Self-directed desensitization for acrophobia

Acrophobic outpatients received therapist- or self-directed (tape-recorded) desensitization in a study of (a) treatment effectiveness with diminished therapist contact ; (b) subject characteristics ‘predicting’ outcome; and (c) generalization of change. At Post-test, treated Ss (N=16) had improved significantly more than Waiting List Ss (N=13) on self-report measures of acrophobia and general anxiety, while the treatment methods were equally effective. An 8-month follow-up found that self-directed Ss had attempted more specific behavioral situations than therapist-directed Ss, and showed additional gains on self-report measures while therapist-directed Ss maintained post-test levels. Results suggested: (a) desensitization provides effective treatment even with reduced therapist contact; (b) some subject characteristics relate to outcome and (c) treatment effects generalize to other anxiety indices.     

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.     

Expanding the Limits of Bibliotherapy for Panic Disorder: Randomized Trial of Self-Help Without Support but With a Clear Deadline

Cognitive behavioral bibliotherapy for panic disorder has been found to be less effective without therapist support. In this study, participants were randomized to either unassisted bibliotherapy (n = 20) with a scheduled follow-up telephone interview or to a waiting list control group (n = 19). Following a structured psychiatric interview, participants in the treatment group were sent a self-help book consisting of 10 chapters based on cognitive behavioral strategies for the treatment of panic disorder. No therapist contact of any kind was provided during the treatment phase, which lasted for 10 weeks. Results showed that the treatment group had, in comparison to the control group, improved on all outcome measures at posttreatment and at 3-month follow-up. The tentative conclusion drawn from these results is that pure bibliotherapy with a clear deadline can be effective for people suffering from panic disorder with or without agoraphobia.     

Behavioral treatment of adult obesity: Attentional controls and a 2-year follow-up

This research included controls for both amount of extra-therapy attention focused on target behaviors and for quality and duration of attention provided during therapy. Two pairs of therapists each conducted one group for each of four experimental conditions: nonspecific therapy, nonspecific therapy + attention prompting, behavior therapy, behavior therapy + positive induction (procedures designed to maximize favorableness of expectancies). Sixty-five obese adults ( OVERWEIGHT = 52%) attended 12 weekly group sessions and 3-month and 2-yr follow-ups. Ratings of expectancies, credibility and therapist characteristics were equivalent in all experimental conditions. Attrition was low (9.7%) and Ss averaged 1–2 lb weight losses per week during treatment, while improving concurrently in eating habits, cardiovascular fitness and adjustment. However, only participants who were in groups conducted by the therapist pair which was rated especially ‘democratic’ maintained average weight losses at the 2-yr follow-up. These results demonstrate the potentially vital role of several ‘nonspecific’ factors in long-term outcomes associated with behavioral treatments for adult obesity.     

Goal-setting and spouse involvement in the treatment of obesity

Two types of goal-setting (daily vs weekly) and two levels of spouse involvement (couples vs individual treatment) were evaluated in a 19-week behavioral weight-control program. Forty-seven married Ss with spouses willing to participate were randomly assigned to one of four treatments: Couples/Weekly Goals, Couples/Daily Goals, Individual/Weekly Goals, Individual/Daily Goals. At posttreatment, Ss had lost an average of 171b and reduced their percent over ideal weight from 49 to 36%. Losses were maintained at the 6-month clinic follow-up. Weight losses for the two goal-setting conditions and the two spouse treatments did not differ. Improvements were observed in resting pulse, blood pressure and step-test time, and these were maintained at the 6-month follow-up. Adherence to caloric self-monitoring, self-reported exercise adherence and marital satisfaction were significantly correlated with weight loss. Decreases in depression and improvements in body-image satisfaction were also observed. Mail and telephone follow-up at 12 and 30 months posttreatment indicated satisfactory maintenance for the majority of Ss. Factors associated with maintenance and relapse during long-term follow up are discussed.     

Change in body image and psychological well-being during behavioral obesity treatment: Associations with weight loss and maintenance

This study reports on outcomes from a behavioral obesity treatment program, evaluating if treatment-related changes in body image and psychological well-being are predictors of weight change during treatment and after follow-up. Participants were 142 overweight/obese women (BMI = 30.2 ± 3.7 kg/m²; age = 38.3 ± 5.8 years) participants in a behavioral treatment program consisting of a 4-month treatment period and a 12-month follow-up. Psychosocial variables improved during treatment and these changes were correlated with 4-month weight reduction. Short-term changes in body size dissatisfaction (p = .002) and mood (p = .003) predicted long-term weight loss. Additional results suggest that there might be a predictive role of short-term changes in body size dissatisfaction and self-esteem on long-term weight loss after accounting for initial weight change (p < .028). We conclude that, along with weight changes, cognitive and affect-related processes influenced during obesity treatment may be related long-term success, in some cases independently of initial weight loss.     

An investigation of various performance-based treatments with acrophobics

Five different performance-based treatments (participant modeling, participant modeling without therapist physical contact, modeling plus exposure, therapist-controlled exposure in vivo and rationale only) were compared to evaluate their relative effectiveness in the treatment of acrophobia. Ten subjects were assigned to each of the five groups. Avoidance behavior was assessed using a behavior test, self-report fear measures, heart-rate and self-efficacy expectation measures. Subjects were first submitted to two behavioral approach tests. These two pre-tests were administered 1 week apart, and no significant differences occurred between the evaluations. Analyses of variance for repeated measures at pre-test. post-test and follow-up revealed a significant improvement on all main outcome measures for the five groups. No significant differences among groups were observed. The total treatment time, which was also used as a dependent measure, did not yield any significant differences among treatment conditions. These findings have many implications. For instance, the need for induction aids, such as physical contact with the therapist and modeling, is questioned. Also, exposure per se whether therapist or self-controlled is shown to be effective in reducing avoidance behavior. Finally, the theoretical and clinical implications of these results are discussed.     

Behavioral Versus Nonbehavioral Guided Self-Help for Parents of Children With Externalizing Disorders in a Randomized Controlled Trial

Self-help interventions for parents, which have a behavioral basis, are considered to be an effective treatment option for children with externalizing disorders. Nonbehavioral approaches are widely used but have little empirical evidence. The main objective of this trial was to compare the efficacy of a behavioral and a nonbehavioral guided self-help program for parents. Families of children (aged 4–11 years) diagnosed with attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) were randomized to either a behavioral or a nonbehavioral guided self-help program including 8 parenting booklets and 10 counseling telephone calls. The analyses considered the ratings of 5 informants: blinded clinician, therapist, participant, (her or his) partner, and teacher. Of the 149 families randomized to treatment (intention-to-treat sample [ITT]), 110 parents completed the intervention (per-protocol sample [PP]). For the 4 primary outcome measures (blinded clinician- and participant-rated ADHD and ODD) at post-assessment, the analysis revealed a treatment advantage for the behavioral group in blinded clinician-rated ODD symptoms (ITT: d = 0.37; PP: d = 0.35). Further treatment differences, all in favor of the behavioral group (ITT and PP), were detected in therapist ratings (i.e., ODD) and participant ratings (e.g., parental self-efficacy [only PP], negative parenting behavior, parental stress). In both samples, no differences were found at post-assessment for ratings of the partner and the teacher, or at the 12-month follow-up (only participant ratings available). Behavioral guided self-help shows some treatment advantage in the short term. No superiority over nonbehavioral therapy was detected 12 months after treatment termination.     

Do the effects of behaviour modification programs endure?

In a previous study, Jacobson, Bernai and Lopez (1973) reported the results of an investigation in which a profoundly retarded microcephalic teenager without language or verbal comprehension participated in a behaviour modification program. The objective of the program was to facilitate conceptual learning. As a result of participation in the program, the boy acquired behavioural, conceptual, and linguistic skills.The purpose of the present study was two-fold. The first objective was to perform a follow-up investigation 9 months after the termination of the original study, in order to learn whether the effects of the behaviour modification program had endured or were extinguished. The second objective was to investigate the boy's capacity for further learning by having him participate in a second behaviour modification program, this one a language acquisition program. The investigators hypothesised that since the S had acquired verbal behaviour without receiving direct linguistic training (the nonspecific adaptive effects phenomenon; see Murray and Jacobson, 1971). the S would acquire far greater language usage if he were placed in a behavioural program that trained language skills directly. It should again be noted that the S possessed no meaningful speech during the first 18 yr of his life prior to participation in the Conceptual Development Program.     

AN INDEX FOR ASSESSING WEIGHT CHANGE IN CHILDREN: WEIGHT/HEIGHT RATIOS1

Weight and height data from two studies were recomputed, and original data were computed using a Weight Index formula that accounts for the interaction of actual weight/height changes in growing children and compares this ratio with that of normed weight/height ratios for equal-aged children. Recomputing the data of one study showed that the Weight Index is a more sensitive procedure for assessing long-term behavioral treatment of obesity for girls than weight alone. Recomputing the data of a second study showed that the Weight Index formula is consistent for boys and girls and is a more sensitive procedure for assessing long-term effects of a variety of medical treatments for obesity than the Ponderal Index or weight alone. Computation of the data for 17 “normal” children in a preschool class showed a zero Weight Index score before and after a six-month interval elapsed without treatment. The procedure may be useful in assessing ponderosity or anorexia over intervals of six months or more with growing children or difference between actual and normed weight over shorter intervals.     

The determination of optimal exposure to phobic stimuli in flooding therapy

The present study compared the value of various criteria for determining exposure duration to phobic stimuli in flooding therapy. Results indicated that basing exposure termination on a return to resting ranges of HR was not effective in increasing approach behavior, whereas basing termination on observer's judgements was quite effective. Employing self-reported anxiety reduction as the termination criterion was no more effective than using either the HR criterion or a procedure that combined all three criteria (HR, self-report, and observer's judgements). Self-reported fear data showed similar trends with the HR criterion again failing to produce any greater benefits than control procedures. Nine-weeks follow-up indicated a persistence of the behavioral changes with some loss of the gains in subjective anxiety, and a reduction in the differences between groups.     

Evaluation of self-administered rational emotive therapy programs for interpersonal anxiety

Self-administered rational emotive therapy (RET), withA New Guide to Rational Living (Ellis & Harper, 1975), as the treatment manual, was evaluated by comparing three groups which varied in terms of therapist contact (therapist administered, minimal contact, self-administered). University students who volunteered for the research program involving the treatment of interpersonal anxiety were randomly assigned to one of these treatments or to a wait-list control group. The results for 72 subjects who completed the 5-week program indicated the three treatment groups made significant gains over untreated controls on some of the self-report measures. No between-group differences appeared on ratings by significant others. A four- to five-month follow-up, which obtained data from 41 (58%) of the subjects, provided some support for the maintenance of treatment effects for the therapist administered and minimal contact groups. Correlations of assessed irrational beliefs with outcome measures provided some support for the RET model.Norris D. Vestre, Ph.D., is a Professor in the Department of Psychology, Arizona State University. Terrence J. Judge, M.C., R.N.C., is a nurse therapist at Camelback Vista Treatment Center, Scottsdale, Arizona.     

Childhood obesity and parental reflective functioning: Is there a relation?

Background/ObjectiveIn recent decades, the prevalence of childhood obesity has increased, with the major implications for public health. However, the factors that contribute to obesity in children are still poorly understood. The present study aimed to investigate the role of parental reflective functioning (PRF) in childhood obesity.MethodIn a cross-sectional design, 120 sets of parents of 60 children (n = 30 with obesity, age range 6–11) were recruited by local paediatricians. Parents completed the Parental Reflective Functioning Questionnaire. Children's and parents’ weight (assessed by BMI), as well as their socio-economic status (SES), were assessed to explore the contribution of PRF in the prediction of children's weight, controlling for parents’ weight and SES.Resultst-test showed significant differences with medium effect sizes in BMI, SES and PRF between parents of children with and without obesity. The best model resulted from hierarchical multiple regression analyses and showed that mothers’ PRF predicted children's BMI above and beyond the prediction by parents’ BMI and SES.ConclusionsLow maternal PRF could be an important target for intervention strategies, highlighting the need to consider parental responses to children's emotions in the treatment of childhood obesity, particularly in parents with low SES and high BMI.     

Multiple criteria follow-up of behavior modification with families

This report presents termination and follow-up evaluations of a parent training program based on behavior modification principles. Treatment termination outcome data were obtained for 22 families, and follow-up data were collected on 14 of these families 3 and 8 months after treatment. Results indicated a fairly high level of success at termination on the basis of parent-collected observational data, parent attitude change toward the children, and parent attitude concerning the process and outcome of treatment. Modest levels of success were evidenced on the basis of behavioral data recorded by trained observers in the home. Families who participated in follow-up demonstrated greater cooperation and involvement with the treatment program than those who did not participate. In all other respects, however, these two groups were similar. Follow-up data on parent attitude measures demonstrated maintenance of the treatment effects. Parent observational data were incomplete, but also showed maintenance in follow-up. For the subsample of 14 cases, home observation records indicated a nonsignificant decline in deviant behavior at termination followed by a nonsignificant increase in deviant behavior during follow-up. The meaning and implications of these discrepant findings were discussed and compared with results from other laboratories.     

The Relationship Between Dropout and Outcome in Naturalistic Cognitive Behavior Therapy

Dropout from psychotherapy is frequent and limits the benefits patients can receive from treatment. The study of factors associated with dropout has the potential to yield strategies to reduce it. This study analyzed data from a large sample of adults (N = 1,092) receiving naturalistic cognitive behavioral therapy (CBT) to test the hypotheses that dropouts, as compared to completers, had (1) higher symptom severity at treatment termination, (2) a slower rate of symptom change during treatment, and (3) a higher odds that the therapist rated treatment as ending for reasons related to poor outcome. Results showed that although dropouts ended treatment with higher symptom severity than completers, dropouts and completers did not differ in their rate of symptom change during treatment, suggesting that dropouts had higher symptom severity at termination because they received fewer sessions of treatment, not because their symptoms changed at a slower rate. Dropout was also associated with a higher odds of having a therapist-rated termination reason indicating a poor outcome, suggesting that dropout is more likely if patients are dissatisfied with some aspect of the therapy outcome or process. These findings suggest that strategies for monitoring and enhancing patient satisfaction with the process and outcome of treatment may help patients stay in treatment longer and end treatment with fewer symptoms than if they had dropped out.     

An Open Trial of an Acceptance-Based Behavioral Intervention for Weight Loss

Innovative approaches are urgently needed to improve behavioral treatment for weight loss. The weight regain that is so common after treatment may be a result of an environment that makes it challenging to adhere, long-term, to a dietary and physical activity regimen. This study was designed to test, via a 12-week open trial, the preliminary feasibility, acceptability, effectiveness, and possible mechanisms of action of a behavioral treatment that was modified to incorporate acceptance-based therapy components designed to (a) bolster participants’ commitment to behavior change, (b) build distress-tolerance skills, and (c) promote mindful awareness of eating behaviors and goals. Participants (n = 29) were overweight or obese women. Among completers (n = 19; 34% attrition), weight loss averaged 6.6% of body weight at posttreatment and 9.6% at 6-month follow-up (n = 14; 52% attrition). Intention-to-treat weight losses were 4.5% at posttreatment and 6.6% at 6-month follow-up. Psychological variables targeted by the intervention (e.g., cognitive restraint, disinhibition, urge-related eating behavior, emotional eating, eating-related experiential acceptance, mindfulness and motivation) changed in the expected directions, and many of these changes were consistent with decreases in weight loss. Moreover, despite the limitations of the single-group design, this pilot study demonstrated the preliminary feasibility, acceptability, and effectiveness of a novel, acceptance-based behavioral treatment for obesity. One potential implication is that behaviorally based weight loss interventions might be improved by overlaying an acceptance-based framework.     

Evaluation apprehension and response withholding in solution of anagrams

Sixty male Ss who were classified as high or low scorers on the Sarason Test Anxiety Scale performed a difficult anagrams task either alone, before a passively observing experimenter or in the presence of an experimenter who both observed and evaluated the S's performance. Ss who were high in test anxiety attempted fewer anagrams and had fewer correct solutions in the Evaluated condition than in the Alone condition, but also had a higher proportion of correct solutions out of total attempts. Low test-anxiety Ss did not show variable performance across conditions for any measure. Follow-up studies showed that when Ss were encouraged to attempt partial solutions neither test anxiety nor experimental treatment influenced any of the measures of performance. State anxiety change scores from baseline to post-treatment assessment showed a generally negative correlation between anxiety and number of anagrams attempted. The results indicate that fear of failure engendered by test anxiety and experimenter evaluation caused Ss to withhold responding.     

Group interpersonal skills training in a natural setting: an experimental study.

This study assessed effectiveness of group interpersonal skills training conducted in a natural setting with nonanalogue clients. Subjects (Ss) in a behavioral-training condition received 4 hr of instruction consisting of modeling, behavioral rehearsal, coaching, feedback and reinforcement. Training focused on positive and negative social responses and on initiating interactions, as well as reacting to interactions initiated by others. Subjects in a discussion-control condition engaged in focused discussion of interpersonal concerns but received no experiential practice. Within a pre-test-post-test control group design, subjective and objective measures were used to assess training effects. When compared to Ss involved in group discussion. Ss participating in group behavioral training revealed greater pre- to post-test changes on selfreported probability of engaging in selected interpersonal responses and on objective measures of eye contact, speech duration, positive affective responses, use of no-statements, compliance, refusals and requests for new behavior. Support for generalization of training is presented and methodological issues are discussed.     

Attributional Training Versus Contact in Acculturative Learning: A Laboratory Study1

A culture assimilator, a programmed learning technique for teaching about another culture, was combined with behavioral contact to test for the joint effectiveness of the two approaches to acculturative training. A total of 45 White male college students were randomly assigned to five training conditions in a modified Solomon four-group design. Results indicated significant differences between trained and untrained S s on knowledge of Black culture and better behavioral performance (as rated by Black confederates who were blind as to the training conditions) for S s receiving assimilator training followed by contact than the reverse condition. Apparently, the assimilator provides an opportunity to consolidate new attributions prior to their use in a real interaction. The reverse pattern (interaction before the formation of new attributions) is seen as anxiety producing and a test for the role of anxiety in intercultural training was generally positive. Possible implications of the results for cross-cultural training theory and methodology are discussed.     

A comparative outcome study of behavioral social-skills training, interpersonal-problem-solving and non-directive control treatments with child psychiatric outpatients

The purpose of the present study was to compare the short- and long-term efficacy of behavioral social-skills training and interpersonal-problem-solving with a control condition (non-directive treatment) with a clinical population of 61 socially-maladjusted outpatient boys. Treatment consisted of 12 weekly 1-hr sessions, with follow-up conducted at 12 months. A comprehensive assessment strategy was employed which included direct behavioral observations, parent, teacher, peer, self-report and academic performance measures. The results of this social-skills comparative outcome study indicated that the behavioral and interpersonal treatments resulted in changes on parent, teacher, self-report and peer sociometric ratings at post-treatment. At the 1-yr follow-up, the behavioral treatment maintained it's gains and continued to show modest improvement. Conversely, the interpersonal treatment manifested significant declines, as did the control group. These findings and implications for future research are discussed.