Parent-Child Interaction Therapy for Children Born Premature: A Case Study and Illustration of Vagal Tone as a Physiological Measure of Treatment Outcome

Evidence-based psychosocial interventions for externalizing behavior problems in children born premature have not been reported in the literature. This single-case study describes Parent-Child Interaction Therapy (PCIT) with a 23-month-old child born at 29 weeks gestation weighing 1,020 grams, who presented with significant externalizing behavior problems. Treatment outcome was assessed using standard measures of maternal and child functioning and observational measures of the parent-child interaction, as well as a physiological measure of heart rate variability (i.e., vagal tone) used to assess parasympathetic control in the child. Maternal reports of child behavior problems and their own stress and depressive symptoms decreased after treatment. Behavioral observations demonstrated improved parenting practices and child compliance, and vagal tone showed comparable increases as well. Results suggest that PCIT is a promising psychosocial intervention for children born premature with externalizing behavior problems, and that vagal tone may be a useful measure of treatment outcome.     

Psychoanalysis: Practical and Research Aspects by Willi Hoffer

The outcome of clients who saw one of four “expert” professional group therapists selected by peer nomination or four “natural helper” nonprofessionals nominated by students is contrasted in a 15-session psychotherapy group. Process measures tapping specific group and “common factors” were drawn from sessions 3, 8, and 14; outcome was assessed at pre-, mid-, posttreatment, and a 6-month follow-up. Results were examined by leader condition (professional vs. nonprofessional therapists) and time (group development). Virtually no reliable differences were found on measures of outcome primarily because of a floor effect on several measures. Therapist differences on the process measures tapping the “common factors” of therapeutic alliance, client expectancy, and perception of therapists were either nonsignificant or disappeared by the end of treatment. A complex picture of differences on one therapeutic factor (insight), common factor measures, and subtle variation in the outcome data suggests a distinct pattern of change, however. Methodological limitations are also addressed including problems inherent in large-scale clinical-trial studies, ethical concerns raised by using nonprofessional leaders, and problems with generalizability, given the absence of significant psychopathology in group members.     

Child social skills training in developmental crime prevention: effects on antisocial behavior and social competence

Social skills training for children is becoming increasingly popular as a measure for developmental crime prevention. Although previous reviews of such programs have shown positive effects, they have also revealed problems of research design, outcome measures, and long-term follow up. Accordingly, this article reports on a recent meta-analysis of randomized evaluations of the effect of social skills training in preventing antisocial behavior and promoting social competence. Of 841 retrievable references, 84 research reports with a total of 136 treatment-control comparisons fulfilled the eligibility criteria. Results showed a small but significant overall positive effect of d = .39 at post-intervention and d = .28 at follow-up (3 months and later). Effect sizes were somewhat greater for outcome measures of social competence than for measures of antisocial behavior, particularly when delinquency was assessed. Cognitive-behavioral programs revealed the best results in terms of generalization over time and on outcome criteria. In addition, prevention measures indicated for children and adolescents who already manifested some behavioral problems had higher effect sizes than universal approaches. Because most studies dealt with small sample sizes, non-official outcome data, and measurements after less than one year, the results should be interpreted with caution. Further high-quality studies with long-term empirical outcome criteria are needed, particularly outside the United States.     

Motivational Interviewing Versus Cognitive Behavioral Group Therapy in the Treatment of Problem and Pathological Gambling: A Randomized Controlled Trial

Pathological gambling is a widespread problem with major implications for society and the individual. There are effective treatments, but little is known about the relative effectiveness of different treatments. The aim of this study was to test the effectiveness of motivational interviewing, cognitive behavioral group therapy, and a no-treatment control (wait-list) in the treatment of pathological gambling. This was done in a randomized controlled trial at an outpatient dependency clinic at Karolinska Institute (Stockholm, Sweden). A total of 150 primarily self-recruited patients with current gambling problems or pathological gambling according to an NORC DSM-IV screen for gambling problems were randomized to four individual sessions of motivational interviewing (MI), eight sessions of cognitive behavioral group therapy (CBGT), or a no-treatment wait-list control. Gambling-related measures derived from timeline follow-back as well as general levels of anxiety and depression were administered at baseline, termination, and 6 and 12 months posttermination. Treatment showed superiority in some areas over the no-treatment control in the short term, including the primary outcome measure. No differences were found between MI and CBGT at any point in time. Instead, both MI and CBGT produced significant within-group decreases on most outcome measures up to the 12-month follow-up. Both forms of intervention are promising treatments, but there is room for improvement in terms of both outcome and compliance.     

The measurement of role variables: Exploratory examination of a new approach

New measures of role ambiguity, role conflict, and role overload were developed for a group of attorneys located in the headquarters of a large energy company. These measures were based upon a recently developed theory of behavior in organizations, which focuses on specific job products as an essential component of organizational roles. The measures have an attractive potential for applied efforts (e.g., training) to rectify or diminish role stress problems. Forty respondents completed the product-based measures in addition to commonly used measures of the role variables and a number of outcome measures. Results indicated that (1) the product-based role measures displayed patterns of relationships with outcomes which were quite similar to the patterns for commonly used role measures, and (2) the product-based measures of role variables compared favorably to commonly used measures in terms of frequency of relationships to outcome variables and appeared to be somewhat superior in terms of method variance problems.     

Predicting problem behaviors with multiple expectancies: expanding expectancy-value theory

Expectancy-value theory emphasizes the importance of outcome expectancies for behavioral decisions, but most tests of the theory focus on a single behavior and a single expectancy. However, the matching law suggests that individuals consider expected outcomes for both the target behavior and alternative behaviors when making decisions. In this study, we expanded expectancy-value theory to evaluate the contributions of two competing expectancies to adolescent behavior problems. One hundred twenty-one high school students completed measures of behavior problems, expectancies for both acting out and academic effort, and perceived academic competence. Students' self-reported behavior problems covaried mostly with perceived competence and academic expectancies and only nominally with problem behavior expectancies. We suggest that behavior problems may result from students perceiving a lack of valued or feasible alternative behaviors, such as studying. We discuss implications for interventions and suggest that future research continue to investigate the contribution of alternative expectancies to behavioral decisions.     

Using response ratios for meta-analyzing single-case designs with behavioral outcomes

Methods for meta-analyzing single-case designs (SCDs) are needed to inform evidence-based practice in clinical and school settings and to draw broader and more defensible generalizations in areas where SCDs comprise a large part of the research base. The most widely used outcomes in single-case research are measures of behavior collected using systematic direct observation, which typically take the form of rates or proportions. For studies that use such measures, one simple and intuitive way to quantify effect sizes is in terms of proportionate change from baseline, using an effect size known as the log response ratio. This paper describes methods for estimating log response ratios and combining the estimates using meta-analysis. The methods are based on a simple model for comparing two phases, where the level of the outcome is stable within each phase and the repeated outcome measurements are independent. Although auto-correlation will lead to biased estimates of the sampling variance of the effect size, meta-analysis of response ratios can be conducted with robust variance estimation procedures that remain valid even when sampling variance estimates are biased. The methods are demonstrated using data from a recent meta-analysis on group contingency interventions for student problem behavior.     

Patient activity and outcome in group psychotherapy: new findings

The relation of patient verbal activity to pretherapy symptom status and outcome was examined for ninety patients in time-limited group psychotherapy. For each half-hour segment the most verbally active member, or main actor (MA), was identified. Verbal activity was measured by counting the number of times each patient was MA during the course of the group. Outcome was assessed by administering a battery of instruments pre- and posttherapy and by obtaining direct ratings of patient benefit from the patient, therapist, and an independent rater: the number of times MA was found to be significantly correlated with four pretherapy measures, indicating that the most disturbed patients were most active in these groups; the number of times MA was also correlated with patient and therapist benefit ratings, indicating that therapists and patients themselves agreed that those who spoke the most benefited the most. However, partial correlations between number of times MA and other outcome measures did not produce any significant relationships. Thus, it does not appear that patient verbal activity is related to outcome, as measured by objective instruments.     

Group Treatment in Psychotherapy by Robert G. Hinckley and Lydia Hermann

A recently completed clinical trial that investigated the effectiveness of a group-oriented, day treatment program provided an opportunity to pursue a multidimensional approach to the prediction of treatment outcome. The sample consisted of 99 psychiatric outpatients, most of whom had received diagnoses of affective and personality disorders. The predictor variables included a patient personality characteristic (psychological mindedness), a group process variable (patient work), and their interaction. Univariate analyses revealed significant direct relationships between psychological mindedness and both work and favorable outcome, and between work and favorable outcome. Multivariate analyses indicated that psychological mindedness and work had independent significant relationships (additive or interactive) with several of the outcome variables. In combination they accounted for up to a quarter of the outcome variance. The results demonstrate the benefit of using a theoretically consistent multidimensional approach. The time-efficient nature of the predictor measures used in the study make them particularly amenable for use by clinicians and researchers.     

Perceived Match or Mismatch on the Gottman Conflict Styles: Associations with Relationship Outcome Variables

Gottman has proposed that there are 3 functional styles of conflict management in couple relationships, labeled Avoidant, Validating, and Volatile, and 1 dysfunctional style, labeled Hostile. Using a sample of 1,983 couples in a committed relationship, we test the association of perceived matches or mismatches on these conflict styles with relationship outcome variables. The results indicate that 32% of the participants perceive there is a mismatch with their conflict style and that of their partner. The Volatile‐Avoidant mismatch was particularly problematic and was associated with more stonewalling, relationship problems, and lower levels of relationship satisfaction and stability than the Validating matched style and than other mismatched styles. The most problematic style was the Hostile style. Contrary to existing assumptions by Gottman, the 3 matched functional styles were not equivalent, as the Validating Style was associated with substantially better results on relationship outcome measures than the Volatile and Avoidant styles.     

Group Psychotherapy in the Treatment of Some Neurodermatoses

The relation of patient verbal activity to pretherapy symptom status and outcome was examined for ninety patients in time-limited group psychotherapy. For each half-hour segment the most verbally active member, or main actor (MA), was identified. Verbal activity was measured by counting the number of times each patient was MA during the course of the group. Outcome was assessed by administering a battery of instruments pre- and posttherapy and by obtaining direct ratings of patient benefit from the patient, therapist, and an independent rater: the number of times MA was found to be significantly correlated with four pretherapy measures, indicating that the most disturbed patients were most active in these group; the number of times MA was also correlated with patient and therapist benefit ratings, indicating that therapists and patients themselves agreed that those who spoke the most benefited the most. However, partial correlations between number of times MA and other outcome measures did not produce any significant relationships. Thus, it does not appear that patient verbal activity is related to outcome, as measured by objective instruments.     

A Two-Year Longitudinal Study of Neuropsychological and Cognitive Performance in Relation to Behavioral Problems and Competencies in Elementary School Children

Despite interest in early neuropsychological status as a possible contributor to children's behavioral development, prospective longitudinal investigations of neuropsychological measures in relation to later behavioral outcomes in childhood are few. A 2-year longitudinal study in a nonselected childhood sample is reported. The study tested the influence of early neuropsychological performance (verbal fluency, mental inhibitory control, and visual spatial ability) on later childhood behavioral problems and social competency. Regular education children (n = 235) were assessed at three time points 1 year apart. To control for autocorrelation of outcome measures, Time 1 behavior was partialed while testing the effects of Time 1 neuropsychological scores on Time 3 outcome. To control for autocorrelation of neuropsychological scores, Time 2 scores were partialed while testing the predictive effect of Time 1 scores on Time 3 outcome. Both sets of regression models suggested modest but statistically significant effects for inhibitory control and verbal fluency, but not IQ, reading, or visual spatial ability, on behavioral outcome. Study results are consistent with a modest causal effect of selected neuropsychological skills on later behavioral adjustment. The findings support theories that implicate subtle neuropsychological dysfunction in the development of behavioral problems in childhood.     

Marital Problems Occurring in Midlife: Implications for Couples Therapists

The ability of therapists to adequately address the presenting problems of couples impacts the process and outcome of therapy. Although research has examined the types of problems that couples commonly experience, little is known about problems among midlife couples. Midlife marital problems were examined using data from a national random sample of 632 married people between the ages of 40 and 50. The results indicated that the most common problems were financial matters, ways of dealing with children, and sexual issues. Values, commitment, spiritual matters, and violence were the least common problem areas. There were few differences when gender, remarriage, and length of marriage were considered.     

The experiences of therapists using a new client‐centred psychometric instrument,PSYCHLOPS (Psychological Outcome Profiles)

PSYCHLOPS (‘Psychological Outcome Profiles’) is a newly developed client‐generated psychometric instrument which can be used as an outcome measure. Uniquely, it asks clients to state their own problems, in their own words. As part of its validation, we used it alongside an existing measure, CORE‐OM (‘Clinical Outcomes Routine Evaluation – Outcome Measure’). Based on a qualitative methodology, we report here on the first‐hand experiences of four therapists using both instruments. The key themes that emerged from therapists’ responses were feasibility, validity and usefulness. Both questionnaires were perceived as complementing each other, the qualitative information from PSYCHLOPS balancing the quantitative information from CORE‐OM and that both could contribute to the therapist‐client interaction. The key features of PSYCHLOPS are likely to prove attractive to therapists and should increase acceptance and uptake of outcome measures.     

Improving Service Evaluation in Clinical Genetics: Identifying Effects of Genetic Diseases on Individuals and Families

Outcome measurement in clinical genetics is challenging. Outcome attributes used currently have been developed by service providers or adapted from measures used in other areas of healthcare. Many of the ‘patients’ in clinical genetics are healthy but at risk of developing or transmitting a condition. Usually no pharmacological or surgical treatment is offered, although information-giving is an objective of most consultations. We argue that services should be evaluated on the basis of how well they alleviate the effects of disease, from a patient perspective. This paper describes a qualitative study using seven focus groups with health professionals, patients and patient representatives. Social and emotional effects of genetics diseases were identified. Some differences emerged between the effects identified by health professionals and those identified by patients. These findings will be used to inform the evaluation of existing outcome measures and develop robust measures of outcome for clinical genetics services.     

A brief cognitive behavioural therapy psychoeducational group for Chinese people with chronic illnesses: an evaluation study

This pilot study attempted to examine the effectiveness of a brief cognitive behavioural therapy (CBT) psychoeducational group for Chinese people with chronic illness in Hong Kong. It adopted a single group design, and 52 participants joined the group. A questionnaire with three outcome measures, measuring general mental health, quality of life and dysfunctional attitudes and beliefs, was administered to participants at pre-test, post-test and six month follow-up. Repeated measures ANOVAs were employed and revealed positive changes in most of the outcome measures across the three time points. Cohen’s d showed a moderate to large effect size for most outcome measures. From a step care perspective, a culturally attuned brief CBT psychoeducational group may serve as an early intervention and a triage to attract suitable people with chronic illness to engage in the treatment process.     

Toward quality criteria for collective judgments

While most organizational and social decision making is done in a group or collective mode, there are few guides or evaluative criteria for judging when a high-quality outcome has been reached. Most past studies of group decision making have been conducted in laboratories using student subjects and factual problems with correct answers as means for judging outcome quality. Such proxies are rough approximations at best of real-world conditions where value differences can be intense and problems have no correct or best answer. Drawing upon the existing literature, evaluative criteria are proposed including process, content, and outcome concerns. An instrument based upon these criteria is then applied retrospectively to six cases of ad hoc collective decision making. Using dimensional analyses, a set of more detailed evaluative factors is derived from actual participant responses. The results provide some insights into the nature of high-quality collective judgments as well as the most effective procedures for their achievement.     

Attention and executive function in children with and without single-suture craniosynostosis

Children with single-suture craniosynostosis (SSC) have higher rates of learning disabilities and related neurocognitive problems than unaffected peers. Executive function (EF) and attention are thought to be areas of particular vulnerability, though studies to date have been limited by small sample sizes and a lack of control groups. We evaluated 179 school-aged children with SSC (cases) and 183 unaffected controls at an average age of 7 years using clinician-administered and parent and teacher report measures of EF and attention. Among children with SSC, we examined differences as a function of suture location (sagittal, metopic, unicoronal, or lambdoid) and age of corrective surgery. We used linear regression analyses, adjusted for potential confounders, to compare the two groups on all outcome measures. Cases scored lower than controls on most measures, though the magnitude of these differences was small and most were statistically insignificant. The largest relative deficit was on a measure of inhibitory control. Results changed little in sensitivity analyses adjusting for potential attrition bias and for the effects of developmental and academic interventions. Among cases, there were few differences in relation to the location of suture fusion or timing of surgery. Overall, we found limited evidence of broad deficits in EF or attention in children with SSC relative to unaffected controls. Neurocognitive development for children with SSC appears to be variable, across affected children and outcomes assessed. Further research is needed to understand the potential sources of this variability.     

Concurrent and predictive validity of the psychopathy checklist: youth version across gender and ethnicity

The concurrent and predictive validity of the Psychopathy Checklist: Youth Version (PCL:YV) were examined across gender and ethnicity using multiple outcome measures on a community-based sample of 130 adjudicated youths. The PCL:YV demonstrated concurrent validity with externalizing behavior problems but, it is important to note, was also associated with internalizing measures of negative affect. With a mean follow-up period of 3 years, the PCL:YV was found to predict general and violent recidivism in male, Native Canadian, and Caucasian youths. However, the PCL:YV demonstrated weaker concurrent and predictive validity with girls and failed to predict nonviolent recidivism in all subgroups. Implications of the findings for clinical practice are discussed.     

Behaviorally referenced experimentation and symptom validation: a paradigm for 21st-century personality disorder research

Construct validity problems in contemporary personality disorder (PD) symptoms and diagnoses include poor interrater reliability, high comorbidity, limited discriminant validity, and inadequate criterion validity. These problems are due in part to a limited range of outcome measures and research methods utilized by PD investigators: The vast majority of PD studies use correlational methods to assess relationships among questionnaire- and interview-based self-reports. To strengthen the PD database, researchers must: (1) emphasize behaviorally referenced criterion validation of PD symptoms; and (2) explore PD dynamics using manipulations that alter PD-related psychological processes and produce measurable changes in behavior. Frameworks for conducting behaviorally referenced PD symptom validation studies and experiments are outlined. The advantages of a behaviorally referenced experimental approach to PD research are described, along with possible objections to this approach.