Treating boys with low school achievement and behavior problems: comparison of two kinds of intervention

Children with low school achievement frequently have behavior problems and interpersonal difficulties that pose a risk for psychosocial maladjustment. 39 boys were assessed and randomly assigned to one of two group treatment conditions: (a) interpersonal cognitive problem-solving for whom training was provided through oral and written language activities that met children's social and academic needs and (b) a language workshop, during which only academic difficulties were treated. Parents of children in both groups received group attention. Posttreatment assessments indicated that boys in both conditions showed significant improvements on school achievement and behavior problems, as they were measured by behavior scales reported by mothers and by an academic achievement test. Children in the problem-solving group improved significantly more than the other group on most measures. These results suggest that work with interpersonal cognitive problem-solving skills combined with reading and writing activities is a useful means to produce improvements in child behavior and school achievement.     

Methylphenidate and cognitive therapy: A comparison of treatment approaches with hyperactive boys

This study of hyperactive boys evaluated the effects of three modes of treatment in relation to an untreated group. The treatments were administered over a 3-month period and included cognitive training, stimulant drug therapy (methylphenidate), and the two treatments combined. A follow-up assessment was conducted approximately 3 months after contact between the training staff and the child had ceased. Analyses of attentional deployment and cognitive style measures, tests of academic achievement, and behavioral ratings showed that only those children in the two medication treatment conditions demonstrated improvement in attentional deployment and behavioral ratings. In the cognitive therapy condition, there were changes only on measures of attentional deployment. The data did not provide evidence indicating that the combined medication and cognitive therapy condition was any more effective than that condition involving medication alone. Discussion provides future guidelines for evaluation of the relative effectiveness of stimulant drug therapy and other psychological treatment modalities.     

Effects of group experiential cognitive therapy for the treatment of panic disorder with agoraphobia.

A treatment protocol, called experiential cognitive therapy (ExCT), was developed. It integrated traditional cognitive behavior therapy (CBT) with virtual reality exposure for the treatment of panic disorder with agoraphobia (PDA). The objective of this study was to test the efficacy of short-term (four sessions) ExCT compared with a traditional 12-session panic control program (PCP) for the treatment of PDA. Forty patients diagnosed as having PDA by the diagnostic criteria of DSM-IV were randomly assigned to ExCT and PCP groups of 20 patients each. The treatment effects were measured with self-report questionnaires, including the BDI, STAI, ASI, PBQ, ACQ, and BSQ. The authors also assessed high end-state functioning (HES), including the success rate of stopping or reducing medication at post-treatment and 6-month follow-up. In all ratings, both ExCT and PCP groups showed significant improvement post-treatment compared with pre-treatment scores. There were no significant differences between the two treatment groups in HES and medication discontinuation at post-treatment, but there was a significant difference in medication discontinuation at 6-month follow-up. These results suggested that although short-term effectiveness of ExCT might be comparable to the effectiveness of PCP, long-term effectiveness of ExCT might be relatively inferior to the effectiveness of PCP.     

Effects of methylphenidate alone and in combination with behavior modification procedures on the behavior and academic performance of hyperactive children

Twenty hyperactive 6- to 9-year-old children of normal intelligence were studied in a half-day laboratory classroom in a 2-week period baseline-treatment-reversal design for behavior modification. Under double-blind conditions half the children were placed on .3 mg/kg of Ritalin and half on placebo for the entire program. The classroom program consisted of a group period with immediate reinforcement possible, and an individual time period without immediate reinforcement possible. Behavior modification caused a significant decrease in nonattending, out-of-seat, inappropriate vocalizing and inappropriate peer interaction behavior in the group period. Fidgeting, a nontargeted behavior, was not significantly decreased during this period but did signficantly decrease as a result of medication. No other drug effects occurred during this period. During the individual period, the results were essentially reversed. There were no significant behavior modification effects observed. Significant reductions resulted from medication in all behaviors except out-of-seat and fidgeting. Behavior modification alone significantly affected the two academic measures. No significant effects were seen on the Conners Abbreviated Teacher Rating Scale. No significant interactions were noted between medication and behavior modification.This study was supported by a grant from the Health Services and Mental Health Administration, Maternal and Child Health Service Project 920. Special thanks are due to Judy Racheleu, Charles Cunningham, Christopher P. S. Williams, Dan Lee, Russell Barkley, Ross Danielson, Sally Gray, Don Slyman, and Linda Shambeck.     

Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions.     

Training Verbal-Nonverbal Correspondence

This study assessed the influence of strengthening a verbal self-referent statement on later corresponding nonverbal behavior performed outside the treatment setting. Seventeen preschool children were randomly assigned to two groups: (1) Experimental group, in which subjects were reinforced for repeating anti-litter statements; (2) control group in which subjects merely repeated statements unrelated to littering. Subsequent paper-picking behavior in the lavatory was counted. The results suggest that verbal, training can strongly augment the control function of self-repeated instructions in preschool children despite a time lapse between training and opportunity to perform the behavior, and a difference between the training and the performance settings.     

Vagal influence during worry and cognitive challenge

Abstract

The primary foci of the study were exploration of the linkage between cognitive and autonomic inflexibility of worry and generalized anxiety disorder (GAD) and examination of the effects of an analog cognitive restructuring task on this relationship. Cardiac responses of GAD and non-GAD participants were measured to examine the sympathetic and parasympathetic effects of worry and cognitive challenge. Diagnostic groups of undergraduate students were determined via administration of a structured interview, yielding a GAD group (n=16) and a control group (n=19) of individuals without GAD, depression, or panic disorder diagnoses. Cardiac autonomic responses were acquired via electrocardiogram during rest, worry, and cognitive challenge conditions by an experimenter blind to diagnosis. Metrics were compared between the two groups and across the three conditions. Individuals diagnosed with GAD did not differ significantly from controls on autonomic indices. Worry was associated with significantly decreased parasympathetic influence and increased sympathetic activity. Cognitive challenge did not result in significant increased cardiac responsivity. The results indicate that worry behavior is associated with decreased vagal activity, suggest a linkage between autonomic and cognitive inflexibility, and provide further suggestions for improving protocols to assess the autonomic effects of cognitive therapy techniques.     

Social interaction,social observation,and cognitive development in young children

Eighty first-grade childen were pretested on a variety of conservation tasks. Subjects who were either nonconservers or intermediate conservers were randomly assigned to one of three conditions: social interaction, social observation, and individual control. Subjects in the social interaction condition worked collaboratively on conservation tasks with a same sex partner. Subjects in the social observation condition individually observed pairs of subjects working together and control subjects worked individually on conservation tasks. The purpose of the social observation condition was to control for the effects of task relevant information that was expressed during dyadic interactions. All subjects were individually post-tested on conservation tasks that were the same form but different content than the pretest items. Subjects in the social interaction condition had significantly greater cogntive change scores (post-test less pretest) than subjects in the social observation and control conditions. There were no significant differences between change scores of subjects in the latter two conditions. Also, subjects in the social interaction condition gave significantly more novel explanations for conservation judgments than subjects in the social observation condition. These findings supported a socio-cognitive conflict model of cognitive development in young children.     

Passive smoking is associated with cognitive and emotional impairment in adolescent girls

It is well established that smoking is associated with impaired mental health and sleep problems. However, the possible effects of passive smoking on cognitive and emotional characteristics have not previously been evaluated in adolescents. We investigated the association between passive smoking and cognitive and emotional function, and sleep patterns in 940 adolescent girls. The girls were divided into two groups [305 exposed subjects and 635 non-exposed subjects (the controls)]. The passive smokers had a significantly lower cognitive function and higher depression, aggression, and insomnia scores compared to the control group (P?<?0.05). No significant difference was detected with respect to day-time sleepiness and sleep apnea. Logistic regression analyses showed that the passive smokers were more likely than the controls to have cognitive impairments, depressive mood, aggressive behavior, and insomnia. Adolescent passive smokers had significant differences in their cognitive abilities and emotional function.     

The effects of venlafaxine and cognitive behavioral therapy alone and combined in the treatment of co-morbid alcohol use-anxiety disorders

The effects of the antidepressant venlafaxine (VEN-225 mg daily) and transdiagnostic cognitive behavioral treatment (CBT) alone and in combination on alcohol intake in subjects with co-morbid alcohol use disorders (AUDs) and anxiety disorders were compared. Drinking outcomes and anxiety were assessed for 81 subjects treated for 11 weeks with one of 4 conditions: 1) VEN–CBT, 2) VEN-Progressive Muscle Relaxation therapy (PMR), 3) Placebo (PLC)-CBT and 4) a comparison group of PLC-PMR. For subjects who reported taking at least one dose of study medication, the Time × Group interaction was significant for percent days of heavy drinking and drinks consumed per day. For the measure of percent days heavy drinking, the paired comparison of PLC-CBT versus PLC-PMR group indicated that the PLC-CBT group had greater drinking reductions, whereas other groups were not superior to the comparison group. In Week 11, the proportion of subjects in the PLC-CBT group that had a 50% reduction from baseline in percent days heavy drinking was significantly greater than those in the comparison group. Of the 3 “active treatment” groups only the PLC-CBT group had significantly decreased heavy drinking when contrasted to the comparison group. This finding suggests that the transdiagnostic CBT approach of Barlow and colleagues may have value in the management of heavy drinking in individuals with co-morbid alcoholism and anxiety.     

Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children

Parents of 43 conduct-problem children, aged 3-8 years, were randomly assigned to one of two treatments: an individually self-administered video-tape modeling treatment (IVM) and IVM treatment plus therapist consultation (IVMC). Randomization also included a waiting-list control group (CON). Compared with the control group, both treatment groups of mothers reported significantly fewer child behavior problems, reduced stress levels, and less use of spanking. Home visit data indicated that both treatment groups exhibited significant behavioral changes. There were relatively few differences between the two treatment conditions. However, the IVMC children were significantly less deviant than the IVM children, suggesting that the IVMC (with therapist consultation) treatment was superior to self-administered treatment with no therapist involvement. The added benefits of therapist involvement are discussed.     

Sleep deprivation and naps

It is important for military commanders to know the likely effects of a small amount of sleep under conditions of sustained operations. To this end, two laboratory-based experiments on naps were carried out. The first examined the effect of 2 h of sleep following 90 h of wakefulness. Ten infantrymen subjects were not told the scheduled length of their vigil, or that they would be allowed a nap at some stage, until a few hours before the 2-h nap. After 3 nights without sleep, the subjects’ average cognitive performance was 55% of the control values. During a test session immediately before the 2-h nap, performance improved by 30%, to 85% of control values, indicating the considerable effect that the incentive of knowing that a nap is imminent can have on even severely sleep-deprived subjects. In the second experiment, two groups, each of six infantrymen, took part in a 5-day trial; for one group, 4 h of uninterrupted sleep was scheduled and for the other, four l-h naps in each 24-h period. There were no significant differences in cognitive test scores or mood between the two groups. On the last experimental day, cognitive test and mood scores were not significantly different from baseline values for either group, indicating the utility of 4 h of sleep, either in one uninterrupted block or in four scheduled 1-h naps per 24 h.     

The Effects of Classroom Guidance on Children's Success in School

The authors investigated the effects of classroom guidance on children's classroom behavior, attitudes toward school, and achievement in language arts and mathematics. Pretreatment and posttreatment data were collected on each variable for the treatment and control groups. The study involved 896 children (grades 4 and 5) from 18 different schools in North Carolina. The children came from virtually every geographic region of North Carolina and represented varying economic, social, and cultural environments. Eighteen school counselors volunteered to lead the guidance sessions for children in the treatment group. Results showed the treatment group (n = 453) improving and the control group (n = 443) declining on two measures of classroom behavior and on a single measure of attitude toward school. The differences in score changes between the groups on all these measures were statistically significant (p<.001). The results showed no significant differences in language and math grade changes between the groups. The differences in language grade changes between the groups approached significance (p<.10, however, with the treatment group's language grades improving and the control group's language grades not changing.     

The Severely Impaired Do Profit Most: Differential Effectiveness of a Parent Management Training for Children with Externalizing Behavior Problems in a Natural Setting

We investigated the differential effectiveness of a parent management training program for children with externalizing problem behavior. The parent management training was tested using a within-subject control group design. 270 families with children aged 3–10 years were included and assessments were made at 3 months before treatment, immediately before treatment, immediately after treatment, and at 12 months follow-up. We analyzed data using growth mixture modeling. For attention problems, we obtained a two-subgroup solution. One subgroup started with high initial values indicating more severe impairment, and the other subgroup had low initial values. The more impaired group showed stronger treatment effects. For disruptive behavior problems, our analyses revealed a three-subgroup solution. Two subgroups exhibited high initial levels of disruptive behavior problems and the third subgroup had low initial levels. One of the more impaired groups exhibited a strong decrease in problem behavior during treatment, while the other two groups only showed moderate decreases. For attention problems and disruptive behavior problems, some of the most impaired children gained the most from parent training.     

Psychophysiological and cognitive responses to stressful stimuli in subjects practicing progressive relaxation and clinically standardized meditation

Thirty-six volunteer subjects were assigned to one of three conditions: progressive relaxation, clinically standardized meditation, or a waiting list control group asked to relax daily (without specific instruction). Subjects were given paper and pencil tests two times, separated by 5 weeks during which time the two treatment groups received 4 weekly sessions of group training. All subjects were tested in the psychophysiology laboratory at the end of the 5-week period, during which time they were exposed to 5 very loud tones. While relaxing as deeply as possible using the techniques they had learned and anticipating the loud tones, the meditation group exhibited higher heart rates and higher integrated frontalis EMG activity, but they also showed greater cardiac decelerations following each tone, more frontal alpha, and fewer symptoms of cognitive anxiety than the other two groups. The relaxation group reported more sensations of muscular relaxation than the other groups, but also some symptoms of hyperventilation. The results are generally consistent with Davidson and Schwartz's (1976) categorization of meditation as a ‘cognitive’ technique, and suggest that frontal EEG alpha may be a physiological marker for the absence of cognitive anxiety. Physiological findings also support Goleman and Schwartz's (1976) suggestion that meditation prepares people to cope with stress.     

Influence of televised modeling and verbalization on children's delay of gratification

Voluntary delay of gratification in 9-year-old children was assessed 4 weeks prior to, immediately after, and 4 weeks subsequent to exposure to one of four televized films. The modeling group observed an adult female model exemplify high-delay behavior. The persuasion group observed the model verbalize good reasons for waiting. The persuasion-modeling group observed the model exemplify high-delay behavior and verbalize reasons for waiting. Subjects in each of the treatment groups emitted more delay choices on the posttest than control group subjects who observed the model exhibit neutral behavior. The greatest magnitude of change occurred when modeling and persuasive cues were combined. Treatment effects were still in evidence for the modeling and the persuasion-modeling groups after a period of 4 weeks.     

Self-instructions: Effects of cognitive level and active rehearsal

This research examined the effects of a self-instruction intervention on the relationship between cognitive level and conceptual tempo. Preoperational and concrete operational children received the Matching Familiar Figures Test prior to and after serving in either a no training control group, a content only control group, or a self-instruction group. Children in the content only control group received the same set of self-guiding strategy statements as those in the self-instruction group but without overt rehearsal of the statements. Cognitive level and conceptual tempo were strongly related; preoperational children tended to be classified as impulsive, concrete operational chidlren, as reflective. Although cognitive level predicted overall performance, with concrete operational children being more successful and more reflective than preoperational children, the influence of training was similar for both groups. On posttest, children in the self-instruction groups made more correct responses and were more reflective than children in the other two training groups.     

激活右腹外侧前额叶提高抑郁症患者对社会疼痛的情绪调节能力：一项TMS研究

负性人际交往经历和负性社会事件是抑郁症的重要诱导因素, 而社会功能受损是抑郁症患者的重要特征之一, 患者通常表现出对社会疼痛的情绪失调。为了提高抑郁症患者在负性社交情境中或面对负性社会事件时的情绪调节能力, 本研究采用经颅磁刺激技术(transcranial magnetic stimulation, TMS), 考察抑郁症患者在腹外侧前额叶(the ventrolateral prefrontal cortex, VLPFC)被激活后其情绪调节能力的改变。结果表明, 当右侧VLPFC被TMS激活且患者采用认知重评策略调节情绪时, 实验组患者(n = 64)比对照组患者(n = 63)在社会排斥情境下报告了更弱的负性情绪体验, 这说明激活右侧VLPFC可以有效提高患者对社会疼痛的外显性情绪调节能力。本研究是采用TMS提高抑郁症患者情绪调节能力的首次尝试, 实验发现不但支持了VLPFC与认知重评策略的因果关系, 还为临床改善抑郁症等社会功能障碍患者的情绪调节能力提供了明确的神经治疗靶点。后续研究还需探讨多疗程TMS刺激方案、改变社会疼痛的诱发方式、对比左右侧VLPFC的治疗效果、尝试使用其他的情绪调节策略, 进一步验证本研究的结论, 优化TMS治疗方案。     

Programming generalization and maintenance of treatment effects across time and across settings

Effects of three experimental and one control strategy were investigated in facilitating generalization and maintenance of treatment effects after two months in a token-economy classroom. At the conclusion of treatment, subjects were randomly assigned to one of three maintenance strategies or a control group and returned to their regular classrooms. The maintenance strategies were peer reprogramming, equating stimulus conditions between the experimental and regular classrooms, and teacher training in behavior management techniques. The maintenance strategies were implemented in the regular classroom for a two-month period and then terminated. Results indicated a powerful treatment effect produced by the token economy. Behavior maintenance effects following treatment were also obtained. The mean per cent appropriate behavior for the peer reprogramming and equating stimulus conditions strategies was significantly greater than the mean for the control subjects. The teacher training and control group means were not significantly different.