Evidence-based treatment of stuttering: IV. Empowerment through evidence-based treatment practices

Assertion-based treatments for stuttering have historically been more popular than evidence-based treatments. In this paper it is argued that the use of evidence-based treatments for stuttering is professionally empowering for clinicians, but that the use of assertion-based treatments is a circular process that inhibits professional development. The arguments in favor of evidence-based treatment are elaborated under headings of "professional investment," "professional development and diversity," and "optimizing treatment efficacy." EDUCATIONAL OBJECTIVES: The reader will understand and be able (1) to describe the distinction between assertion-based and evidence-based treatment practices (2) to present a series of arguments that evidence-based treatment practices are professionally empowering.     

Group psychotherapy treatment of borderline personalities.

Borderline personalities have been treated in psychotherapy groups for over 40 years. This article elaborates some of the characteristics pertinent to the treatment of these patients. Combined treatment of group and individual therapy addresses the needs for object constancy, the integration of object and self representations, and the possibility of attachment to others. Collaboration with individual therapists in this process is essential and there are specific conditions that allow this to occur as well as guidelines to help them make referrals. Cotherapy can be especially beneficial if the cotherapy team is knowledgeable and experienced. The group therapist must have special training and supervision to conduct groups of such intensity and affectively laden content.     

Functional analysis and treatment of elopement.

Elopement is a dangerous behavior because children who run away may encounter life-threatening situations (e.g., traffic). We conducted functional analyses of the elopement of 3 children who had been diagnosed with developmental disabilities. The results identified a maintaining reinforcer for the elopement of 1 child, but the data were difficult to interpret for 2 of the children. Subsequent reinforcer assessments were used to help to clarify the reinforcers for elopement for these 2 children. Results of the functional analyses and reinforcer assessments then were used to develop successful treatments to reduce elopement. The findings are discussed in terms of (a) the application of functional analysis methodology to elopement, (b) the use of reinforcer assessments to identify potential reinforcers when standard functional analyses are undifferentiated, and (c) the utility of assessment-based treatments for elopement.     

J. Skelly wright and refusal of treatment

This article is a critical analysis of Judge J. Skelly Wright's “Application of President and Directors of Georgetown College.” Wright's paper concerns the refusal of a Mrs. Jones to allow a blood transfusion needed to save her life and Wright's decision, based on a number of social, medical, legal, religious, and psychological facts, to permit the transfusion. The presentation is a close paraphrase of Wright's own case write-up. Critical expositions of five arguments explicitly advanced by Wright for his decision to allow a transfusion are given, as are attempts to track down other justifying reasons he may have had for his decision.     

Behavioral treatment of thunder and lightning phobias.

The use of four different behavioral techniques in the treatment of six female clients with thunder and lightning phobia is described. The techniques (Systematic desensitization. Covert reinforcement. Stress inoculation training, and Self administered desensitization with tape recorder) were evaluated in single-case experimental designs, using both self-report, behavioral, and physiological data.The immediate and follow-up results showed that five of the clients were completely recovered and the sixth markedly improved after their respective treatment (10–14 session). These results and the questions concerning continuous assessment in single-case design and external validity of laboratory assessment in phobic conditions are discussed.     

MMPI profiles of women in codependency treatment.

The Minnesota Multiphasic Personality Inventory (MMPI) profiles of 73 women presenting themselves for treatment of codependency in a 10-day residential setting were examined. Results suggest a significant amount of psychopathology to be present in this population. More than 50% of these individuals produced clinically significant elevations of five or more scales, and 38% produced elevations on six or more scales.     

Severity of unipolar depression and choice of treatment.

The National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (Elkin et al., Archives of General Psychiatry, 46, 971-982; 1989) reported treatment-by-severity interactions favouring pharmacotherapy for more depressed outpatients, on a minority of relevant comparisons. The present study reports secondary analyses from a similar, preexisting data set in which treatment-by-severity interactions are systematically investigated with depressed outpatients treated either with nondirective psychotherapy, behaviour therapy, pharmacotherapy, or relaxation/placebo. Despite multiple severity measures and variable severity cut scores, no treatment was differentially effective in improving more severely depressed patients. Also, there was little difference across symptom severity levels in the proportions of recovered patients between treatment groups. Finally, dynamic cluster analysis demonstrated that the proportion of pharmacotherapy nonresponders (20%) did not differ from the proportion of nonresponders in behaviour therapy or placebo groups. It is concluded that this failure to replicate the NIMH trial findings can not be attributed to treatment differences, populations or statistical power. The suggestion that pharmacotherapy be the treatment of choice for more severely depressed outpatients appears to be unjustified on the basis of available evidence.     

Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment.

OBJECTIVE: Family-based treatments for pediatric obesity were developed over 25 years ago. Over that time, youth have become more obese and the environment more obesiogenic, which may influence efficacy of pediatric weight control. Mixed-effects regression models were used to compare the efficacy of programs initiated 20 to 25 years ago to current programs through 24-month follow-up, as well as to reanalyze 10-year outcomes of previous research using contemporary measures and analytic strategies. MAIN OUTCOME MEASURES: z-BMI and percent overweight. RESULTS: Results showed significant reductions over time, with no differences in z-BMI change for older versus contemporary studies. Age was a predictor of z-BMI up to 24 months, with younger children showing larger change. Mixed-effects regression models replicated previous long-term effects of family-based interventions. Gender was a predictor of long-term z-BMI change, with girls benefiting more over time than did boys. CONCLUSION: The efficacy of the family-based behavioral approach to treating pediatric obesity replicates over a 25-year period. Challenges in evaluating treatment effects over time are discussed. Ideas for studying choice of treatments that vary in effect size and for strengthening family-based behavioral treatments are noted.     

Clinician's comment on treatment of childhood overweight meta-analysis.

Given the prevalence and urgency of the childhood overweight problem, pediatric providers are searching for evidence-based management to translate into clinical practice, particularly in primary care. There are numerous challenges to translation and therefore to more widespread adoption of childhood overweight treatment recommendations. In this article, the authors try to bridge this gap between childhood overweight treatment research and clinical care by discussing the current evidence-based recommendations through a clinical case and by examining the challenges of translation. Looking at this issue through the lens of a clinician, the authors consider the broader social context within which childhood overweight exists, and highlight areas for further translational work.     

A follow-up study on short-term treatment of agoraphobia.

The differential effectiveness of three treatment packages for agoraphobia was tested. Patients received one of three short-term treatments: Breathing Retraining and Cognitive Restructuring, graded Self-Exposure in vivo, or a combination of both. No differential effects were found between the treatment conditions at posttest and at an 18 months follow-up. Improvement at follow-up assessment was associated with whether patients had further treatment during the follow-up period. No relationship was found between further improvement and demographic variables, pre- and posttest scores on psychological questionnaires or the use of medication at follow-up. Implications of these findings are examined.     

Habit reversal vs. negative practice treatment of nailbiting

A previous study of the habit reversal treatment of nailbiting was extended by using more subjects (97) and a comparison with an alternative method (negative practice). Negative practice reduced nailbiting episodes by about 60% whereas habit reversal reduced nailbiting episodes by about 99% throughout the 5-month follow-up.     

Aerobic exercise in the psychological treatment of adolescents.

A small group of psychiatrically institutionalized adolescents (16 boys, 11 girls) were assigned to a three-day-per-week running/aerobic exercise program or a regular physical activity class. The complete program continued over 9 weeks, with 11 subjects remaining throughout the program. Dependent measures of body-mass index, timed performance on a one-mile run, resting, exercise, and recovery heart rates, and measures of depression, mood-states, and self-efficacy were assessed pre-, mid-, and post-9-wk. treatment and at a 4-wk. follow-up. Improvements in depression, anxiety, hostility, confused thinking, and fatigue were shown in treated girls, with increases in vigor and self-efficacy for all treated subjects.     

Locus of control and behavior in treatment groups.

Studied the Rotter Locus of Control scale for effective prediction of behavior in small groups. Subjects were 205 male VA Hospital patients participating in self-directed groups who completed the AGCT, Psychological and Somatic Symptom Scales, and Rotter's I-E measure of locus of control. Group behavior was measured through sociometry and a Group Member Evaluation form. Three hypotheses were not supported: (a) Persons scoring high in the direction of internal control (internals) will be more likely to act to influence their social environment; (b) internals will be more active than externals in gathering and processing information in group discussions, and (c) internals will be more self-directed and less susceptible to being influenced by others. Two hypotheses were supported: (a) externals will express more somatic and psychological complaints than internals, and (b) externals will be perceived as behaving more defensively than internals. In contrast, intelligence was correlated with a large number of group process measures. Locus of control and intelligence measures predict different kinds of behavior in groups.