Development of a modified treatment evaluation inventory

Kazdin's (1980a) Treatment Evaluation Inventory (TEI) is the major instrument used to assess parents' acceptance of procedures for behavior problem children. The length of the TEI, however, as well as problems with its scaling and wording limits its value as a clinical research instrument. In the present study, three experiments were conducted to develop a modified TEI. In Experiment 1, 153 parents completed the TEI to evaluate a behavioral treatment for noncompliant and oppositional children. A factor analysis of the data was used to obtain a reliable factor structure for the TEI and to construct a 9-item TEI-Short Form (TEI-SF) with a 5-point scale, consistent anchors on the scale, and simplified text and instructions. Experiment 2 evaluated the psychometric characteristics of the TEI and the TEI-SF. These data indicated the TEI-SF is a sound alternative to the original TEI. Experiment 3 compared the readability and completion time of the two instruments.     

Acceptability bias: The effects of treatment acceptability on visual analysis of graphed data

Vignettes depicting a mildly or severely self-abusive child with profound mental retardation who received either a differential reinforcement of other behavior or a contingent electric shock treatment were presented to 161 undergraduates. After subjects rated the acceptability of the given treatment on the Treatment Evaluation Inventory (TEI), they evaluated the efficacy of the given treatment based upon six AB data graphs. Visual analytic judgments were not significantly effected by type of treatment, severity of self-injurious behavior (SIB), or the treatment × SIB interaction. TEI scores differed significantly according to type of treatment. Simple and multiple correlations computed between TEI scores and graph evaluations provided evidence ofacceptability bias, such that more favorable appraisals of treatment acceptability were related to perceptions of greater treatment effectiveness.     

INCREASING TREATMENT ACCEPTABILITY THROUGH VIDEO

The effects of a video vignette on the treatment acceptability ratings of four behavioral interventions were evaluated. Two interventions involved positive reinforcement (DRO and DRI) and two negative consequences (contingent physical restraint and contingent electric shock). Seventy-four undergraduate psychology students were randomly assigned into two groups. The experimental group (n=36) viewed a video vignette of a self-abusive individual whereas the control group (n=38) did not. Acceptability ratings prior to the video showed no differences between the experimental and control groups. The post video ratings indicated significant acceptability increases for physical restraint for the experimental group. There also was a significant group by testing effect because the means for the experimental group rose whereas the control group's means were stable. These results replicated and extended Foxx, McHenry and Bremer (in press) who showed that treatment acceptability is alterable through video.     

The effects of a video vignette on increasing treatment acceptability

The effects of a video vignette on the treatment acceptability ratings of four behavioral interventions were evaluated. Two interventions involved positive reinforcement (DRO and DRI) and two negative consequences (contingent physical restraint and contingent electric shock). Eighty-five individuals involved in programs for individuals with developmental disabilities were randomly assigned into two groups. The experimental group (n=41) viewed a video vignette of an extremely aggressive individual whereas the control group (n=44) did not. Acceptability ratings prior to the video showed no differences between the experimental and control groups except for the physical restraint intervention. The experimental group’s post video ratings indicated significant acceptability increases for electric shock and significant decreases for DRO. There also was a significant group by testing effect with the means for the experimental group rising whereas the control group means were stable. These results showed that acceptability is alterable through video. © 1997 John Wiley & Sons, Ltd.     

Acceptability of aversive procedures and medication as treatment alternatives for deviant child behavior

The present investigation evaluated the acceptability of alternative treatments for deviant child behavior. Clinical cases of children who displayed severe behavioral problems at home and at school were described along with three different treatments. The treatments, time-out from reinforcement, locked seclusion, and medication, were rated by psychiatric inpatient children and parents in a 3 × 3 replicated Latin-square design. The investigation also evaluated whether acceptability ratings were influenced by the clinical effectiveness of treatment in altering behavior. Although children and parents did not differ overall in acceptability ratings, they differed in their ranking of different treatments. Children viewed medication as the most acceptable treatment, whereas parents viewed time out as the most acceptable treatment. For both children and parents, treatments described as producing marked effects were rated as more acceptable than treatments producing weaker effects. The results indicated that disturbed children and their parents can readily distinguish the acceptability of alternative treatments. The implications of treatment acceptability for clinical applications of treatment are discussed.Completion of this investigation was facilitated by a Research Scientist Development Award (MH00353) and a grant (MH35408) from the National Institute of Mental Health. The author is grateful for the assistance of the clinical research team of the Child Psychiatric Treatment Service, especially that of Irene Heidish, M.A., who assisted with the data analyses.     

Acceptability of a brief computerized intervention targeting anxiety sensitivity

Despite the well-documented efficacy of cognitive behavioral treatments for anxiety disorders, the acceptability of these treatments remains an under-researched area. A better understanding of acceptability could help to improve the initiation of, and engagement in, these effective interventions. Recent research has suggested computerized interventions of anxiety-related risk factors may be one way to improve acceptability and overcome several common barriers to treatment. Considering this, the current study tested the acceptability of a computerized, anxiety sensitivity (AS)-focused treatment among a sample of treatment-seeking community participants and military veterans (N = 58). Results indicated that the majority of participants rated the intervention as acceptable, and that drop-out rate was low (ie 5%). Moreover, higher acceptability scores were associated with older age, veteran status, lower income levels, African-American race, and being separated/divorced. Findings suggest that a computerized AS-focused treatment may be an acceptable treatment method, and may have advantages in acceptability for hard to reach populations.     

ACCEPTABILITY OF ALTERNATIVE TREATMENTS FOR DEVIANT CHILD BEHAVIOR

The acceptability of alternative treatments for deviant child behavior was evaluated in two experiments. In each experiment, clinical cases were described to undergraduate students along with four different treatments in a Replicated Latin Square Design. The treatments included reinforcement of incompatible behavior, time out from reinforcement, drug therapy, and electric shock and the treatments were described as they were applied to children with problem behaviors. Experiment 1 developed an assessment device to evaluate treatment acceptability and examined whether treatments were rated as differentially acceptable. Experiment 2 replicated the first experiment and examined whether the severity of the presenting clinical problem influenced ratings of acceptability. The results indicated that treatments were sharply distinguished in overall acceptability. Reinforcement of incompatible behavior was more acceptable than other treatments which followed, in order, time out from reinforcement, drug therapy, and electric shock. Case severity influenced acceptability of alternative treatments with all treatments being rated as more acceptable with more severe cases. However, the strength of case severity was relatively small in relation to the different treatment conditions themselves which accounted for large portions of variance.     

The acceptability and preference for the psychological treatment of PTSD

The acceptability and preference of psychological treatments is important in understanding patient treatment seeking, choice, engagement and attrition and possibly treatment response in health care. The acceptability of, and preference for, 14 different types of psychological treatment for posttraumatic stress disorder (PTSD) were investigated in a student population through invitation to participate in a web-based survey. Respondents were asked to rate each treatment on 10 scales and to rank the treatments in order of preference. Respondents were also asked whether they would seek treatment themselves, recommend treatment to friends and family, feel stigmatised by suffering from PTSD, had any prior knowledge of the treatments and if this had been positive or negative and whether they had a history of psychological problems or treatment. A total of 330 respondents completed the survey. A past or current history of psychological problems and treatment was surprisingly high. Almost all respondents indicated that they would seek or recommend treatment in spite of high levels of stigmatisation. Factor analysis of the 10 scales indicated two factors: Endorsement and Discomfort. Rank ordering on preference and Endorsement scores was highly consistent. The highly preferred and endorsed treatments involved cognitive therapy, exposure or psycho-education in spite of high levels of discomfort anticipated with exposure. Treatments involving new technologies, EMDR and psychodynamic psychotherapy received the lowest Endorsement and preference. There was a modest influence of prior knowledge of a treatment.     

The Relationship Between Child Behavior and Acceptability of Contingency Management Procedures

Relationships between maternal ratings of treatment acceptability and three predictor variables, change in child noncompliance during treatment, disruptive child behavior associated with treatment procedures, and severity of child behavior problems, were examined in the context of a brief parent training program. Stepwise multiple regression analysis indicated that amount of disruptive behavior and change in child noncompliance were significant predictors of treatment acceptability, with those treatments which produced less disruptive behavior and greater reductions in noncompliance being rated as more acceptable. The combination of these two variables accounted for nearly 40% of the variance in acceptability ratings. These results are discussed in relation to previous findings with treatment analogues.     

Treatment Acceptability

The present study assessed mothers' and fathers' acceptance of six interventions frequently used to alter children's problem behavior. This is the first study to assess fathers' perceptions of behavioral interventions for children. Positive reinforcement, response cost, medication, room timeout, chair timeout and spanking were rated by parents using the Treatment Evaluation Inventory (TEI). In addition, parents' perceptions of their children's behavior and own marital adjustment were measured using standardized checklists. Parents' acceptability ratings differed significantly across treatment conditions depending on parent gender, child behavior problems, and marital adjustment. Treatment preference order was equivalent for all groups.     

Perceived Barriers to Treatment Participation and Treatment Acceptability Among Antisocial Children and Their Families

This study examined the role of perceived barriers to participation in treatment and the acceptability of treatment among children and parents. Children (N = 144, ages 6–14) referred for outpatient treatment for oppositional, aggressive, and antisocial behavior and their families participated. The main findings were that: (a) perceived barriers to participation in treatment predicted treatment acceptability as rated by children and parents; (b) the effect was not accounted for by socioeconomic disadvantage, parent psychopathology and stress, and severity of child dysfunction; and (c) treatment acceptability was related to therapeutic change in the children over the course of therapy but the relation was small. Overall, the findings indicate that families vary considerably in the barriers they perceive in coming to treatment and that these barriers influence the extent to which they and their children evaluate the acceptability of the treatments they receive. The implications of treatment acceptability for evaluation and delivery of psychotherapy are discussed.     

The Acceptability of Computer-Aided Cognitive Behavioural Therapy: A Pragmatic Study

The clinical and cost-effectiveness of a computer-aided cognitive behavioural therapy (CCBT) programme, Beating the Blues, is indicated by a number of studies, but relatively little is known about its acceptability for patients with depression, anxiety, or both. This study investigated the acceptability of Beating the Blues offered on eight scheduled clinic visits with brief face-to-face support. Pre and posttreatment measures explored the relationship among programme acceptability, treatment continuation, and outcomes for people accessing the programme in routine care. Two hundred and nineteen patients with depression, anxiety, or both were offered Beating the Blues in 11 primary and secondary care practices. One hundred and ninety-one (87%) completed the pretreatment measures and 84 (38%) completed a treatment feedback questionnaire. Analysis of treatment acceptability for CCBT indicated a positive patient experience with the programme. Pretreatment expectancies predicted CCBT treatment completion but not outcomes. No differences were found between men and women on pretreatment measures. Posttreatment, women reported more favourable responses to the therapy, finding the programme more helpful and more satisfactory, than did men. No relationship between treatment acceptability and age was found. Study limitations, including research methods and attrition rates, and implications for future research are discussed. It is concluded that the Beating the Blues CCBT programme is an acceptable treatment for common mental health problems in routine care.     

Preparing Families for Evidence-Based Treatment of ADHD: Development of Bootcamp for ADHD

Objective: Many families of children with attention-deficit/hyperactive disorder (ADHD) do not initiate evidence-based treatments (EBTs), placing these children at risk for poor outcomes. Bootcamp for ADHD (BC-ADHD) is a novel, four-session, group intervention designed to prepare parents as informed consumers to engage in multimodal EBTs for ADHD. This paper describes the theory of change and the development of BC-ADHD, outlines its components, and provides an initial proof of concept of the program. Method: Participants were 11 families of children with ADHD (ages 5–11; 55% male; 91% non-Hispanic; 55% White, 27% Black, 18% more than one race) who were the initial participants receiving BC-ADHD during a small-scale, randomized controlled trial. Parent-report outcome measures assessed parental empowerment, treatment preferences, affiliate stigma, intention to pursue treatment, and treatment initiation at baseline, posttreatment, and 6-week follow-up. Results: Parent engagement was high, as indicated by an 86% session attendance rate and high ratings of program satisfaction. Parents reported an increase in empowerment to access systems of care. Ratings of acceptability for behavior therapy increased at posttreatment and follow-up with minimal or no concerns about feasibility. The acceptability of medication was high at each assessment, although parents expressed increased concerns about stigma and adverse effects of medication at posttreatment and follow-up. Nonetheless, there was a marked increase in parental intention to use medication at posttreatment and follow-up. Accounting for ceiling effects, parents reported substantial increases in intention to use medication, behavioral parent training (BPT), and school services. Changes in treatment initiation were in the expected direction. Conclusions: BC-ADHD has the potential to promote family empowerment in seeking services and increase their intent to initiate EBTs, as well as actual initiation of these treatments.     

The robustness of the factor structure of the Self-Restraint Scale: What does self-restraint encompass?

In contrast with the original version of the Self-Restraint Scale (SRS; [Weinberger, D.A., & Schwartz, G.E. (1990). Distress and restraint as superordinate dimensions of self-reported adjustment: A typological perspective. Journal of Personality, 58, 381–417]), confirmatory factor analysis did not support a four-factor solution. In the current study an exploratory factor analysis revealed a three-factor structure. Although the original subscales suppression of aggression, consideration of others, and impulse control were confirmed by the data, responsibility did not fit within the overall concept of self-restraint. These results provide some indication that although the subscales can be used independently, the way self-restraint is conceptualized should be reconsidered. Future studies are needed to confirm the factor structure observed in the current study.     

Comparative study of trait emotional intelligence and executive functioning among youth

This study investigated the relationship between trait emotional intelligence (TEI) and executive skills (ESs), and the differences between TEI and ESs among Malaysian and Iranian youths. In this study, 226 Malaysians and 248 Iranians completed the TEIQue-SF and Executive Skills Questionnaire. Hypotheses were tested with Partial Least Squares-Structural Equation Modeling (PLS-SEM). Findings indicated that TEI had significant predictions on ESs, depending on cultural contexts. Significant differences were found in the effects of TEI on ESs, including emotional control, metacognition, goal-directed persistence, response inhibition, planning/prioritization, sustained attention, stress tolerance, task initiation, and working memory among Malaysian and Iranian youth. No significant difference was found in the effects of TEI on ESs, including flexibility, organization, and time management across both groups. This study makes a unique contribution to emotional intelligence and executive functioning research literature by considering several ESs at the same time for personal development and promoting healthier lives. Comparison of the effect of TEI on ESs in the Malaysian and Iranian contexts using advanced analysis methods is one of the most important methodological contributions of the study.     

Development of the Treatment Acceptability Questionnaire

This article describes the development and psychometric properties of a measure designed to assess the treatment acceptability of psychological treatments for both adult and child populations. Initial evidence on the Treatment Acceptability Questionnaire (TAQ) indicates that it has a good internal consistency and test-retest stability (over a 3-week period). The pattern of correlations with other measures of treatment acceptability for child-oriented interventions provides evidence of concurrent validity. Suggestions are made regarding the further validation and use of the TAQ.     

Are dietary restraint scales valid measures of acute dietary restriction? Unobtrusive observational data suggest not

The finding that dietary restraint scales predict onset of bulimic pathology has been interpreted as suggesting that dieting causes this eating disturbance, despite the dearth of evidence that these scales are valid measures of dietary restriction. The authors conducted 4 studies that tested whether dietary restraint scales were inversely correlated with unobtrusively measured caloric intake. These studies, which varied in foods consumed, settings, and populations, indicated that common dietary restraint scales were largely uncorrelated with acute caloric intake. Results suggest that these scales are not valid measures of short-term dietary restriction and imply that it may be prudent to reinterpret findings from studies thai use these scales, including those that suggest dietary restraint is a risk factor for bulimic pathology.     

Relationships between personal beliefs and treatment acceptability, and preferences for behavioral treatments

Background

The literature on preferences for behavioral interventions is limited in terms of understanding treatment-related factors that underlie treatment choice. The objectives of this study were to examine the direct relationships between personal beliefs about clinical condition, perception of treatment acceptability, and preferences for behavioral interventions for insomnia.

Methods

The data set used in this study was obtained from 431 persons with insomnia who participated in a partially randomized clinical trial and expressed preferences for treatment options. The data were collected at baseline. Logistic regression was used to examine the relationships between personal beliefs and treatment acceptability, and preferences. The relationships between personal beliefs and perception of treatment acceptability were explored with correlational analysis.

Results

Perception of treatment acceptability was associated with preferences. Persons viewing the option as convenient tended to choose that option for managing insomnia. Personal beliefs were not related to preferences. However, beliefs about sleep promoting behaviors were correlated with perceived treatment effectiveness.

Conclusions

Perception of treatment acceptability underlies expressed preferences for behavioral interventions. Personal beliefs about insomnia are not directly associated with preferences. Importance is highlighted for providing information about treatment options and exploring perception of each option's acceptability during the process of treatment selection.