A comparison of social-skills training, pharmacotherapy and psychotherapy for depression

This study compared four treatments for unipolar (non-psychotic) depression: Amitriptyline, Social-Skills Training (SST) + Amitriptyline, SST + Placebo and Psychotherapy + Placebo. In addition, 25 normal women were assessed on the behavioral measures in order to evaluate the ecological validity of the dependent measures and the changes produced by treatment. The four treatments, conducted by experienced clinicians, all produced statistically-significant and clinically-meaningful changes in symptomatology. However, there were several notable differences. The SST groups had greater improvement on measures of social skill, and were more similar to the normal women after treatment. In addition the SST + Placebo group had the lowest level of attrition and had the highest proportion of patients who were significantly improved. Significance of the results for future research on SST and role-play measures of social skill was discussed.     

Binge eating and outcome of behavioral treatment of obesity: a preliminary report

A survey was carried out of binge-eating behavior in a group of 44 patients who had completed group behavioral treatment for obesity. Obese binge eaters, defined by DSM-III criteria for bulimia, lost significantly less weight immediatedly posttreatment and at 6-month follow-up than non-binge eaters.     

Factors in the referral of children for behavioral treatment: A comparison of mothers of clinic-referred deviant,clinic-referred non-deviant and non-c

The purpose of this study was to compare a non-clinic sample of mothers and children to two groups of clinic-referred children and their mothers. The two clinic-referred groups differed from one another in that the selection criterion for one group of children (Clinic Deviant) was that they were significantly more deviant and non-compliant than the non-clinic group whereas the selection criterion for the second group of children (Clinic Non-deviant) was that they did not differ significantly from the non-clinic group on deviant and non-compliant behavior. Home observations by independent observers and parent questionnaires examining parental adjustment and parental perceptions of child adjustment were completed. The results indicated that both clinic groups perceived their children as more maladjusted than parents in the non-clinic groups perceived their children. Parents of the children in the Clinic Non-deviant group were significantly more depressed than those in the remaining two groups, whereas parents in the Clinic Deviant group issued more vague, interrupted commands than those in the Clinic Non-deviant group. Implications of the findings are discussed.     

Exposure and communications training in the treatment of agoraphobia

Twenty-one agoraphobics participated in a 6-month study designed to (a) compare imaginal flooding under high- (no sedation) and low- (sedation used) anxiety conditions: (b) examine the long-term effects of imaginal flooding in the absence of further exposure treatment; and (c) explore the impact of communications training on chronic anxiety and panic attacks. A reevaluation of the effects of sedation is presented in this report.Imaginal flooding without sedation was, on the whole, superior to the attention control placebo and imaginal flooding with sedation on therapists' and clients' ratings of fear and avoidance. However, the superiority of the non-drug flooding group cannot be attributed (as was concluded in an earlier report) to higher levels of anxiety across flooding sessions. Rather the drug (methohexitone sodium) appears to have impeded across-session habituation, perhaps by interfering with long-term memorial processes.The effects of imaginal flooding without sedation were stable over 4 months without further exposure treatment. These clients did receive training in solving important interpersonal problems through self monitoring and increased expressiveness. Contrary to hypotheses, not only was no further improvement obtained on fear and avoidance with this treatment, but also anxious mood and panic attacks remained unaffected. It is surprising to note that in-vivo treatment was no more effective than imaginal flooding on fear and avoidance. These and other findings suggest imaginal flooding well warrants further study.     

Assertion training: the effectiveness of a comprehensive cognitive--behavioral treatment package with professional nurses

The purpose of the study was to evaluate the effectiveness of a comprehensive cognitive-behavioral treatment package with a professional population of registered nurses using multiple self-report and role-play measures. Twenty-six self-referred registered nurses were randomly assigned to either a Treatment or Control group. The treatment package consisted of five weekly 2-hr sessions of group assertion training using the cognitive-behavioral model of Lange and Jakubowski. The Assertiveness Self-statement Test, the Rathus Assertiveness Schedule, the Adult Self-expression Scale, two Likert scales and role-play were used to evaluate changes over time. The results indicated: (1) the nurses in both groups at Pretreatment were clearly subassertive; (2) by Posttraining the Treatment-group members increased significantly their assertiveness as indicated on the self-report tests; (3) Treatment-group members had successfully maintained their improved assertiveness by the 2-month Follow-up; (4) the role-play ratings paralleled and supported the self-report results, but not at significant levels; (5) there was strong empirical support for the social validity of the treatment package; and (6) there was a high degree of treatment credibility for the cognitive-behavioral Assertion-training group. Overall, the results indicate clear support for the effectiveness of a broad-based cognitive-behavioral treatment package for treating subassertive behavior in a professional population of registered nurses.     

Assertive training for agoraphobics

Twenty-one unassertive agoraphobic patients were assigned to one of three treatments: (1) prolonged exposure in vivo, (2) assertive training and (3) a combination of assertive training and prolonged exposure in vivo. Each treatment was conducted in groups which were led by two therapists. Assessments involved both phobic targets and assertiveness, and were made before and after treatment, and at 1-month follow-up. Exposure in vivo was found to be superior to assertive training on phobic targets. Assertive training produced greater gains in assertiveness than exposure in vivo. The combination of treatments produced results comparable to exposure in viro. Results indicated that the type of change produced by the treatments is a rather specific one and is related to the specific target of treatment.     

Four process studies in the behavioral treatment of chronic headache

Four studies of ‘process’ variables in the behavioral treatment of chronic headache are examined. No relation between headache activity-level reduction and therapist variables such as level of experience (study 1) or warmth, competence or helpfulness as perceived by the patient (Study 2) was found from treatments using relaxation training and/or biofeedback. A significant relation was found, however, between regularity of relaxation practice at home (Study 4) and headache-activity reduction and between regularity of showing some degree of hand warming in thermal biofeedback treatment for vascular headache and headache activity-level reduction (Study 3). Finally, no relation was found between changes in EMG and headache activity-level for tension-headache sufferers treated with frontal EMG biofeedback.     

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.     

The effects of control and lack of control on active and passive avoidance in rhesus monkeys

Most studies which have examined the effects of lack of control have utilized test tasks in which active responding is required, and generally they have found impaired learning. Those few studies which have required passive responding in the test task generally have found facilitation of learning. The present two experiments examined the effects of lack of control in both active and passive avoidance tasks in a primate species (Macaco mulatta) not previously used in this research area. In Experiment 1, although the group without control (IE) tended to be inferior at active and superior at passive avoidance in comparison to the group with control (E), there were no significant differences. In Experiment 2, utilizing a difficult discrimination task in which subjects were required to learn when and when not to respond actively to avoid aversive stimulation, greater group differences were found. Two monkeys from Group IE failed to escape in active avoidance acquisition and, as a whole. Group IE was somewhat slower to respond than Group E. At passive avoidance, however. Group IE was superior to Group E and, as a consequence, more efficiently solved the discrimination problem. Implications of the present results for interpretation of the effects of lack of control as deficits are discussed.     

Generalization of treatment effects in training public speakers

Three studies compared the efficacy of various treatments for public-speaking incompetence. These effects were evaluated for the target behavior as well as for generalization effects across situations (conversations), settings (different sizes and types of audiences) and time (6-month follow-up). The first study showed that Self-instructional Training, either alone or in combination with other procedures, produced little or no benefits. The second study demonstrated the superiority of a Skills Training program over flooding therapy, while the final study failed to detect any enhancement of treatment benefits for the addition of home-practice to the Skills Training. In the first two studies generalization occurred across the three dimensions (settings, situations and time), while in the final study it was shown that the program was effective for a clinical population as well as recruited volunteers.     

Behavioral training for myopia: generalization of effects

The present study assessed generalization of training effects using a video computer system (VCS) as a training medium for modifying acuity. Eighteen myopic volunteers were matched according to pre-training acuity and assigned to either fading and feedback training group or a practice only control. Subjects were pre- and post-tested on three measures: the Snellen Letter Chart, a Behavioral Acuity Test and a performance test with the VCS. Compared to controls, trained subjects displayed significant improvements in acuity on the Behavioral Acuity Test. These results suggest that training effects generalize to untrained stimuli. Implications for the clinical implementation of behavioral training procedures for modifying myopia are discussed.     

Overlearning and instructional control of extinction of vasomotor responding

In a previous study by the authors, immediate extinction of conditioned vasomotor responding was obtained, under conditions of both continuous and partial reinforcement, when the UCS delivery apparatus was removed and subjects were informed that there would be no further UCS presentations. The present study varied the number of continuous reinforcement trials using the same conditioning procedure. Forty human subjects were randomly divided into two groups, given thermal vasomotor conditioning procedures on either 25 or 100 continuous reinforcement trials. At the onset of extinction half of each group was given traditional noninformed extinction procedures, while the other (informed) half had the thermal stimulator removed. Immediate extinction was obtained in informed subjects given 25 conditioning trials. However, there was no significant reduction of responding in informed subjects given 100 conditioning trials. Consequences for behavior theories and therapies are discussed.     

Anxiety management training in the treatment of essential hypertension

The study was conducted to assess the efficacy of Anxiety Management Training as an adjunctive treatment for essential hypertension. Twenty-one patients with essential hypertension, all but one of whom were on antihypertension medication, were randomly assigned either to an Anxiety Management Training condition or a waiting-list control condition. At the time of a posttest assessment session, compared to subjects in the control condition, subjects in the Anxiety Management Training condition manifested a decrease in resting systolic and diastolic blood pressure and a decrease in systolic and diastolic blood pressure following a stressful task. At the time of a follow-up assessment session, subjects in the Anxiety Management Training condition not only manifested good maintenance of reduced blood pressure but also exhibited a further decrease in resting systolic blood pressure and a decrease in systolic blood pressure during the stressful task.     

Cognitive-behavioral treatment of agoraphobia: paradoxical intention vs self-statement training

Twenty-six agoraphobics were randomly assigned to either Paradoxical Intention (PI) or Self-Statement Training (SST) which consisted of 12 weekly 90-min group sessions with 4–5 patients per group. Major assessments were carried out at pre-treatment, 6th week and 12th week of treatment, and at 1- and 6-month follow-ups. Measures included clinical ratings of severity of condition, phobia, anxiety and depression. Furthermore, a behavioral test was administered during which changes in subjective units of discomfort and cognitions were assessed. The results indicated statistically-significant improvement over time with both treatments. ANCOVAs performed revealed superior effects on several agoraphobia measures for the PI condition at post-treatment. However, by the 6-month follow-up assessment, the groups were equivalent due to marked improvement during the follow-up phase in the SST condition. Cognitive changes were marked by a decrease in self-defeating statements without concomitant increase in coping statements. These results and recommendations for future research are discussed.     

Therapeutic Contract Program: preliminary report on a behavioral alternative to the token economy

The token economy has been the primary model for the behavioral management of inpatient populations. However, this basically operant approach seldom emphasizes the development of cognitive-coping skills to help patients more effectively manage stressors that result in hospitalization. The Therapeutic Contract Program (TCP) is described as an inpatient-treatment strategy that is designed to help foster such cognitive-coping and self-control skills. While external structure is provided by components of this program, subprograms of the TCP have as their goal the development of internally-attributed coping skills and self-perceptions of competence. This preliminary report describes the structure of the TCP, as well as planned and in-progress measures of program participation and treatment outcome.     

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or,the machines may be necessary some time of the time

Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.     

Efficacy of self-instructional training for reducing children''s anxiety in an evaluative situation

Fifty-six fourth-grade children were categorized as either high or low in trait anxiety and then assigned to a self-instruction treatment, minimal-treatment, or no-treatment control condition. At both pretest and posttest, the subjects recited a memorized poem while being videotaped with the expectation that they would be judged on their performance. State anxiety measures, a behavior rating of anxiety, a measure of performance accuracy and the time involved in reciting a poem were obtained at both pretest and posttest. Contrary to expectation, the self-instructional training resulted in subjects' exhibiting greater signs of behavioral anxiety, subjects' hurrying through the task (taking less time to recite the poem) and high trait-anxiety subjects' reporting more state anxiety while anticipating reciting the poem. Correlational analyses indicated that trait anxiety was significantly related to the measures of state anxiety and the behavior rating of anxiety but not to performance accuracy.     

Heterosocial-skills training and covert sensitization. Effects on social skills and sexual arousal in sexual deviants

There are few experimental investigations of the effects of social-skills training (SST) on sexual deviation. This study used a multiple baseline across 4 subjects with undesired sexual arousal to investigate the effects of heterosocial-skills training and covert sensitization on heterosocial skills and sexual-arousal patterns. SST produced large increases in heterosocial skills but it had unclear effects on sexual arousal. Subsequently, covert sensitization tended to reduce remaining deviant arousal but did not increase appropriate arousal significantly. These data generally support the view that individual components of sexual arousal require separate assessment and intervention.     

The assessment of depression in children: The internal structure of the child depression inventory (CDI)

In the present report three separate studies of childhood depression were conducted. First, the internal structure of the Child Depression Inventory (CDI), with 216 children representing various ethnic groups with equal numbers of boys and girls, was evaluated through a factor analysis and by various internal-reliability measures (e.g. split-half reliabilities, Pearson correlations of each item to the total score). Four factors were established and internal reliability of the scale proved to be high. The relationship of the factor structure of the CDI to Kendell's Type A and B categorization of depression are discussed. In Study 2 the relationship of demographic variables to the CDI using the same group of children described for Study 1 was employed. Evaluating the characteristics of depression across age, sex and so on in children has not been frequently studied, and was deemed appropriate for the present investigation. Age proved to be a significant factor in depression scores although race and gender did not. With respect to age, older children tended to display more symptomatology. Comparisons of depressed children to nondepressed children also showed that age was a factor in the obtained scores, and range of severity in both groups. Depressed children differed from nondepressed children on all 27 items indicating that all the items on the CDI seem to be measuring a unitary concept. Study 3 compared CDI scores to a measure of social behavior, the Matson Evaluation of Social Skills with Youngster (MESSY). Seventy-six children (36 girls and 40 boys), ages 4–10 yrs $\text{(}\text{X}\text{?}\text{= 7)}$ were evaluated. Appropriate Social Skills was negatively correlated with childhood depression, and Inappropriate Impulsive/Assertiveness was positively correlated with depressive features described under the factor Guilt/Irritability. The implications of these data for further research on assessment, differential diagnosis and evaluation of treatment research are discussed.