Refining the experimental analysis of academic skills deficits: part II. Use of brief experimental analysis to evaluate reading fluency treatments

The technology of brief experimental analysis is just beginning to be used for identification of effective treatments for individual students who experience difficulty with oral reading fluency. In this study, the effect of a reading fluency treatment package was examined on easy and hard passages, and generalization was assessed on passages with high content overlap. The results suggest that the treatment package increased reading fluency for all 3 students. Effects were moderated by difficulty level for all 3 students. Results are discussed in terms of future refinements to the procedures, validation of the methods, and potential applications in clinical and school settings.     

Sequential combinations of drug and cognitive behavioral therapy for chronic insomnia: an exploratory study

This study explores the efficacy of sequential treatments involving medication and cognitive behavioral treatment (CBT) for primary insomnia. Seventeen participants took part in a multiple baseline design and were assigned to: (a) medication for 5 weeks, followed by combined medication plus CBT for 5 weeks; (b) combined treatment for 5 weeks, followed by CBT alone; or (c) CBT alone. Each treatment sequence produced significant sleep improvements, but at different points in time. For the first sequence, most of the sleep improvement was obtained after the introduction of CBT, while for the other sequence and CBT alone, improvement appeared during the first weeks. These results suggest that sleep improvement seems affected by the way treatments are combined. Also, a sequence beginning with a combined treatment followed by CBT alone seems to produce the best outcome. Additional research should be conducted with larger samples to determine the most effective sequence.     

MULTIPLE TREATMENT INTERFERENCE IN THE ALTERNATING TREATMENTS DESIGN AS A FUNCTION OF THE INTERCOMPONENT INTERVAL LENGTH

In experimental designs requiring the administration of more than one treatment to the same subject(s), the effect of one treatment may be influenced by the effect of another treatment (Campbell & Stanley, 1963), a phenomenon known as multiple treatment interference. We conducted two studies in which multiple treatment interference in an alternating treatments design was shown to be a function of the length of the intercomponent interval (ICI) separating treatment conditions. In the first study, we evaluated the effects of four different treatments on the mouthing of a severely retarded boy. Under a 1-min ICI no consistent differential responding to treatment was obtained. Differential responding emerged when the ICI was increased from 1 min to 120 min, thus suggesting multiple treatment interference in the lack of differential responding under a 1-min changeover interval. Functional control of the nondifferential and differential responding as a function of the ICI length was replicated in a reversal phase. In the second study, we compared two treatment procedures for the disruptive noncompliant behavior of a moderately retarded boy. Multiple treatment interference (i.e., the lack of differential responding) occurred with the 1-min intercomponent interval. An increase to a 120-min ICI again resulted in differential responding. A replication of multiple treatment interference by a reversal to a short interval phase was not achieved in the second subject. Results of this study support much of the basic literature on discrimination and multiple treatment interference. Major findings of this study are twofold: Multiple treatment interference can depend on the length of the changeover interval between treatments and multiple treatment interference can take the form of a lack of differential responding to various treatments. Implications for future research are discussed.     

Psychological assessment, treatment, and outcome with sex offenders

The frequency and impact of sexual offenses have led to the recent enactment of sexual "predator" laws. Such laws are intended to reduce sexual violence through treatment and involuntary confinement. Sixty years ago, similar laws identifying "sexual psychopaths" were enacted and, in many states, eventually repealed for multiple reasons; among those reasons was an inability to demonstrate that treatment had any significant impact on recidivism. That inability forced us to reexamine, among other issues, the population(s) which undergo treatment, the outcomes that are used to measure treatment effectiveness, and the processes that constitute treatment itself. Those issues are considered in this paper through a review of treatment programs based on psychodynamic, behavioral, and cognitive-behavioral theories. Although the evidence is sparse, it is fair to conclude that the latter have been found to be effective. We call for dynamic measures, effective treatments, and the resources necessary for both developments.     

When the Evidence Says, "Yes, No, and Maybe So": Attending to and Interpreting Inconsistent Findings Among Evidence-Based Interventions

ABSTRACT— An international, multidisciplinary effort aims to identify evidence-based treatments (EBTs) or interventions. The goal of this effort is to identify specific techniques or programs that successfully target and change specific behaviors. In clinical psychology, EBTs are identified based on the outcomes of randomized controlled trials examining whether treatments outperform control or alternative treatment conditions. Treatment outcomes are measured in multiple ways. Consistently, different ways of gauging outcomes yield inconsistent conclusions. Historically, EBT research has not accounted for these inconsistencies. In this paper we highlight the implications of inconsistencies, describe a framework for redressing inconsistent findings, and illustrate how the framework can guide future research on how to administer and combine treatments to maximize treatment effects and how to study treatments via quantitative review.     

Clinical Experiences in Conducting Empirically Supported Treatments for Generalized Anxiety Disorder

Knowledge of the efficacy of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) predominantly derives from randomized controlled trials (RCTs). However, there may be unique or complex issues encountered in practice, but not necessarily in the context of a controlled clinical trial. Therefore, launching a systematic dialogue between researcher and practicing clinician can be instrumental in augmenting evidence-based therapies through identification of variables that promote and interfere with clinical effectiveness. Through an initiative sponsored by the American Psychological Association’s Divisions 12 (Society for Clinical Psychology) and 29 (Psychotherapy), this study aimed to examine clinical experiences conducting CBT for GAD. The participants were 260 psychotherapists who completed an online survey on assessment and therapeutic intervention utilization and their experience of factors that limit successful GAD treatment and symptom reduction. The majority of respondents reported 20 years or less experience using ESTs for GAD, typically treating clients in outpatient clinics, treatment centers, and private practice. Some of the most commonly used interventions address clients’ maladaptive cognitions and elevated anxiety and muscle tension typical of GAD. Approximately one half of respondents reported incorporating integrative techniques into treatment. Factors perceived as limiting effective GAD treatment included severity and chronicity of GAD, presence of comorbid conditions, stressful home and work environments, client motivation and resistance to treatment, and issues encountered when executing therapy techniques. This study provides researchers with clinically derived directions for future empirical investigation into enhancing efficacy of GAD treatment.     

Do We Know Which Interventions are Effective for Disruptive and Delinquent Girls?

Disruptive and delinquent girls are not well served by the mental health and juvenile justice systems. Interventions that have been developed for the behavior problems of boys are frequently applied to girls despite growing evidence for a female-specific phenotype, developmental course, and set of risk factors from middle childhood onwards. The current review demonstrates that evidence of the effectiveness of treatments for girls with disruptive and delinquent behaviors is extremely limited, with relatively few studies including sufficient numbers of females or reporting on treatment effects by gender. However, a small body of evidence suggests that interventions specifically designed to address female behavior problems or risk factors can be effective in ameliorating disruptive and delinquent behaviors in both pre-adolescence and adolescence. Multi-modal interventions that target interacting domains of risk also show promise. Methodological issues are discussed and recommendations are made for the development and evaluation of future interventions to prevent and reduce girls’ disruptive and delinquent behavior.     

Interventions for Child and Adolescent Depression: Do Professional Therapists Produce Better Results?

We reviewed and analyzed child and adolescent depression treatment studies (1980–2001) through a comprehensive literature search. The outcome data from 19 studies (31 treatments) were extracted and weighted standard mean effect sizes were computed. Outcomes were compared across two levels of therapist training: professional and graduate student. Moreover, age was examined to test for differential effects on treatment outcome. Overall, professionals and graduate student therapists produced impressive yet commensurate outcomes when treating depressed youth. There were no significant differences found when treating children versus adolescents. The implications and limitations are reviewed, as are the suggestions for future research.     

Cognitive Behavioral Treatment of PTSD with Comorbid Panic Attacks

Many individuals that experience traumatic events such as sexual and physical assault develop posttraumatic stress disorder (PTSD). More recently, research has indicated that a significant proportion of PTSD sufferers may also have comorbid panic attacks. Although there are several effective treatments that focus on alleviating PTSD symptoms, until now there were no treatments that focused on also treating comorbid panic attacks. Multiple channel exposure therapy (M-CET) is the first treatment developed to specifically treat comorbid PTSD and panic attacks. It is also unique in that it has been used to treat women who have multiple trauma histories as well as a wide range of different types of traumatic event exposure in a group format. This treatment is described in a session by session format and special considerations in implementing the treatment are discussed.     

Psychosocial Interventions for Children with Early-Onset Bipolar Spectrum Disorder

Once considered virtually nonexistent, bipolar disorder in children has recently received a great deal of attention from mental health professionals and the general public. This paper provides a current review of literature pertaining to the psychosocial treatment of children with early-onset bipolar spectrum disorder (EOBPSD). Commencing with evidence of the emerging interest in this topic, we then focus on terminology, the rationale for studying EOBPSD in children, current research and clinical progress, possible explanations for the recent increase in recognition, and essential issues that form the foundation of effective psychosocial treatment. Next we explore areas of research with direct implications for psychosocial treatment. These include biological and psychosocial risk factors associated with bipolar disorder; and the psychosocial treatment of adult-onset bipolar disorder, childhood-onset unipolar disorder, and anger management in children. Following this, we discuss treatments being developed and tested for children with EOBPSD. Finally, we conclude with recommendations for future studies needed to move the field forward.     

Child and adolescent disorders: Issues for psychosocial treatment research

The recent efforts of the National Institute of Mental Health (NIMH) to encourage child and adolescent research are described, including the creation of the Child and Adolescent Psychosocial Interventions Research Consortium as a forum to identify, delineate, and examine research needs in psychosocial treatments. This is followed by a summary review of the contents of this special issue: history of psychotherapy research with children, developmental issues, diagnosis and assessment, ecological and cultural validity, laboratory versus clinic research outcomes, cognitive behavioral treatments for childhood disorders, nontraditional treatments, and overview and future directions. Finally, methodological issues that need to be addressed in future research are discussed, such as the developmental level of children in treatment research, issues of comorbidity, family involvement, and duration of treatment.     

Meta-Analysis of the Effects of Peer-Administered Psychosocial Interventions on Symptoms of Depression

Many community mental health centers have implemented peer treatment models that employ recovered former clients as cost‐efficient adjunct providers. The effectiveness of these and other peer‐administered interventions (PAIs) for treating depression symptoms has not been well‐established. The current study is a meta‐analysis of PAIs’ effects on depression symptoms. Twenty‐three eligible studies were identified. Study characteristics were coded by multiple raters, random‐effects models were used to compare mean effect sizes, and mixed‐effects models were used to test for moderation. PAIs produced significant pre‐post reductions in depression symptoms (d = .5043 [95 % CI .3675–.6412]). In direct comparisons, PAIs performed as well as non‐peer‐administered interventions (.0848 [?.1455–.3151]), and significantly better than no‐treatment conditions (.2011 [.0104–.3918]). PAIs that involved a professional in a secondary treatment role were significantly less effective than those that were purely peer‐administered, and educational/skills‐based PAIs produced better outcomes than those that were mainly supportive. Follow‐up data, when available, indicated that PAIs’ benefits were maintained. PAIs reduce depression symptoms and warrant further study. The clinical significance of PAIs’ benefits, and whether they are better suited as stand‐alone or adjunct treatments, remain to be established. Implications for the roles of mental health professionals are discussed.     

Improving Methodologies for the Treatment of Child and Adolescent Disorders: Introduction

This special issue grew out of a workshop sponsored by the National Institute of Mental Health, the MacArthur Foundation, and the Child and Adolescent Psychosocial Interventions Consortium. The goals of the workshop are outlined. The contents of the special issue are then described: definitions of psychotherapy and its mechanisms of action, developmental issues in psychotherapy research, methodologies for the treatment of anxious youth, measurement of change in interventions, predicting the outcome of treatment, and advancing the efficacy and effectiveness of psychosocial treatments. Finally, some areas that need to be addressed in the future are discussed, such as process research, the effects of comorbidity on outcomes, intensity, and duration, and transferability of treatments.     

SEQUENTIAL APPLICATION OF MAJOR HABIT-REVERSAL COMPONENTS TO TREAT MOTOR TICS IN CHILDREN

In this study, we sequentially administered up to four components of the habit-reversal treatment to 4 children with motor tics within a multiple baseline design. The habit-reversal components included (a) awareness training; (b) awareness training and self-monitoring; (c) awareness training, self-monitoring, and social support; and (d) awareness training, social support, and the use of a competing response. Results demonstrated that the combined use of awareness training, social support, and competing response training was effective in eliminating motor tics in 2 of 4 children, that awareness training alone was effective for 1 child, and that a combination of awareness training and self-monitoring was effective for the 4th child. The treatment and ensuing improvement were found to be socially valid. We discuss possible explanations for these results and recommend directions for future research.     

Assessing Efficacy of Stuttering Treatments

Efficacy has been defined as the extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideally controlled conditions when administered or monitored by experts. Studies on efficacy can be divided into those that study methods of conducting treatment (i.e., treatment process research) and those that are concerned with the effects of treatments (i.e., treatment outcome research). This review covers both areas, emphasizes the former, and considers such key determinants of efficacy as measurement, treatment integrity, and design issues. A set of criteria is given and a meta-analysis of whether studies published since 1993 meet these criteria is reported (incorporating some pragmatic and ethical considerations). The review ends by considering directions that warrant further investigation in the future.

Educational objectives: The reader will learn about and be able to describe (1) measurements appropriate for evaluating treatment efficacy studies; (2) how to evaluate reports of stuttering treatment programs; and (3) different designs used in treatment efficacy studies.     

Motivational Interviewing as an Adjunct to Cognitive Behavior Therapy for Anxiety Disorders: A Critical Review of the Literature

Cognitive behavior therapy (CBT) is efficaciously and effectively used in the treatment of anxiety disorders; however, as CBT for anxiety routinely utilizes exposure components, clients often experience ambivalence about treatment and their clinicians often must deal with resistance. Motivational Interviewing (MI) is a therapeutic strategy that addresses ambivalence about change in clinical interventions. MI has been applied as an adjunct for treatments such as CBT in order to increase motivation for and commitment to the intervention, especially when components of the treatment may be challenging (e.g., exposure, cognitive restructuring). Though researchers have commented specifically on the use of MI as a supplement to CBT for anxiety disorders, no comprehensive review has systematically assessed the strengths and limitations of extant literature on the topic, nor across anxiety disorders. Findings are summarized from 6 case studies and uncontrolled trials and 11 randomized controlled trials published through March 2016. An integrated critique of this literature also is offered. Limitations and the preliminary nature of the work in this area notwithstanding, it appears that it is feasible to supplement or integrate CBT with MI and that doing so has the potential to improve treatment initiation and engagement, as well as clinical outcomes. A number of directions for future research are addressed, such as determining which MI approaches to implement, with whom, when, and in what contexts.     

Psychosocial treatments for social phobia

Increasing recognition of the prevalence and impairment associated with social phobia has spurred the development of effective psychosocial treatments for this disorder. Exposure-based interventions have the most empirical support. This article applies the tripartite model of anxiety to social phobia, describes state-of-the-art psychosocial treatments, and highlights studies on the comparative and combined efficacy of psychological and pharmacologic treatments. Clinical issues related to treatment implementation, limitations of extant psychosocial interventions, and suggestions for future research are also discussed.     

Behavioral versus Behavioral and Pharmacological Treatment in ADHD Children Attending a Summer Treatment Program

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed.     

Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder

This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.     

Marginal mean weighting through stratification: a generalized method for evaluating multivalued and multiple treatments with nonexperimental data

Propensity score matching and stratification enable researchers to make statistical adjustment for a large number of observed covariates in nonexperimental data. These methods have recently become popular in psychological research. Yet their applications to evaluations of multi-valued and multiple treatments are limited. The inverse-probability-of-treatment weighting method, though suitable for evaluating multi-valued and multiple treatments, often generates results that are not robust when only a portion of the population provides support for causal inference or when the functional form of the propensity score model is misspecified. The marginal mean weighting through stratification (MMW-S) method promises a viable nonparametric solution to these problems. By computing weights on the basis of stratified propensity scores, MMW-S adjustment equates the pretreatment composition of multiple treatment groups under the assumption that unmeasured covariates do not confound the treatment effects given the observed covariates. Analyzing data from a weighted sample, researchers can estimate a causal effect by computing the difference between the estimated average potential outcomes associated with alternative treatments within the analysis of variance framework. After providing an intuitive illustration of the theoretical rationale underlying the weighting method for causal inferences, the article demonstrates how to apply the MMW-S method to evaluations of treatments measured on a binary, ordinal, or nominal scale approximating a completely randomized experiment; to studies of multiple concurrent treatments approximating factorial randomized designs; and to moderated treatment effects approximating randomized block designs. The analytic procedure is illustrated with an evaluation of educational services for English language learners attending kindergarten in the United States.