Group Cognitive Behavior Therapy for Chronic Posttraumatic Stress Disorder: An Initial Randomized Pilot Study

Individuals with posttraumatic stress disorder (PTSD) related to a serious motor vehicle accident were randomly assigned to either group cognitive behavioral treatment (GCBT) or a minimum contact comparison group (MCC). Compared to the MCC participants (n = 16), individuals who completed GCBT (n = 17) showed significant reductions in PTSD symptoms, whether assessed using clinical interview or a self-report measure. Among treatment completers, 88.3% of GCBT participants did not satisfy criteria for PTSD at posttreatment assessment, relative to 31.3% of the MCC participants. Examination of anxiety, depression, and pain measures did not show a unique advantage of GCBT. Treatment-related gains were maintained over a 3-month follow-up interval. Patients reported satisfaction with GCBT, and attrition from this treatment was comparable with individually administered CBTs. Results are discussed in light of modifications necessitated by the group treatment format, with suggestions for future study of this group intervention.     

The Driving Behavior Survey as a Measure of Behavioral Stress Responses to MVA-Related PTSD

Numerous treatments are available that address the core symptoms of posttraumatic stress disorder (PTSD). However, there are a number of related behavioral stress responses that are not assessed with PTSD measures, yet these behavioral stress responses affect quality of life. The goal of the current study was to investigate whether a recently developed measure of behavioral stress response, the Driving Behavior Survey (DBS), was sensitive to change associated with treatment among a group of participants diagnosed with PTSD. The DBS indexes anxious driving behavior, which is frequently observed among individuals with motor vehicle accident-related PTSD. Participants (n = 40) were racially diverse adults (M age = 40.78, 63% women) who met diagnostic criteria for motor vehicle accident-related PTSD. Hierarchical linear modeling analyses indicated that participants who were assigned to a brief, exposure-based intervention displayed significant reductions on the DBS subscales relative to participants assigned to the wait-list control condition (r = .41–.43). Moreover, mediational analyses indicated that the observed reductions on the DBS subscales were not better accounted for by reductions in PTSD. Taken together, these findings suggest that the DBS subscales are sensitive to changes associated with PTSD treatment and can be used to augment outcome assessment in PTSD treatment trials.     

Stepped care for obsessive-compulsive disorder: An open trial

This study evaluated the effectiveness and treatment costs associated with a stepped care protocol of exposure and response prevention (EX/RP) for obsessive-compulsive disorder (OCD). In the current open trial, patients (N = 14) began with self-directed EX/RP and minimal therapist guidance over the course of six weeks (Step 1). During this phase of treatment, no therapist-directed exposures were conducted. Those who did not respond optimally to Step 1 went on to Step 2, which consisted of 15 sessions of twice-weekly therapist-directed exposures. Results of this study show promise for stepped care utilizing EX/RP for some patients with OCD, with a response rate of 88% and a 60% reduction on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score among treatment completers. Significant improvements were found in Y-BOCS from pre to post-treatment for both Step 1 and Step 2 completers. Forty-five percent of participants (n = 5) responded following completion of Step 1, resulting in reduced cost of treatment among these participants. All participants who responded to Step 1 maintained acute gains during the brief follow-up period. Limitations include a small sample size and high attrition rate.     

The effect of training in verbal self-guidance on the self-efficacy and performance of Native North Americans in the selection interview

Native North Americans (n = 35) received training in verbal self-guidance (VSG) designed to increase self-efficacy in a selection interview. At the end of the training program, the trainees who acquired skills in VSG had higher self-efficacy than the participants in the control group (n = 31) regarding their interview performance. They also performed better in the selection interview as judged by managers who were blind to the experimental conditions.     

All at Once or One at a Time? A Randomized Controlled Trial Comparing Two Ways to Deliver Bibliotherapy for Panic Disorder

Bibliotherapy is potentially effective in the treatment of panic disorder (PD). A still unanswered question is whether pacing is important. This study was designed to test whether there is a difference between being assigned a full book as therapy and receiving one individual chapter every week (i.e. pacing). A total of 28 participants were randomized to either 10 paced chapters or one book with 10 chapters. To maximize compliance, short weekly telephone calls were added in both conditions (M = 17.8 min, SD = 4.2). Both treatments showed promising results, with effects maintained up to 2 years and with within-group effect sizes (Cohen's d) between 0.95 and 1.11. Pretreatment ratings of credibility were positively correlated with the change scores at both posttest and 2-year follow-up for three panic measures. Pacing of text material in bibliotherapy for PD is not needed, and all material can be provided at once when the treatment is guided by a therapist.     

Testing the long-term efficacy of a prevention program for improving marital conflict in community families

Family-focused prevention programs for community samples have potentially broad, clinically relevant implications but few studies have examined whether any program benefits continue to be observed over the long term. Although benefits of a marital conflict focused parent education program, the Happy Couples and Happy Kids (i.e., HCHK) program, were supported in a study based on pre-test, post-test, 6-month follow-up, and 1-year follow-up assessments, the longer-term stability of treatment effects has not been established. Couples with children between 4 and 8 years of age who had previously participated in the HCHK study completed a two-year follow-up, including a parent-only group (PO, n = 12); parent-child group (PC, n = 15); and a self-study group (SS, n = 12). Greater knowledge about the effects of marital conflict on families and behavioral improvements in constructive conflict, and specifically in problem-solving behaviors, were observed at the two-year follow-up for couples who received the HCHK program. Reflecting an innovative analysis of mediating mechanisms, change-to-change analyses showed that these changes were linked with improvements in other family processes over time, including marital satisfaction, parenting and child adjustment. The findings support the relatively long-term efficacy of brief, psychoeducational programs for educating community samples about marital conflict and family processes.     

Does a Positive Bias Relate to Social Behavior in Children With ADHD?

This study examines whether positively biased self-perceptions relate to social behaviors in children with attention-deficit/hyperactivity disorder (ADHD) as compared to control children. The social behaviors of children with ADHD (n = 87) were examined relative to control children (CTL; n = 38) during a laboratory-based dyadic social interaction task. Children with ADHD were subgrouped into those with a positive illusory bias (PIB) in their self-perceptions (ADHD + PIB) versus those without such a bias (ADHD – PIB). Using a behavioral coding system adapted for this study, ADHD + PIB, ADHD – PIB, and CTL participants were compared on objectively coded social behaviors occurring within the context of the social interaction task. Whereas both ADHD groups displayed more disruptive behavior than controls, only the ADHD + PIB group displayed less prosocial behavior and less effortful behavior. This study breaks new ground by examining positively biased self-perceptions as they relate to social behavior in children with ADHD and provides promising new insight into the social problems experienced by these children.     

Combined Medication and CBT for Generalized Anxiety Disorder With African American Participants: Reliability and Validity of Assessments and Preliminary Outcomes

Using data from a study of combined cognitive behavioral therapy (CBT) and venlafaxine XR in the treatment of generalized anxiety disorder (GAD), the current article examines the reliability and convergent validity of scales, and preliminary outcomes, for African American compared with European American patients. Internal consistency and short-term stability coefficients for African Americans (n = 42) were adequate and similar or higher compared with those found for European Americans (n = 164) for standard scales used in GAD treatment research. Correlations among outcome measures among African Americans were in general not significantly different for African Americans compared with European Americans. A subset of patients with DSM-IV–diagnosed GAD (n = 24 African Americans; n = 52 European Americans) were randomly selected to be offered the option of adding 12 sessions of CBT to venlafaxine XR treatment. Of those offered CBT, 33.3% (n = 8) of the African Americans and 32.6% (n = 17) of the European Americans accepted and attended at least one CBT treatment session. The outcomes for African Americans receiving combined treatment were not significantly different from European Americans receiving combined treatment on primary or secondary efficacy measures.     

A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder

This study examined the efficacy of guided self-help based on dialectical behaviour therapy (DBTgsh) for binge eating disorder (BED). Individuals (88.3% female; mean 42.8 years) were randomized to DBTgsh (n = 30) or wait-list (WL; n = 30). DBTgsh participants received an orientation, DBT manual, and six 20-min support calls over 13 weeks. All participants were assessed pre- and post-treatment using interview and self-report; also, DBTgsh participants were re-assessed six months post-treatment. At treatment end, DBTgsh participants reported significantly fewer past-month binge eating episodes than WL participants (6.0 versus 14.4) and significantly greater rates of abstinence from binge eating (40.0% versus 3.3%). At six-month follow-up, DBTgsh participants reported significantly improved quality of life and reduced ED psychopathology compared to baseline scores. In addition, most improvements in the DBTgsh group were maintained, although binge eating abstinence rates decreased to 30%. These preliminary positive findings indicate that DBTgsh may offer an effective, low-intensity treatment option for BED.     

A Randomized Trial of Attention Training for Generalized Social Phobia: Does Attention Training Change Social Behavior?

The use of attention training protocols for the treatment of generalized social anxiety disorder (SAD) is undergoing increased examination. Initial investigations were positive but more recent investigations have been less supportive of the treatment paradigm. One significant limitation of current investigations is overreliance on self-report. In this investigation, we expanded on initial investigations by using a multimodal assessment of patient functioning (i.e., including behavioral assessment). Patients with a primary diagnosis of SAD (n = 31) were randomly assigned to eight sessions of attention training (n = 15) or placebo/control (n = 16). Participants were assessed at pre- and posttreatment via self- and clinician-report of social anxiety as well as anxious and behavioral response to two in vivo social interactions. Results revealed no differences between groups at posttreatment for all study outcome variables, suggesting a lack of effect for the attention training condition. The results are concordant with recent investigations finding a lack of support for the use of attention training as an efficacious treatment for patients with SAD.     

Facial asymmetry detection in patients with body dysmorphic disorder

Cognitive-behavioral models of body dysmorphic disorder (BDD) propose that individuals with BDD may possess a better or more developed sense of aestheticality than do individuals without BDD. Evidence for this proposition, however, is limited. One perceptual process that could contribute to heightened aestheticality is the ability to detect differences in symmetry. In this experiment we tested whether individuals with BDD (n = 20), relative to individuals with obsessive compulsive disorder (OCD; n = 20) and healthy controls (n = 20), show an enhanced ability to detect differences in the symmetry of others’ faces, symmetry of dot arrays, and/or show a greater preference for symmetrical faces. Individuals with BDD were not significantly more accurate in detecting differences in facial symmetry or dot arrays relative to individuals with OCD and healthy controls. Individuals with OCD took longer to make facial symmetry judgments than did individuals in the other two groups. All participants, regardless of diagnostic group, preferred more symmetrical faces than nonsymmetrical ones. Taken together, our results do not support a heightened perceptual ability or evaluative preference for symmetry among individuals with BDD.     

All at once or one at a time? A randomized controlled trial comparing two ways to deliver bibliotherapy for panic disorder

Bibliotherapy is potentially effective in the treatment of panic disorder (PD). A still unanswered question is whether pacing is important. This study was designed to test whether there is a difference between being assigned a full book as therapy and receiving one individual chapter every week (i.e. pacing). A total of 28 participants were randomized to either 10 paced chapters or one book with 10 chapters. To maximize compliance, short weekly telephone calls were added in both conditions (M = 17.8 min, SD = 4.2). Both treatments showed promising results, with effects maintained up to 2 years and with within-group effect sizes (Cohen's d) between 0.95 and 1.11. Pretreatment ratings of credibility were positively correlated with the change scores at both posttest and 2-year follow-up for three panic measures. Pacing of text material in bibliotherapy for PD is not needed, and all material can be provided at once when the treatment is guided by a therapist.     

Reinforcement sensitivity theory and symptoms of personality disorder: Specificity of the BIS in Cluster C and BAS in Cluster B

Gray’s reinforcement sensitivity theory, consisting of the behavioral inhibition (BIS) and behavioral activation (BAS), is frequently used to represent basic dimensions of psychopathology. However, notably few investigations have examined the link between the BIS/BAS and symptoms of personality disorder (PD). Although the Fight-Flight-Freeze System has emerged in the revised model as an important aspect of motivation, the BIS (linked to anxiety) and BAS (linked to impulsivity) have been the primary foci. The current investigation uses a dimensional measure of PD, the schedule for nonadaptive and adaptive personality (SNAP; Clark, 1993) applied to two independent samples of English-speaking participants: undergraduates (n = 276) and clinical patients (n = 47). Results were consistent across both samples, demonstrating that symptoms of Cluster B PDs are indicative of high BAS levels whereas symptoms of Cluster C PDs are characterized by high BIS levels.     

A Clinical Trial of In-Home CBT for Depressed Mothers in Home Visitation

Despite negative outcomes for depressed mothers and their children, no treatment specifically designed to address maternal depression in the context of home visitation has emerged. In-Home Cognitive Behavioral Therapy (IH-CBT) is an adapted treatment that is delivered in the home, focuses on the needs of new mothers, and leverages ongoing home visiting to optimize engagement and outcomes. This study examined the efficacy of IH-CBT using a randomized clinical trial. Subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3 months postpartum were randomized into IH-CBT and ongoing home visitation (n = 47) or standard home visitation (SHV; n = 46) in which they received home visitation alone and could obtain treatment in the community. Depression was measured at pre- and posttreatment, and 3-month follow-up using interviews, clinician ratings, and self-report. Mothers receiving IH-CBT showed improvements in all indicators of depression relative to the SHV condition and these gains were maintained at follow-up. For example, 70.7% of mothers receiving IH-CBT were no longer depressed at posttreatment in terms of meeting criteria for major depressive disorder compared to 30.2% in the SHV group. These findings suggest that IH-CBT is an efficacious treatment for depressed mothers in home visitation programs.     

Enhancing the Benefits of Written Emotional Disclosure Through Response Training

Writing about a personal stressful event has been found to have psychological and physical health benefits, especially when physiological response increases during writing. Response training was developed to amplify appropriate physiological reactivity in imagery exposure. The present study examined whether response training enhances the benefits of written emotional disclosure. Participants were assigned to either a written emotional disclosure condition (n = 113) or a neutral writing condition (n = 133). Participants in each condition wrote for 20 minutes on 3 occasions and received response training (n = 79), stimulus training (n = 84) or no training (n = 83). Heart rate and skin conductance were recorded throughout a 10-minute baseline, 20-minute writing, and a 10-minute recovery period. Self-reported emotion was assessed in each session. One month after completing the sessions, participants completed follow-up assessments of psychological and physical health outcomes. Emotional disclosure elicited greater physiological reactivity and self-reported emotion than neutral writing. Response training amplified physiological reactivity to emotional disclosure. Greater heart rate during emotional disclosure was associated with the greatest reductions in event-related distress, depression, and physical illness symptoms at follow-up, especially among response trained participants. Results support an exposure explanation of emotional disclosure effects and are the first to demonstrate that response training facilitates emotional processing and may be a beneficial adjunct to written emotional disclosure.     

Treatment of panic disorder: live therapy vs. self-help via the Internet

A randomized trial was conducted comparing 10 individual weekly sessions of cognitive behaviour therapy for panic disorder (PD) with or without agoraphobia with a 10-module self-help program on the Internet. After confirming the PD diagnosis with an in-person structured clinical interview (SCID) 49 participants were randomized. Overall, the results suggest that Internet-administered self-help plus minimal therapist contact via e-mail can be equally effective as traditional individual cognitive behaviour therapy. Composite within-group effect sizes were high in both groups, while the between-group effect size was small (Cohen's d=16). One-year follow-up confirmed the results, with a within-group effect size of Cohen's d=0.80 for the Internet group and d=0.93 for the live group. The results from this study generally provide evidence to support the continued use and development of Internet-distributed self-help programs.     

A randomized pilot study of motivation enhancement therapy to increase utilization of cognitive–behavioral therapy for social anxiety

Despite the efficacy of cognitive–behavioral therapy (CBT), most socially anxious individuals do not seek treatment or seek treatment only after many years of suffering. This study evaluated the efficacy of a three-session motivation enhancement therapy (MET) designed to increase CBT utilization among socially anxious individuals. Twenty-seven non-treatment-seeking socially anxious individuals (92.6% met current DSM-IV criteria for social anxiety disorder) were randomly assigned to either MET for CBT (n = 12) or a control condition (n = 15). The primary outcome was attendance at first CBT appointment. Secondary outcomes included openness to therapist contact and willingness to schedule a CBT appointment. After the intervention, seven of the 12 (58.3%) participants in the MET condition attended a CBT appointment compared to two of 15 (13.3%) control participants. Eight of 11 (72.7%) participants in the MET condition indicated they would like a CBT therapist to contact them compared to four of 12 (33.3%) controls. Further, willingness to schedule a CBT appointment increased at a significantly greater rate in the MET condition. Results suggest MET for CBT may be a time-efficient means to increase CBT utilization among socially anxious individuals.     

Social skills and social phobia: An investigation of DSM-IV subtypes

Social phobia is characterized as pervasive social timidity in social settings. Although much is known about this disorder, aspects of its clinical presentation remain unexplored, in particular characteristics that distinguish the generalized and non-generalized subtypes. For example, it remains unclear whether patients with the non-generalized subtype display social skills deficits in social interactions, and if so, are these deficits clinically, as well as statistically, significant? In this study, adults with either the non-generalized (NGSP; n = 60) or generalized (GSP; n = 119) subtype of social phobia and adults with no psychological disorder (n = 200) completed an extensive behavioral assessment of social skill and social anxiety. As expected, adults with NGSP and GSP reported equal distress and displayed similar rates of avoidance during an Impromptu Speech Task when compared to adults with no disorder. In contrast, the three groups were distinctly different when interacting with another person in various social situations. Adults with NGSP displayed social skill deficits when compared to individuals with no disorder, but they had fewer deficits than the GSP subtype. However, the identified skill deficits were clinically as well as statistically significant only for the GSP subtype. The results are discussed in terms of the contribution of skill deficits to the conceptualization and treatment of social phobia.