake, saturated fat intake, and the proportion of energy derived from fat decreased significantly in the experimental group but not in the control group. This difference could not be explained by differences in motivation between the 2 groups. The findings are discussed in relation to the use of implementation intentions instead of tailored interventions to change behavior in general populations.     

Reduction in disability in a randomized controlled trial of telephone-administered cognitive-behavioral therapy.

OBJECTIVE: The authors examined the efficacy of telephone-administered cognitive-behavioral therapy (T-CBT) and telephone-administered supportive emotion-focused therapy (T-SEFT) in reducing disability among disabled patients with multiple sclerosis and depression. Telephone administration of therapy allowed care to be delivered to a more disabled population. This is a secondary analysis of a randomized controlled trial; the primary outcome results for depression are reported in D. C. Mohr, S. L. Hart, L. Julian, C. Catledge, L. Honos-Webb, L. Vella, et al. (2005). DESIGN: A randomized controlled trial, comparing 16 weeks of T-CBT with T-SEFT. MAIN OUTCOME MEASURES: Disability was measured using Guy's Neurological Disability Scale; fatigue was measured using the Fatigue Impact Scale; depression was measured using the Hamilton Depression Rating Scale and the Beck Depression Inventory-II. RESULTS: Patients in both treatments showed significant improvements in disability and fatigue. These improvements were related to reductions in depression. T-CBT produced significantly greater decreases in disability and fatigue, compared with T-SEFT, even after controlling for depression. The greater benefit of T-CBT on disability was mediated by physical fatigue. CONCLUSION: These findings support the hypothesis that significant reductions in disability can be achieved by reducing depression in patients with multiple sclerosis. There was also evidence that further reductions could be achieved through CBT-specific interventions that include a focus on symptoms such as fatigue management.     

Prevention of anxiety symptoms in children: results from a universal school-based trial

The present study evaluated the effectiveness of a universal school-based cognitive behavior prevention program (the FRIENDS program) for childhood anxiety. Participants were 638 children, ages 9 to 12 years, from 14 schools in North Rhine-Westphalia, Germany. All the children completed standardized measures of anxiety and depression, social and adaptive functioning, coping strategies, social skills, and perfectionism before and after the 10-week FRIENDS program and at two follow-up assessments (6 and 12 months) or wait period. Children who participated in the FRIENDS program exhibited significantly fewer anxiety and depressive symptoms, and lower perfectionism scores than children in the control group at 12-month follow-up. Younger children (9-10-year-olds) displayed treatment gains immediately after the intervention, whereas older children (11-12-year-olds) showed anxiety reduction only at 6- and 12-month follow-up. Perfectionism and avoidant coping acted as mediators of pre- to postintervention changes in anxiety scores. This study provides empirical evidence for the utility of the FRIENDS program in reducing anxiety and depressive symptoms among German children.     

The relation of patients' treatment preferences to outcome in a randomized clinical trial

Randomization procedures are performed in order to maximize the internal validity of treatment outcome studies. Objections have been made that this practice undermines the external validity of these studies because it ignores patients' treatment preferences, thereby precluding the self-selection of treatment that can occur in the community. This study used data from a multisite, double-blind, randomized, placebo-controlled trial comparing antidepressant medication to cognitive therapy for moderately to severely depressed outpatients. It compared the treatment outcomes of patients who, via randomization, received their preferred treatment versus those who did not. Although the majority of patients stated a preference for one treatment over the other, there was no significant difference in the magnitude of reduction in symptoms of depression between those who received their treatment of choice versus those who did not. These results do not provide support for the claim that the external validity of randomized controlled trials suffers from this aspect of the randomization procedure.     

A randomized trial comparing the effects of self-help materials and proactive telephone counseling on teen smoking cessation.

We conducted a 2-arm randomized trial to test the efficacy of self-help materials with or without proactive telephone counseling to increase cessation among teen smokers. Teen smokers (N = 402) recruited from 11 shopping malls and 1 amusement park in the southeastern United States were randomized to 1 of 2 groups: written self-help material plus video; or written self-help material, video, and telephone counseling. Cessation rates based on 7-day point-prevalent abstinence for the self-help and counseling arms were 11% and 16%, respectively (p = .25), at 4 months postbaseline and 19% and 21%, respectively (p = .80), at 8 months postbaseline. Sustained abstinence, reflecting 7-day abstinence at both time points, in the self-help and counseling arms was 7% and 9% (p = .59). Results suggest that minimal self-help cessation approaches that target youth have comparable success to that shown among adult smokers. However, refinements in telephone-counseling approaches may be needed to achieve the success observed in adult populations.     

Depression vulnerability moderates the effects of cognitive behavior therapy in a randomized controlled trial for smoking cessation

Several clinical trials have tested the hypothesis that smoking cessation treatments with a mood management component derived from cognitive behavior therapy (CBT) for depression would be specifically effective for depression-vulnerable smokers, with mixed results. This trial addressed methodological concerns with some of the previous studies to clarify whether depression vulnerability does in fact moderate CBT smoking cessation outcome. The study compared 8-session group CBT with a time-matched comparison group condition in a sample of 100 cigarette smokers randomized to treatment condition. Each treatment group was led by one of 7 American University clinical psychology graduate students; therapists were crossed with treatment conditions. Outcome (7-day point prevalence abstinence) was evaluated 1 month and 3 months after quit date. Baseline self-reported depression vulnerability (sample median split on the Depression Proneness Inventory) moderated treatment response, such that more depression-prone smokers fared better in CBT whereas less depression-prone smokers fared better in the comparison condition. These results may have implications for determining when to use CBT components in smoking cessation programs.     

Caffeine attenuates vasovagal reactions in female first-time blood donors.

The experience of vasovagal reactions during blood donation (e.g., faintness, dizziness, lightheadedness) can be a deterrent to repeat donation. Because these reactions are associated with decreases in blood pressure, caffeine was examined as a potential modulator of vasovagal reactions by virtue of its pressor effects. Using a randomized, double-blind design, 62 female undergraduate 1st-time blood donors received either 0, 125, or 250 mg of caffeine prior to blood donation. Participants who received 250 mg of caffeine had lower scores on the Blood Donation Reactions Inventory, required fewer interventions by phlebotomists for negative reactions, and reported a greater likelihood of repeat donation than participants who received placebo. These findings suggest that a moderate dose of caffeine attenuates negative reactions in novice female blood donors and may increase the likelihood of repeat donations.     

The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study.

In this study, Herbert Benson's (1975) Relaxation Response Meditation program was tested as a possible treatment for Irritable Bowel Syndrome (IBS). Participants were 16 adults who were matched into pairs based on presence of Axis I disorder, primary IBS symptoms and demographic features and randomized to either a six week meditation condition or a six week wait list symptom monitoring condition. Thirteen participants completed treatment and follow-up. All subjects assigned to the Wait List were subsequently treated. Patients in the treatment condition were taught the meditation technique and asked to practice it twice a day for 15 minutes. Composite Primary IBS Symptom Reduction (CPSR) scores were calculated for each patient from end of baseline to two weeks post-treatment (or to post wait list). One tailed independent sample t-tests revealed that Meditation was superior to the control (P=0.04). Significant within-subject improvements were noted for flatulence (P=0.03) and belching (P=0.02) by post-treatment. By three month follow-up, significant improvements in flatulence (P<0.01), belching (P=0.02), bloating (P=0.05), and diarrhea (P=0.03) were shown by symptom diary. Constipation approached significance (P=0.07). Benson's Relaxation Response Meditation appears to be a viable treatment for IBS.