Alcoholics treated by individualized behavior therapy: One year treatment outcome

One-year treatment outcome results are reported for 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating ‘Individualized Behavior Therapy (IBT)’ techniques. Initially, subjects had been assigned to a controlled drinking or non-drinking (abstinence) treatment goal, and then were randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment. One year follow-up results demonstrated that IBT treated subjects had functioned significantly better than control subjects. Dependent variable measures included daily drinking disposition, general emotional adjustment, vocational satisfaction, occupational status, driving status and an index of residential status and stability. The results support the view that some ‘alcoholics’ can acquire and maintain controlled drinking behavior over at least a 1-yr follow-up interval. The difficulties of designing and applying sophisticated follow-up procedures and measures are discussed.     

A learning approach to the treatment of homosexuality

‘Aversive’ techniques in the treatment of homosexuality provide practical and ethical difficulties for the therapist. A technique involving ‘imaginary’ aversive therapy and a discrimination learning task is described. It is felt that such an approach following on classical desensitization of neurotic disturbances which may underly the homosexual disorder, offers hope of early symptom removal and lasting improvement.     

Electrical aversion therapy with alcoholics: An analogue study

Chronic alcoholic patients matched on age, education and length of problem drinking were assigned to one of three treatment conditions, with 10 subjects in each group: (1) Electrical Aversion Conditioning (high shock paired with alcohol sips); (2) Control Conditioning (very low shock paired with alcohol sips); and (3) Group Therapy (confrontation psychotherapy). Groups 2 and 3 were included to control for possible ‘attention-placebo’ and expectancy factors involved in the conditioning procedures. Subjects in each group were given instructions designed to produce high expectancy for therapeutic success. Pre-post measures of alcohol consumption and attitudes toward alcohol were obtained using an analogue ‘taste test’ assessment procedure. No statistically significant differences in reduced alcohol consumption or attitudes toward alcohol were found among the groups. Trends in the data support the contention that effects of electrical aversion may be more related to such factors as therapeutic instructions, expectancy, specificity of the procedure or experimental demand characteristics than to conditioning factors.     

Panic attacks without fear: An overview*

‘Non-fearful panic disorder’ (NFPD) is a condition that meets DSM III-R criteria for panic disorder but lacks a report of subjective fear or anxiety. Presenting the first comprehensive overview of this issue, the authors describe studies investigating a wide range of apparently overlapping phenomena including NFPD, ‘somatically expressed panic’, ‘non-cognitive panic’, ‘alexithymic panic’, ‘non-clinical panic’, and ‘masked anxiety’. The review shows that such conditions account for from 20 to 40% of the panic disorder found in various medical populations, and that this group resembles conventional panic disorder in cross-sectional comparisons. We emphasize that a ‘triple-response’ model of anxiety is consistent with our conclusion that NFPD should be conceptualized as a panic disorder subtype. Finally, we discuss unresolved issues regarding the construct and predictive diagnostic validity of NFPD.     

Group play therapy and tangible reinforcers used to modify the behavior of 8-yr-old boys

Eleven third-grade boys were randomly assigned to three play therapy groups. The boys had been referred by their teachers because of shy, withdrawn behavior. The Token Group met in a play group (4 Ss), had a therapist, and received tangible reinforcements for social approach behavior. The Verbal Group (4 Ss) was treated similarly to the Token Group except that no tangible reinforcements were used. The Control Group (3 Ss) met in a play group without a therapist present. Fourteen play sessions were held for each group. The Token Group changed more than the Verbal Group; the Verbal Group changed more than the Control Group; the Control Group showed no change on the objective measures used. The Token Group exhibited an increase in social approach behavior and a decrease in discrete, problem behavior. The Verbal Group increased slightly in social approach behavior. All groups failed to demonstrate changes in “productivity”, “anxiety” and “general psychological adjustment”.     

More historical dimensions of commonsense knowledge: Spiritual consolation for the depressed

Ss were given 15 propositions derived from the neoclassical canon of advice on spiritual consolation for the depressed and were asked either to rate the extent of their personal agreement with each and to predict the average ratings for the group, or to say whether they regarded each proposition as ‘true’ or ‘not true’ and to predict the percentage of the group that would choose ‘true’ for each proposition. The observed and mean predicted rank orders were compared within and between methods; all correlations were high, positive, and significant. The results suggest that people's higher-order ideas about other people's ideas include notions about the intensity of beliefs as well as about the proportion of believers. Contemporary developments of those propositions which a clear majority of the present Ss endorsed are discussed.     

Increasing purposeful activity of severely and profoundly mentally-handicapped adults

A time-series reversal design was used to evaluate the effect of a ‘room manager’ procedure on the level of purposeful activity of severely and profoundly mentally-handicapped people in a residential home. The room manager procedure consisted of systematic prompts to participate in recreational activity and social reinforcement contingent on engagement. Data were collected on group and individual client behaviour and two measures of staff performance were taken to assess whether the procedure was implemented consistently across subjects and in line with the experimental design. The results showed that, as well as a group of subjects who engaged at a higher level during the room manager condition, there were consistently ‘high-engaging’ and ‘low-engaging’ groups, reflecting in part the general level of ability of the subjects. However, data on the independent variables show that the the contingency of staff contact did not vary across conditions and it cannot therefore be assumed that these subjects would not respond to the intervention. Some limitations of the procedure as used are discussed, and areas where further work is needed are indicated.     

Acute pain in a clinical setting: Effects of cognitive-behavioural skills training

The present study evaluated the efficacy of cognitive-behavioural skills training, patterned after stress-inoculation training, as a preventive intervention for the attenuation of acute clinical pain during a noxious X-ray procedure—the knee arthrogram. Thirty-six adult male outpatients were randomly assigned to one of three groups: Skills Training. Attention-Placebo, and No-Treatment Control. An experimental pain test was administered before and after the interventions, as a generalization measure. Arthrogram pain was assessed by three dependent measures: patient's ratings, radiologist's ratings and videotape ratings completed by two‘blind’ raters. The results failed to support the efficacy of skills training for the attenuation of acute clinical pain, or its generalization to the experimental pain test. Although Skills Training subjects reported using significantly more coping strategies during the arthrogram. many subjects in the two control groups also reported using their own spontaneous strategies. Equivocal data were obtained on the role of ‘self-efficacy’ expectancies in mediating pain behaviour and experience. Experimental pain threshold but not pain tolerance was significantly related to acute clinical pain experienced during the arthrogram.     

Commonsense beliefs about depression and antidepressive behaviour: A study of social consensus

The present study examines consensus in endorsed beliefs about depression and antidepressive behaviour in a group of 100 psychologists. Ss were given 20 pairs of items and asked to indicate which member of each pair they felt was ‘nearer the truth’. The numbers (and percentages) of Ss choosing each item was examined for each pair. Consensus was found to span the range from 100% agreement to near-complete disagreement and to be distributed roughly normally within the sample of items. People tended to agree about propositions that could be verified by an individual's own firsthand experience and observation and to disagree about more abstract matters that the ‘experts’ are still debating. The congruence of these findings with previous results in the present series of studies is discussed and suggestions for further exploration in the realm of ‘what everybody knows’ about depression and how to deal with it are given.     

Mitigating aggression and promoting prosocial behavior in aggressive elementary schoolboys

The effects of four school-based interventions designed to decrease children's aggression and promote prosocial behavior were assessed. One hundred and four aggressive boys, ages 8–13, from ‘Behavior Disorder’ classrooms, were assigned to one of four training conditions: cognitive (self-control) training, behavioral (prosocial skills) training, combined cognitive-behavioral training, or attention/play training. School psychologists trained the boys in small groups for 10 1-h sessions. It was hypothesized that training in both cognitive and behavioral competencies would lead to the most behavioral improvement. Results indicated that, according to teacher report, those children receiving the cognitive-behavioral and attention/play interventions improved significantly more than those exposed to cognitive and behavioral training by decreasing their aggression and increasing their prosocial behavior immediately following the intervention. At 6-month follow-up, only those children exposed to the attention/play intervention remained significantly improved.     

Selecting a best multiattribute alternative with partial information about attribute weights

Use of approximate weights would greatly simplify decision analysis under certainty since detailed weight elicitation could be avoided. This paper examines the degree to which rank order information about weights can be used to identify a best alternative, or falling uniqueness prescribes an easily implemented rule for selecting a ‘best’ alternative. The prescribed rule uses as weights the centroid of the feasible region defined by the rank order information. In conjunction with the rule, the value of the rank order information can be determined using an ‘expected gain from weight precision’ (EGWP) measure, analogous to ‘expected value of perfect information’ in decision analysis under uncertainty.     

Spouse involvement and a possible long-term follow-up trap in weight loss

The present study was conducted to determine if husband attendance at treatment sessions and participation in behavioral contracting would produce greater weight losses than two other levels of spouse involvement. The three treatment groups investigated did not significantly differ at post-treatment but by 1-yr follow-up female Ss who attended treatment sessions alone and contracted with the counselor (HA) lost significantly more weight than women who attended sessions with their husbands and also contracted with the counselor (HNC). The Ss who attended sessions with their husbands and contracted with them (HC) did not significantly differ from Ss in the other two conditions. The total amount lost by Ss in the HA, HNC and HC conditions by 1-yr follow-up was 16.4, 4.4 and 15.5 lb, respectively. The study was also conducted to collect preliminary data about procedures Ss used during long-term follow-up to ascertain if weight losses during follow-up could be attributed to the behavioral weight-loss techniques learned during the treatment program. At all follow-up periods, many Ss reported using behavioral weight-loss techniques but 4 of the 36 Ss (11.1%) at 1-yr follow-up, 15 of the 23 (65.2%) and 24 of the 25 (96.0%) who responded, respectively, at 3- and 4-yr follow-up had used other weight-loss programs or methods. A possible confound for follow-up data was identified and suggestions for future research were presented.     

Factors influencing sexual performance in male rhesus monkeys.

A 5-yr retrospective study of the sexual behavior of eight adult male rhesus monkeys showed that sexual vigor declined over the years but testosterone levels in peripheral vein plasma did not. Two prospective experiments were then carried out on these males during the sixth year. (a) The four poorest performers were injected daily for 28 days with testosterone propionate (1 mg/kg of body weight). There was no significant increase in level of performance, and behavior was not correlated with plasma levels of testosterone either before or 24 hr after the last hormone injection. (b) All eight males were exposed to novel nonspecific sensory stimulation during tests of sexual behavior. Eight different adult male rhesus strangers-present in the room but not in the test cage-were used as stimuli, one for each experimental test. Sexual behavior during experimental and control tests did not differ.     

A Theory-Based Treatment of Psychotic Symptoms in Schizophrenia: Treatment Successes and Obstacles to Implementation

This study investigated the use of the immediacy theory to explain the existence of auditory hallucinations and delusions in individuals with schizophrenia and to develop treatment strategies. In a 2-phase approach, a therapist trained 6 individuals with schizophrenia to stop responding to the immediate stimuli ostensibly evoking their symptoms and instead to respond to more remote stimuli unrelated to the problem behavior. Two other participants received nonspecific supportive psychotherapy to control for rater bias and to provide some comparison to the experimental treatment. Following 6 weeks of therapy, participants in the experimental group improved on 66% of the symptom measures. By contrast, participants in the control group improved on only 11% of the measures. The individuals in the experimental group retained some of these benefits during the follow-up period. The findings are discussed in light of several contributory factors.     

A clinical trial of continuous, intermittent and overlearning ‘bell and pad’ treatments for nocturnal enuresis

Sixty-one enuretic children were allocated sequentially to ‘standard’, ‘intermittent’ or ‘overlearning’ bell and pad treatment. The results suggest that the ‘overlearning’ modification of standard treatment was successful in bringing about a reduction in the relapse rate. The present status and implications of research into nocturnal enuresis were discussed in the light of the results of the investigation.     

Group aversion by imaginal, vicarious and shared recipient-observer shocks

Sixty college students completed waiting control or alternative group aversion conditions, matched for severity and chronicity of nail-biting. Treatments spanned four sessions. Imaginai aversion (covert sensitization) clients visualized shocks to themselves. Vicarious aversion clients observed shocks to a trained model. A ‘hotseat’ format randomized a few actual shocks to each client with observing peers shocked on remaining trials. The predominant pattern of outcome and subjective impact results was as follows: Hotseat consistently best; vicarious typically second; imaginal usually third; controls worst. Clinical and conceptual issues are raised.     

Needs met through computer game play among adolescents

Despite much research on video/computer game play, especially the relationship between such play and aggression, little attention has been directed at needs met through play. The aim of the present study was to extend Selnow’s (1984) needs’ scale, and to identify individual differences in needs among adolescents. Focus groups were conducted, followed by a content analysis, and items corresponding to emerging themes were added to reasons identified in previous research for use in a quantitative survey. Four factors emerged from a factor analysis of the results; ‘companionship’, ‘prefer to friends’, ‘fun challenge’, and ‘stress relief’, and these, with the exception of ‘companionship’, were found to be significant predictors of play.     

Parent Expectancies for Child Therapy: Assessment and Relation to Participation in Treatment

Two studies examined parents' pre-treatment expectancies for their child's psychotherapy among children (N = 405, ages 2–15) referred for oppositional, aggressive, and antisocial behavior. Study I focused on the development of a measure to assess expectancies. The results indicated that the measure was internally consistent. Moreover, socioeconomic disadvantage and ethnic minority status, severity of child dysfunction, child age, and parental stress and depression were significant predictors of lower parent expectancies for child therapy. Study II examined the relation of parent expectancies and participation in therapy. The results indicated that parent expectancies predicted subsequent barriers to treatment participation, treatment attendance, and premature termination from therapy. Overall, these findings have implications for the study of expectancies for therapy, for identifying families at risk for premature termination from treatment, and for the development of interventions designed to increase parent participation in child therapy.     

THERAPIST DEFENSIVENESS AND MARITAL THERAPY PROCESS AND OUTCOME

Abstract

This study examined the effect of couple socioeconomic status (SES); pretherapy marital adjustment; and therapist, husband, and wife defensiveness during the third session of marital therapy on posttherapy marital adjustment. Participants were 22 therapists and 88 couples. Each therapist treated 4 couples, 2 from the middle SES level and 2 from the lower SES level. Path analyses revealed that for husbands higher marital satisfaction before therapy was associated with higher adjustment at the end of therapy, but defensive therapist behavior during therapy was associated with lower posttherapy adjustment. A similar pattern was found for wives, but this should be interpreted with caution owing to potential dependencies in the wives' posttherapy adjustment scores. Neither SES nor pretherapy adjustment predicted therapist defensive behavior in therapy, and SES did not predict marital therapy outcome variance. Results suggest that therapist defensive behavior may reflect a style or characteristic of some marital therapists.