The process-observer in group therapy

This case study describes the inclusion of a nonverbal, trained process-observer into therapy groups for parents having severely disturbed family systems. The observer remained nonverbal during the sessions while taking notes to be used in writing a one-page clinical summary, which was mailed to each group member. The process-observer was included to improve the clients' initial involvement in dealing with personal problems and as a catalyst for group development. Among the important functions of the written summaries were: reduction of initial anxiety, focusing the group on important issues, enhancement of continuity across sessions, and promoting therapeutic work between sessions. The observer was also valuable in providing feedback to the therapists. Specific guidelines for the use of a process-observer are provided.     

Classroom behavior and the ability to decode nonverbal cues in boys with severe emotional disturbance

Nonverbal decoding skills are important for successful social functioning, particularly for emotionally disturbed children. Boys with severe emotional disturbance (n = 25) and a control group of boys (n = 22) were compared regarding the relationship between ratings of classroom social behaviors and nonverbal decoding skills. Participants were predominantly African American. The Diagnostic Analysis of Nonverbal Accuracy (Nowicki, 2001; Nowicki & Duke, 1994) was administered individually to the boys while teachers completed ratings of their social behavior in the classroom. The 2 groups of boys did not differ in nonverbal skills. However, aggressive classroom behaviors were associated with specific nonverbal skills only for the boys with severe emotional disturbance. These findings suggest that nonverbal abilities may have a greater impact on the social behavior of emotionally disturbed boys. Future research is needed to better understand the social difficulties of boys with severe emotional disturbance.     

Classroom Behavior and the Ability to Decode Nonverbal Cues in Boys With Severe Emotional Disturbance

Abstract

Nonverbal decoding skills are important for successful social functioning, particularly for emotionally disturbed children. Boys with severe emotional disturbance (n = 25) and a control group of boys (n = 22) were compared regarding the relationship between ratings of classroom social behaviors and nonverbal decoding skills. Participants were predominantly African American. The Diagnostic Analysis of Nonverbal Accuracy (Nowicki, 2001; Nowicki & Duke, 1994) was administered individually to the boys while teachers completed ratings of their social behavior in the classroom. The 2 groups of boys did not differ in nonverbal skills. However, aggressive classroom behaviors were associated with specific nonverbal skills only for the boys with severe emotional disturbance. These findings suggest that nonverbal abilities may have a greater impact on the social behavior of emotionally disturbed boys. Future research is needed to better understand the social difficulties of boys with severe emotional disturbance.     

The discrepant repressor: differentiation between low anxiety, high anxiety, and repression of anxiety by autonomic-facial-verbal patterns of behavior

This study examined the notion that personality questionnaires can be used to predict different styles of coping with anxiety as expressed by individual differences in patterns of autonomic, verbal, and nonverbal reactions. In line with earlier modifications of the repression-sensitization concept, the Taylor Manifest Anxiety Scale (MAS) and the Marlowe-Crowne Social Desirability Scale (SDS) were used to select four groups of 12 subjects each from a pool of 206 male students in Germany: low-anxious subjects (low MAS, low SDS), repressors (low MAS, high SDS), high-anxious subjects (high MAS, low SDS), and defensive high-anxious subjects (high MAS, high SDS). Several measures of autonomic arousal, facial activity, and self-reported affect were obtained during a potentially anxiety-arousing free-association task and during a number of control conditions, including a funny film. Significant differences in baseline-corrected heart rate and self-reported anxiety as well as rated facial anxiety all indicated that repressors exhibited a discrepancy between low self-reported anxiety and high heart rate and facial anxiety; low-anxious subjects reported an intermediate level of anxiety, although they showed low heart rate and facial anxiety; high-anxious subjects had consistently high values on all three variables; and the defensive high-anxious group showed an intermediate level of anxious responding. These group differences were specific to the task of freely associating to phrases of mixed (sexual, aggressive, neutral) content (but not to other experimental situations) and to self-reported anxiety (but not to other self-rated emotions or task difficult), indicating that they reflect individual differences in coping with anxiety.     

Physiological and nonverbal correlates of extraversion, neuroticism, and psychoticism during active and passive coping

Correlations of extraversion, neuroticism, and psychoticism with state anxiety, physiological arousal, and facial expressivity were assessed in 45 adolescents during a passive task (venipuncture) and an active coping task (speech). Task was a major determiner of the relationship between these variables. During venipuncture heart-rate increase was positively correlated with state anxiety, neuroticism, and anxiety expression and negatively correlated with extraversion. However, during the speech, HR change was negatively correlated with state anxiety and nonverbal indices of anxiety, but was positively correlated with extraversion and positive nonverbal expression. Skin conductance change findings were weaker but, when occurring, were in the same direction as the HR findings. Extraversion was highly associated with all nonverbal expressivity measures: inversely correlating with venipuncture and speech anxiety expression and positively correlating with venipuncture and speech positive expression. Neuroticism was positively correlated with nonverbal expression of anxiety during venipuncture but not speech. Psychoticism correlated positively with nonverbal positive expression during both venipuncture and speech.     

Effects of expectancy and order of report on auditory asymmetries

This study examined the relation between selective attention, perception, and memory factors in the generation of auditory asymmetries. Sixty subjects were randomly assigned to one of three dichotic listening groups. One group was presented with paired linguistic stimuli, a second group with dichotic nonverbal material, while a third group heard randomly inteterspersed verbal and nonverbal pairs. Order of ear report was controlled in all three groups. Significant right ear advantages on first and second reports were found in the verbal group, and a similar pattern of left ear advantages was found in the nonverbal group. This ear by material dissociation was only found on second ear reports in the group which heard the randomly interspersed pairs. No first report ear advantages were evident in the latter group. These results are discussed in terms of the independence of perceptual and memory mechanisms in the production of auditory asymmetries.     

The adequacy of a role play of a previous event as affected by high and low social anxiety and rehearsal

This study was designed as a preliminary step in evaluating the adequacy of a role play of a previous event. Sixty undergraduate males, high or low in social anxiety, interacted with a female assistant. Two groups of subjects then rehearsed this conversation overtly or covertly, while a third group became involved in a distraction task. Finally, all subjects role played the initial interaction with a second female assistant. Individual Pearson product-moment correlations between the initial and the role-play sessions yielded moderate, but significant correlations for most of the rated behaviors. Canonical correlations for the verbal and for the nonverbal ratings showed the two sessions, as a whole, highly related. Two (high-versus low-social anxiety group) × three (overt, covert, or no rehearsal) analyses of variance were performed on four measures. Significant results were found only for the anxiety group effect and rehearsal group effect on one rating, anxiety behaviors. The implications of the modest individual correlations suggest that estimation of specific levels of behavior is not appropriate from a role play of a previous event. However, the use of such a role play to make global distinctions of relative competence may be appropriate. The results of this study are consonant with earlier studies on role-play assessment.This article is based on a master's thesis completed by the first author in partial fulfillment of the requirements for the Master of Science degree at Ohio University.     

A challenging intervention with maternal anxiety: Babies requiring surgical correction of a congenital anomaly after missed prenatal diagnosis

The objective of this study is to assess the impact on maternal anxiety of a short‐term intervention in a particularly stressful situation, such as a surgical anomaly diagnosed only at birth after repeated negative prenatal ultrasounds. The patients were 30 mothers of babies requiring surgical correction of a congenital anomaly who were randomly assigned to an intervention (N = 16) or control (N = 14) group. The intervention group received standard care plus short‐term intervention that included weekly meetings with the psychologist and weekly team meetings. The control group received only standard care available on the Neonatal Surgery Unit. The main outcome measure was maternal anxiety levels, assessed at birth and on discharge with the Spielberger State–Trait Anxiety Inventory (STAI–S). Statistical comparisons were made, and no significant differences were found at birth in the STAI–S scores of the two groups. At discharge, the intervention group exhibited a much lower STAI–S score than the group without short‐term intervention. The authors concluded that psychological counseling for parents of newborn babies has been shown to be helpful. However, the impact of such assistance was shown to be particularly beneficial for parents facing the emotional stress of their children requiring unexpected surgical corrections of congenital anomalies at birth. Therefore, the presence of a psychologist, as part of the standard care of newborns requiring surgical correction, is recommended. ©2003 Michigan Association for Infant Mental Health.     

The elimination of learned helplessness deficits as a function of induced self-esteem

The efficiency of induced self-esteem in reducing various deficits caused by learned helplessness was tested in this study. Sixty undergraduate students were divided into three equal groups. The first group received uncontrollability treatment, the second received controllability treatment, and the third received no treatment. The subjects in the first two groups were asked to reduce the anxiety reaction of a confederate, as shown on an oscilloscope, by talking to him. The anxiety waves were shown on the oscilloscope and were preprogrammed so that subjects in the uncontrollability treatment group experienced lack of control over the results, while the ones in the controllability group were led to belive that they successfully controlled the changes of the confederate's anxiety. Then, half of the subjects in each of the three groups received positive feedback on their personality, while the other half received no feedback. In the last phase all subjects participated in a word recognition task using a tachistoscope operated by a combined push-button and microphone device. Response latency, number of correct identifications, and persistence in the task were recorded. In addition, the subjects completed a mood scale. The results indicate that subjects who received induced self-esteem treatment showed significantly more deficit reversal as reflected in response latency, persistence, feelings of potency, and sadness. The results are discussed in relation to (a) the assumption regarding the similarities between learned helplessness and depression, and (b) the usefulness of induced self-esteem as a form of treatment for helplessness depression.     

Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen’s d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46 min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxiety disorders may be successfully administered via the Internet.     

Individual response patterns and the effects of different behavioral methods in the treatment of agoraphobia

The importance of individual response patterns in agoraphobic patients was examined in the present study. Forty psychiatric outpatients with agoraphobia were assessed in individually relevant natural phobic situations. During this behavioral test their heart rates were measured continuously, and self-ratings of experienced anxiety were made at fixed intervals. On the basis of their reactions in the test situation, the patients were divided into two groups showing different response patterns—behavioral and physiological reactors. Within each group the patients were randomly assigned to one behaviorally-focused method (exposure in vivo, E) and one physiologically-focused method (applied relaxation, AR). The patients were treated individually for 12 sessions. Both treatments yielded significant improvements on most measures; 60% of the E group and 70% of the AR group patients were clinically improved after treatment. The between-group comparisons showed that both treatments did equally well both for behavioral and physiological reactors. Thus, the differential effects for these methods obtained in previous studies were not seen.     

Mathematics anxiety and mental arithmetic performance: An exploratory investigation

Abstract

Two exploratory studies were conducted to determine if mathematics anxiety, as assessed by the Mathematics Anxiety Rating Scale (MARS), is related to the underlying mental processes of arithmetic performance. MARS scores were higher when the test was administered by computer, vs. the standard paper-and-pencil format, and were higher for female than male college students. Small but significant processing differences in simple addition and multiplication were found when subjects were divided by quartiles into anxiety groups. Much larger differences in processing speed and accuracy were found with complex addition problems and a set of difficult problems (e.g. 9 × 16 = 134, true or false) that tested all four arithmetic operations. Overall, the low anxiety group was consistently the most rapid and accurate, the medium high was consistently the slowest, and the high anxiety group the most prone to errors. The results suggest that genuine performance differences exist among the several levels of mathematics anxiety, and that chronometric, reaction time-based studies of such performance will be useful in revealing those differences.     

Individual response patterns and the effects of different behavioral methods in the treatment of claustrophobia

The importance of individual response patterns in claustrophobic patients was examined in the present study. Thirty-four psychiatric outpatients with a phobia of enclosed spaces were assessed in a small test chamber. During the test their overt behavior was video-taped, heart-rate was measured continuously, and self-ratings of experienced anxiety were made at certain intervals. On the basis of their reactions in the test situation, the patients were divided into two groups showing different response patterns—behavioral and physiological reactors. Within each group the patients were randomly assigned to one behaviorally-focused method (exposure), one physiologically-focused method (applied relaxation) and a waiting-list control group. The patients were treated individually in eight sessions. The between-group comparisons showed that both exposure and applied relaxation were significantly better than the waiting-list condition. Furthermore, exposure yielded better results than applied relaxation for the behavioral reactors, while applied relaxation was better than exposure for the physiological reactors. The improvements were maintained at a follow-up assessment 14 months after the end of treatment. The results support the hypothesis that greater effects are achieved when the method used fits the patient's response pattern than when it does not.     

虚拟现实暴露疗法在社交焦虑中的应用:效果、机制及展望

由于传统干预方法的诸多局限,虚拟现实暴露疗法(virtual reality exposure therapy,VRET)逐渐应用于对社交焦虑的干预,VRET是将虚拟现实技术与传统行为暴露治疗相结合而形成的一种新的干预方法。文章总结了VRET的三个发展阶段及其研究范式,述评了在VRET过程中的作用机制。未来研究可致力于设计更加自然的人机交互技术,实现技术与社交焦虑治疗的深度融合以及关注第三人称视角应用的作用及机制。     

Fading vs systematic desensitization in the treatment of snake and spider phobia

Fading, a new technique for the treatment of phobias, was compared to systematic desensitization and a waiting-list control group for clients with snake and spider phobia. The fading technique used slides of the phobic stimulus instead of imagery, and slides of positive scenes capable of arousing a calm positive feeling as anxiety-antagonists. The clients were assessed on different self-report, behavioural and physiological measures before and after treatment. The clients were treated individually and received eight sessions, one per week. The within-group comparisons showed that both the fading and the desensitization group changed significantly on most, of the dependent measures, but the control group did not. The between-group comparisons yielded fewer significancies but on four of the 12 dependent measures both treatment groups were significantly better than the control group, while there were no differences between the fading and desensitization groups.     

The effect of pre-treatment enquiries on child dental patient's post-treatment ratings of pain and anxiety

Abstract

The aim of this study was to attempt to replicate a study in adults: to determine whether pre-treatment enquiries about anxiety and pain in children, attending the dentist, influenced their subsequent reports of pain and anxiety immediately after treatment. One hundred and ninety five children aged from seven to 16, attending four Community Dental Clinics, were allocated at random to five groups. Before treatment the first group was asked questions about their dental anxiety, expectations and memories of pain. The second group was asked about dental anxiety and expectations of pain. The third group was asked only about dental anxiety; the fourth was asked only about pain. The fifth, the control group, was asked about none of these topics. All the children were asked after treatment to rate 1) their anxiety about dentistry and 2) their experience of pain in the treatment just completed. The children experienced less pain than they had expected. There were no differences between the groups in disruptiveness or in the amount of pain experienced. However, the children who were asked about both pain and dental anxiety (groups one and two) reported significantly less dental anxiety than the control group. These results are consistent with the conclusion that pre-treatment enquiries about both anxiety and pain have no effect on disruptiveness or the experience of pain but do reduce anxiety about dentistry.     

Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial

Disorder-specific cognitive behavioural therapy programs delivered over the internet (iCBT) with clinician guidance are effective at treating specific anxiety disorders and depression. The present study examined the efficacy of a transdiagnostic iCBT protocol to treat three anxiety disorders and/or depression within the same program (the Wellbeing Program). Seventy-seven individuals with a principal diagnosis of major depression, generalised anxiety disorder, panic disorder, and/or social phobia were randomly assigned to a Treatment or Waitlist Control group. Treatment consisted of CBT-based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. Eighty one percent of Treatment group participants completed all 8 lessons within the 10 week program. Post-treatment data were collected from 34/37 Treatment group and 35/37 Control group participants, and 3-month follow-up data were collected from 32/37 Treatment group participants. Relative to Controls, Treatment group participants reported significantly reduced symptoms of anxiety and depression as measured by the Depression Anxiety and Stress Scales-21 item, Patient Health Questionnaire-9 item, and Generalised Anxiety Disorder-7 item scales, with corresponding between-groups effect sizes (Cohen’s d) at post treatment of.56,.58, and.52, respectively. The clinician spent a mean time of 84.76 min (SD = 50.37) per person over the program. Participants rated the procedure as highly acceptable, and gains were sustained at follow-up. These results provide preliminary support for the efficacy of transdiagnostic iCBT in the treatment of anxiety and depressive disorders.     

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Abstract

An outpatient cognitive-behavioural treatment programme for pain control was administered to chronic pain patients in three primary care practices with a medical psychologist as a group therapist. The patients suffered from headaches, migraines, cervical pain, shoulder-arm pain, and low back pain. A matched sample of patients with the same disorders served as a waiting-list control group. The programme consisted of training in progressive muscle relaxation, several attention related techniques, and cognitive restructuring as well as reinforcing non-pain behaviour, and aimed at an improvement of self-control strategies. At the six month follow-up, the treated subjects showed improvements in their average scores of anxiety, depression and bodily symptoms compared with the untreated controls. Pain intensity was reduced by 34% in those subjects (9 out of 25) who were most adherent to the treatment regimen. Our results indicate a long-term improvement in well-being as a consequence of the treatment. This was confirmed by the ratings of the physicians and by the reduced number of patient-physician contacts three months post treatment as compared to the controls. Treatment adherence seems to be a most important agent in maintaining long-term reductions of pain intensity.     

An evaluation of outcome variables in the systematic desensitization of test anxiety.

This study investigated the effects of group systematic desensitization and group counseling on anxiety and academic performance. Fifty-four undergraduates who requested help for debilitating test anxiety were randomly assigned to Desensitization. Group Counseling, or No-treatment control groups. Measures of test anxiety, trait anxiety, and academic achievement were obtained for all students' pre- and post-treatment. The Desensitization group showed a significant decrease in test anxiety; the Counseling and No-treatment groups showed no changes in these measures. None of the groups showed any change in trait anxiety or academic achievement. The results provided evidence that systematic desensitization was an effective treatment for reducing test anxiety, but not for improving grades.     

THE USE OF PROMPTS TO ENHANCE VICARIOUS EFFECTS OF NONVERBAL APPROVAL

The effect of nonverbal teacher approval (physical contact in the form of patting approvingly) delivered to target subjects on the attentive behavior of adjacent peers was examined in a special-education classroom. In a reversal design, two pairs of moderately retarded children were exposed to nonverbal approval, with only one subject in each pair receiving approval. In different phases, nonverbal approval was delivered alone or in conjunction with a verbal prompt directed to the adjacent peer or to the class as a whole. The prompt was designed to make salient the target subject's attentive behavior and the nonverbal reinforcing consequences that followed. Providing contingent nonverbal approval alone consistently altered attentive behavior of the target subjects but did not alter the attentive behavior of adjacent peers. However, accompanying nonverbal approval with a verbal prompt did increase attentive behavior of nonreinforced peers.