Second year treatment outcome of alcoholics treated by individualized behavior therapy: Results

Second year treatment outcome results are reported for 69 of 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating ‘Individualized Behavior Therapy (IBT)’ techniques. Subjects were initially assigned to either a controlled drinking or non-drinking (abstinence) treatment goal. and were then randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment oriented towards abstinence. Previously reported results found that IBT subjects functioned significantly better than control subjects throughout the first year of follow-up. Second year follow-up results found that IBT subjects treated with a controlled drinking goal functioned significantly better than their respective control subjects on a variety of measures, including drinking behavior. Differences between IBT subjects treated with a non-drinking goal and their control subjects did not retain statistical significance during the second year of follow-up. Individual drinking profiles are presented for all subjects. Only subjects treated by IBT with a goal of controlled drinking engaged in a substantial amount of limited, non-problem drinking during the second year interval, and those subjects also had more abstinent days than subjects in any other group. The nature of adequate follow-up procedures and measures is discussed. Implications of these findings for alcoholism treatment are considered.     

Alcoholics treated by individualized behavior therapy: One year treatment outcome

One-year treatment outcome results are reported for 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating ‘Individualized Behavior Therapy (IBT)’ techniques. Initially, subjects had been assigned to a controlled drinking or non-drinking (abstinence) treatment goal, and then were randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment. One year follow-up results demonstrated that IBT treated subjects had functioned significantly better than control subjects. Dependent variable measures included daily drinking disposition, general emotional adjustment, vocational satisfaction, occupational status, driving status and an index of residential status and stability. The results support the view that some ‘alcoholics’ can acquire and maintain controlled drinking behavior over at least a 1-yr follow-up interval. The difficulties of designing and applying sophisticated follow-up procedures and measures are discussed.     

Individualized Behavior Therapy for Alcoholics – Republished Article

A behavior therapy for alcoholism was designed based on the rationale that alcoholic drinking is a discriminated, operant response. Treatment emphasized determining setting events for each subject’s drinking and training equally effective alternative responses to those situations. Seventy male, hospitalized, Gamma alcoholics were assigned to a treatment goal of either nondrinking (N = 30) or controlled drinking (N = 40). Subjects of each group were then randomly assigned to either an experimental group receiving 17 behavioral treatment sessions or a control group receiving only conventional treatment. Treatment of experimental groups differed only in drinking behaviors allowed during sessions and electric shock avoidance schedules. Nondrinker experimental subjects shaped to abstinence, while controlled drinker experimental subjects practiced appropriate drinking behaviors with little shaping, a result attributed to instructions. Follow-up measuring drinking and other behaviors found that experimental subjects functioned significantly better after discharge than control subjects, regardless of treatment goal. Successful experimental subjects could apply treatment principles to setting events not considered during treatment, suggesting the occurrence of rule learning. Results are discussed as evidence that some “alcoholics” can acquire and maintain controlled drinking behaviors. Traditional treatment of alcoholics may be handicapped by unvalidated beliefs concerning the nature of the disorder.     

Accounting for self-selected drinking goals in the assessment of treatment outcome

Many treatment outcome studies are abstinence-based and rely on achieved abstinence as an indicator of success, making the implicit assumption that participants have an abstinence goal. However, it is often the case that participants self-select controlled drinking goals, even in the context of an abstinence-based treatment. The current study explored the use of an outcome variable, percent weeks meeting goal (PWMG), which takes into account individual goal choice at baseline. The sample consisted of 57 women who participated in a cognitive-behavioral therapy treatment for alcohol dependence and were followed for 18 months after baseline. Twenty-two (39%) women self-selected controlled drinking goals, and 35 (61%) self-selected an abstinence goal at baseline. A repeated measures analysis of variance with PWMG as the dependent variable revealed that both goal groups were equally successful in meeting their goals during the 6-month treatment period. After treatment, participants with a goal of abstinence had more PWMG than did participants with a self-selected controlled drinking goal, but the difference was significant at a trend level. The two goal groups did not differ in outcome when the authors compared them using more traditional measures of outcome, percent days abstinent and percent heavy drinking days.     

Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years

The purpose of this study was to determine the course of the psychosocial functioning of patients with borderline personality disorder (BPD) over 6 years of prospective follow-up. The psychosocial functioning of 290 patients meeting both DIB-R and DSM-III-R criteria for BPD and 72 patients meeting DSM-III-R criteria for another Axis II disorder (and neither criteria set for BPD) was assessed at baseline using a semistructured interview of demonstrated reliability. Over 94% of surviving patients were reinterviewed about their psychosocial functioning blind to all previously collected information at three distinct follow-up waves: 2-, 4-, and 6-year follow-up. The psychosocial functioning of borderline patients improved substantially over time, with the percentage meeting criteria for good overall psychosocial functioning increasing from 26% at baseline to 56% during the third wave of follow-up. Despite this improvement, borderline patients functioned significantly more poorly than Axis II comparison subjects, particularly in the area of vocational achievement. However, a more detailed examination revealed that borderline patients who had experienced a symptomatic remission during the course of the study functioned significantly better both socially and vocationally than never-remitted borderline patients. More specifically, they were significantly more likely to have a good relationship with a spouse/partner and at least one parent, good work/school performance, a sustained work/school history, a GAF score of 61 or higher (43% vs. 0% 6 years after their index admission), and to have good overall psychosocial functioning (66% vs. 27% at 6 year follow-up). Taken together, the results of this study suggest that psychosocial improvement is both common among borderline patients and strongly related to their symptomatic status.     

Brief group psychotherapy in relapse prevention for alcohol dependent patients

The effects of brief group psychotherapy in relapse prevention were tested. The groups focused on the clients' capacity to formulate their own treatment goals, including controlled drinking, programmed relapse, and total abstinence. Twelve months after completion of the eight-week outpatient group treatment, thirty-five clients were followed up. There appeared to be no harmful effects as a result of the treatment. Nobody in the follow-up group had a deteriorated drinking pattern as compared to pretreatment data. The follow-up results were significantly better than before treatment and also than in a comparison group of alcohol dependent patients. It seemed as if those patients who could benefit from the treatment had a shorter duration of abuse and had a later onset of uncontrolled drinking compared to those who continued with a negative drinking pattern and the dropouts. The clients assigned the positive treatment effects to course leaders' encouragement of personal decision making, increased awareness of risk situations, and improved coping skills. The group situation in itself seemed to be of special importance for this result. The degree of structure implemented by course leaders allowed a free and respectful openness to develop between group members.     

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The effects of brief group psychotherapy in relapse prevention were tested. The groups focused on the clients' capacity to formulate their own treatment goals, including controlled drinking, programmed relapse, and total abstinence. Twelve months after completion of the eight-week outpatient group treatment, thirty-five clients were followed up. There appeared to be no harmful effects as a result of the treatment. Nobody in the follow-up group had a deteriorated drinking pattern as compared to pretreatment data. The follow-up results were significantly better than before treatment and also than in a comparison group of alcohol dependent patients. It seemed as if those patients who could benefit from the treatment had a shorter duration of abuse and had a later onset of uncontrolled drinking compared to those who continued with a negative drinking pattern and the dropouts. The clients assigned the positive treatment effects to course leaders' encouragement of personal decision making, increased awareness of risk situations, and improved coping skills. The group situation in itself seemed to be of special importance for this result. The degree of structure implemented by course leaders allowed a free and respectful opennes to develop between group members.     

Brief group psychotherapy for the spousally bereaved: a controlled study.

A consecutive sample of mid- and late-life bereaved spouses were randomly assigned to treatment and no-treatment groups. Two hypotheses were tested: (1) that brief group psychotherapy during the early stages of loss would facilitate adjustment assessed by measures of mental health, positive psychological states, social role, and mourning; and (2) that positive effects would be maximized for subjects who were more distressed psychologically. Although group participants, compared with untreated controls, did over 1 year show modest improvement on role functioning and positive psychological states, overall the study failed to find substantial support for the two major hypotheses. Both experimental and control groups showed improvement over the year, particularly on measures of mental health and mourning. Differential benefit was not observed for the high-risk group.     

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A consecutive sample of mid- and late-life bereaved spouses were randomly assigned to treatment and no-treatment groups. Two hypotheses were tested: (1) that brief group psychotherapy during the early stages of loss would facilitate adjustment assessed by measures of mental health, positive psychological states, social role, and mourning; and (2) that positive effects would be maximized for subjects who were more distressed psychologically. Although group participants, compared with untreated controls, did over 1 year show modest improvement on role functioning and positive psychological states, overall the study failed to find substantial support for the two major hypotheses. Both experimental and control groups showed improvement over the year, particularly on measures of mental health and mourning. Differential benefit was not observed for the high-risk group.     

Giving and receiving autonomy support in a high-stakes sport context: A field-based experiment during the 2012 London Paralympic Games

ObjectiveRecognizing that high-stakes competitions tend to pressure coaches toward a maladaptive controlling motivating style, we sought to evaluate the capacity of an intervention to help coaches adopt a more autonomy-supportive style as they and their athletes prepared for the 2012 London Paralympic Games.DesignWe adopted a coach-focused experimental research design that longitudinally assessed coaches' and athletes' self-report, rater-scored, and objective dependent measures.MethodWe randomly assigned 33 coaches and their 64 athletes from 10 sports into either an experimental or control group and assessed their motivation and functioning longitudinally.ResultsIn the control group, athletes and coaches both showed a significant longitudinal deterioration in all measures of motivation, engagement, and functioning. In the experimental group, none of the measures of motivation, engagement, and functioning deteriorated but, instead, were generally maintained. In terms of performance, athletes of coaches in the experimental group won significantly more Olympic medals than did athletes in the control group.ConclusionEnacting an autonomy-supportive coaching style within the context of a high-stakes sports competition functioned as an antidote to coaches' otherwise situationally-induced controlling style.     

A retrospective analysis of alcohol consumption on laboratory tasks as related to therapeutic outcome

The relationship between drinking on laboratory-analogue measures at the onset of inpatient alcoholism treatment and abstinence subsequent to treatment was examined. Twenty therapeutically successful and 20 unsuccessful chronic alcoholics were selected and did not differ on age, education, length of problem drinking, and length of follow-up. Retrospective analysis of responding on an operant drinking task and a ‘taste test’ assessment technique revealed significant differences between the groups, with successful patients drinking less than the unsuccessful ones. Implications for screening candidates for alcoholism treatment programs are discussed.     

Effectiveness of Rational Emotive Behavior Therapy on Psychological Well-Being of People with Late Blindness

The aim of the present study was to investigate the effectiveness of Rational Emotive Behavior Therapy (REBT) on improving the psychological wellbeing of people with late blindness. The design of this study was organized into pre-test, post-test and follow-up with two groups; experimental and control. After choosing qualified individuals, they were replaced into experimental and control groups at random (30 clients in each group). Pre-test was conducted for both groups. Thereafter, the experimental group received REBT training. Both groups, took part in post-test at the end of the training course. After 1 month, follow-up test was taken. Tools such as demographic particulars, IBT questionnaire, depression, anxiety and stress 21 inventory, Eysenck questionnaire were used for gathering information of the study. All the analytical process has been done by SPSS18 program. The scores of both groups (experimental and control groups) were not different significantly in pre-test. The scores gained by the experimental group in post-test showed a significant increase compared with the pre-test result. It proved the effectiveness of REBT with experimental group. And also, in comparing post-test with follow-up experimental group no significant difference were yield. So, as a result the effectiveness interference through group training of REBT with experimental group can be evaluated as constant. In control group there were no significant difference among the scores gained in pre-test, post-test and follow up. The findings of this research indicate the effectiveness of group coaching of REBT with enhancing the indices of psychological well being of people with late blindness.     

The use of structured learning therapy and transfer programming with disruptive adolescents in a school setting

In behavior change literature, little attention has been paid to the systematic study of variables affecting transfer of training. The present study employed a skill-training method known as Structured Learning Therapy (SLT) for the dual purpose of testing the effectiveness of this method and to identify variables that will promote transfer of training. Forty-three disruptive male adolescents were assigned to three experimental and two control conditions. One experimental group received SLT plus an additional transfer-enhancing procedure referred to as Transfer Programming (TP) which consisted of in vivo practice of treatment gains and peer reinforcement. Another group received only SLT, and a third group received only TP. One control group received only brief instructions pertaining to the nature of the skill, while the second group served as an attention control. Consistent with predictions, the results were that the two groups receiving the SLT performed significantly better than the three groups not receiving SLT on all dependent measures at posttest. These differences generally maintained at follow-up. Contrary to expectations, the implementation of TP did not prove to promote transfer of training beyond that found with SLT alone.     

Differential correlates of irrational belief

One hundred and ten students completed a battery which included Jones' Irrational Belief Test (IBT), and measures of subjective well-being, affect, alienation, personality, goal characteristics, and goat attainment. Correlations and canonical composites showed a general relationship between irrational beliefs and emotional difficulty, but the specific pattern differed for subgroups of IBT scales. Correlations supported the construct validity of IBT scales, but suggested they also reflect motives, conflicts, affects and personality characteristics. Interdependence of these processes was hypothesized and use of subscore composites rather than total IBT scores was suggested.     

Information processing complexity and leadership status

144 Subjects divided into four-person groups participated in three discussions. In each group, one member (Target subject) was preselected as either being high or low in cognitive complexity. The groups were then assigned to one of three conditions. Under Continuous Reinforcement the Target subject received a reinforcing light cue following each verbalization in the second of three discussions (no light cues used in the first and third discussions). Target subjects under Partial Reinforcement received light cues on a 50% variable ratio reinforcement schedule. Control subjects received no light cues in any session. Target subjects in both experimental groups showed conditioning effects on all dependent measures. While no differences were found between reinforcement conditions, results suggest that abstract subjects are able to make more use of feedback cues than concrete subjects.     

Explicit Learning of a Dynamic System with a Non-salient Pattern

We examine the hypothesis that a specific goal leads to implicit learning, whereas a nonspecific goal leads to explicit learning, even though the pattern to be learnt is non-salient. Subjects learned a dynamic control task (Berry & Broadbent, 1984). One group of subjects had a specific control goal, the second group had a non-specific pattern-search goal, and the third group had both goals. On measures of learning (control performance, prediction, and general questions), the non-specific group learnt explicitly, outperforming the other two groups on all learning measures. The specific group performed next best on control performance and prediction questions but performed very poorly on general questions. The dual-goal group performed poorly on all measures. Non-specific subjects predicted well on both familiar and unfamiliar situations. Specific-goal subjects predicted well on familiar situations, regardless of whether their previous response had been correct or incorrect. Dual-goal subjects predicted well only on familiar correct situations. We conclude that the non-specific group learned through explicit hypothesis testing, the specific group learned through a mixture of explicit problem solving and implicit instance learning, and the dual-goal group learned instances. Results are discussed in terms of dual-space models of problem solving and hypothesis testing and in terms of implicit instance learning. We consider how the choice of learning goal affects the cognitive processes used during learning and suggest that having subjects learn the same information implicitly or explicitly is potentially useful for drawing clearer distinctions between implicit and explicit modes of learning.     

Bladder training and enuresis: A controlled trial

This study was designed to test the effectiveness of a short bladder training procedure to increase bladder capacity and to improve enuresis. Eighteen enuretic children, aged 5–13 years, were randomly assigned to either an experimental or control group. Pre- and post-treatment measures of bladder capacity and frequency of bedwetting were obtained from subjects in both groups. The experimental group received 35 days of bladder training administered at first by the experimenter and then by the parents. The training consisted of required drinking, practice in holding and rewards for retaining progressively larger volumes of fluid before voiding. The control group received no training during the duration of the experiment. The results showed that the mean bladder capacity of the experimental subjects increased significantly with bladder training compared to controls. However, the frequency of bedwetting of the experimental subjects did not decrease significantly with training. Consequently, the efficacy of a bladder training procedure in the treatment of enuresis is questioned     

Is control a viable goal in the treatment of pathological gambling?

According to a report of National Gambling Impact Study Commission (National Gambling Impact Study Commission (1999). Final report. Washington, DC: Government Printing Office.), 97% of problem gamblers in the United States do not seek treatment. Within the small proportion of problem gamblers who enter into treatment, a high percentage drops out. Despite the fact that some researchers argue against abstinence as the only acceptable treatment goal and that regaining control over gambling behaviour appears to be possible for some pathological gamblers (PG), abstinence has been the only gambling intervention treatment goal. The primary goal of this study was to verify whether controlled gambling is a viable goal for pathological gamblers. The second goal was to identify the characteristics that predicted a successful outcome for treatment with a controlled gambling goal. Eighty-nine PGs were enrolled in cognitive-behavioural treatment aimed at controlled gambling. Six and twelve month follow-ups were conducted in order to evaluate the maintenance of therapeutic gains and to identify significant predictors of successful controlled gambling. Results showed that using the intent-to-treat procedure, 63% had a score of 4 or less on the DSM-IV at the end of treatment. That proportion was 56% and 51% at the 6- and 12-month follow-ups. If we retain only those who completed the treatment, these proportions increased to 92%, 80% and 71% at post-treatment, 6- and 12-month follow-ups, respectively. On the majority of the measures, significant improvements were found at post-treatment and the therapeutic gains were maintained at the 6- and 12-month follow-ups. However, few variables were identified to predict who would benefit from control rather than abstinence. The clinical and philosophical implications of these results are discussed in this paper.     

Habit reversal treatment for fingernail biting

A controlled experiment was carried out on 40 habitual fingernail biters to test the following: (1) Whether or not Nunn and Azrin's (1976) ‘habit-reversal’ programme could be simplified and still be effective. (2) Whether or not the use of a competing response is essential for successful outcome. (3) Whether or not a programme of ongoing goals can enhance outcome results.The subjects were equally divided into three experimental groups and a waiting list control group. The experimental groups were: habit reversal plus nail care; habit reversal, nail care plus programme of ongoing target goals; nail care instructions plus programme of ongoing target goals. The dependent variables were length of nails in millimetres and presence or absence of nailbiting. All experimental groups showed significantly greater increases in fingernail length than the control group, but there was no significant difference between the different treatments. However, at follow-up, the two groups incorporating ‘habit reversal’ showed much lower relapse rates than the other experimental group; thus, supporting the argument that use of a competing response is a key component in effective treatment of such compulsive, maladaptive habits.