What are we doing to waiting list controls?

For ethical reasons waiting list controls have been preferred to no treatment controls, provided the wait is still shorter than that for routine services. However, could significant differences arise from the wait being detrimental rather than the intervention being beneficial? Despite the number of studies employing this design, few have analysed intervention trials from the perspective of the waiting list controls rather than the experimental group. A Full Day Stress Management Workshop programme which had run successfully in Birmingham, was repeated in three areas in the South East of England. The data from the four areas were reanalysed to assess progress within the control group and to compare the final assessment points for the two groups. The control group did not show any significant deterioration during the three month wait for their workshop. Three months after their respective workshops, scores in the control groups did not differ significantly from those of the experimental group.     

How do I love thee? Let me count the words: the social effects of expressive writing

Writing about emotional experiences is associated with a host of positive outcomes. This study extended the expressive-writing paradigm to the realm of romantic relationships to examine the social effects of writing. For 3 consecutive days, one person from each of 86 dating couples either wrote about his or her deepest thoughts and feelings about the relationship or wrote about his or her daily activities. In the days before and after writing, instant messages were collected from the couples. Participants who wrote about their relationship were significantly more likely to still be dating their romantic partners 3 months later. Linguistic analyses of the instant messages revealed that participants and their partners used significantly more positive and negative emotion words in the days following the expressive-writing manipulation if the participants had written about their relationship than if they had written about their daily activities. Increases in positive emotion words partially mediated the relation between expressive writing and relationship stability.     

Behavioral Parent Training:

Parents of 42 conduct disordered children were randomly allocated to either contingency management training, communication skills training or a waiting list control condition. The two treatments were conducted with the problem child either present or absent during sessions. Assessment devices included the Behavior Problem Checklist, Becker Adjective Checklist, Parent Attitude Survey, Piers-Harris Self-Concept Scale, and Daily observations made by parents. In comparison to waiting list controls, significant treatment effects were found on the Behavior Problem Checklist and on one attitude subscale (Understanding). More subjects in the contingency management condition met a criterion of clinical success than in the other conditions. No differential effect was associated with the conduct of treatment under conditions where the child was either present of absent form the sessions.     

The Use of Time Limits in Brief Psychotherapy: A Comparison of Six-Session,Twelve-Session,and Unlimited Treatment with Families

This study compared the relative effectiveness of two durations of time-limited psychotherapy with time-unlimited treatment and a waiting list control group. Thirty-seven families applying for treatment at a child guidance clinic were randomly assigned to one of four treatment conditions: (a) time-limited therapy of 6 sessions within 8 weeks; (b) time-limited therapy of 12 sessions within 16 weeks; (c) time-unlimited therapy; and (d) a waiting list control group in which families waited approximately four months before beginning treatment. Outcome was assessed from multiple sources: parents, child, therapist, family interaction ratings, and missed and canceled sessions. Analysis of data provided some evidence that families who received treatment fared better than those on the waiting list. There were no consistent differences between 6-session, 12-session, and unlimited therapy. A model is proposed for the further investigation of time-limited treatment.     

Community-Based Interventions to Reduce Low Income, African American Women's Risk of Sexually Transmitted Diseases: A Randomized Controlled Trial of Three Theoretical Models

A community-based sample of disadvantaged African American women (n = 445) was recruited to participate in 1 of 3 theoretically driven experimental interventions based on either the theory of gender and power, social learning theory, or cognitive behavioral theory. Intervention outcomes were compared with a waiting list control condition. From baseline to postintervention, women in the experimental interventions showed differential change on cognitive indices (knowledge and attitudes) and skill acquisition (partner negotiation skills, correct condom application, lubricant selection, and information-provision to social networks) whereas control participants were unchanged. Women in the 3 experimental interventions also completed follow-up assessments for 1 year following the interventions. In all 3 experimental conditions, condom use increased relative to the control group and there were no differences between the experimental interventions. Women who participated in one of the theoretically grounded interventions continued to increase condom use over the following year. Women entering new relationships reported significantly more condom use than did women who remained in ongoing relationships. The findings suggest that intervention models that have proven effective for women who engage in high-risk behavior may be less effective for women in established relationships for whom risk is primarily derived from the extrarelationship behavior of their partners.     

The effectiveness of various treatment techniques on different degrees and durations of sleep-onset insomnia

Mild and moderate insomniacs were randomly assigned to one of five group therapy conditions: relaxation without muscle-tension, stimulus control plus relaxation without muscletension, placebo, self-monitoring, and waiting list. Mild insomniacs were differentiated according to the duration of their sleep disturbance. Insomniacs were told that improvement would not be noticeable until after the final therapy session. During this counterdemand period, the two relaxation groups showed significantly greater decreases in sleep onset latency than the control conditions. In addition, it appeared that duration affected treated outcome. The effectiveness of treatment packages and self-monitoring in alleviating insomnia is briefly discussed.     

Power in relationships of women with depression

To identify marital power difficulties specifically associated with depression, twenty couples in which the female partner was depressed were compared on a range of interpersonal power variables with twenty healthy control couples and also with twenty couples in which the female partner had a disorder other than depression (specifically panic disorder with agoraphobia (PDA)). Couples in the depressed group had two features that distinguished them from couples in both the PDA and control groups and which were independent of relationship dissatisfaction. In the depressed group, both partners reported more physical assault in the year prior to the study and depressed women were more dissatisfied with their control of surplus spending money. Couples in the depressed group had a series of features that distinguished them from couples in both the PDA and control groups but which were due in part to relationship dissatisfaction. Depressed women were less committed to their relationships. Both partners in depressed couples reported more demand–withdraw transactions and less mutual constructive communication within their relationships. Depressed women reported more dissatisfaction with decision-making and greater dissatisfaction in childcare task distribution.     

Short- and long-term effectiveness of two communication training modalities with distressed couples

Abstract

Communication training is a widely practiced therapeutic approach for the treatment of marital discord. Although there is some empirical support for the theoretical assumptions underlying constructive communication patterns, it has not yet been ascertained whether changing these behaviors is sufficient in bringing about stable changes in distressed marriages. The present study was designed to investigate the efficacy of this treatment approach in a conjoint and conjoint group modality. Following therapy, conjoint couples (n = 16) when compared with a waiting list control group (n = 17) showed improvement on five of the seven outcome variables. Couples in the conjoint group modality (n = 13) improved on only two of the seven variables. Follow-up assessments one year after treatment showed that initial gains had been substantially reduced. On the basis of these results it is now open to question whether conjoint group treatments are an appropriate treatment modality for even moderately distressed couples.     

Behavioral Marital Therapy: An Outcome Evaluation of Conjoint,Group and One Spouse Treatment

Abstract

Behavioral Marital Therapy has focussed on the modification of marital behavior in conjoint and couples group settings. This study extends previously published outcome studies in that one treatment condition involved treating only one of the partners. Fifty-seven couples were consecutively assigned to one of the three treatment conditions. Outcome evaluations included an independent assessment, marital satisfaction, sexual adjustment and an assessment of target problems. The results revealed no significant differences between the three treatment conditions. However, couples in the conjoint treatment resolved their target problems more rapidly than the other two treatments. The implications of the result as well as issues of outcome prediction, cost-effectiveness and the viability of treating one spouse are discussed.     

The effect of couples training and partner co-operativeness in the behavioral treatment of obesity

To evaluate the influence of spouse co-operativeness and couples training in the treatment of obesity, 29 obese men and women were assigned to three experimental conditions: (1) Co-operative spouse-couples training: subjects attended all meetings with spouses. Spouses were trained in modeling, monitoring, and reinforcement techniques; (2) Co-operative spouse-subject alone: subjects attended meetings alone even though their partners had agreed to become involved in treatment; (3) Non-cooperative spouse: subjects had spouses refusing to participate in the program, and attended sessions alone. At the 3-month and 6-month maintenance assessments. subjects in the spouse training condition lost significantly more weight than subjects in the other two conditions. Weight losses compared favorably to those of any controlled study with subjects in the couples training group averaging nearly 30 lbs lost after 8$\text{1}\text{2}$ months of treatment. In the absence of spouse training, subjects with co-operative spouses did no better than subjects with non-co-operative spouses. The findings suggest that spouse training may have a potent facilitative effect in weight reduction, and that this effect may promote long-term maintenance of weight loss.     

Relationships among measures of communication, marital satisfaction and exposure during couples treatment of agoraphobia

The goals of this study were to examine the relationships among measures of couples interactions (satisfaction and communication), and response to treatment within a group of agoraphobic clients and their partners. The treatment included the clients' partners in structured, graduated in vivo exposure practices. Twenty-two clients and their partners completed pre-, mid- and post-treatment assessments. Treatment responders rated themselves and their partners as more communicative regarding the client's fears, at pre- and mid-assessments in comparison to nonresponders; measures of communication related inversely to levels of anxiety reported during exposures, but marital satisfaction did not relate to any measure of exposure. In addition, level of anxiety during exposure differentiated responders from nonresponders; responders experienced a significant reduction in their levels of anxiety. Finally, ratings of frequency of communication at mid-assessment were highly predictive of treatment outcome at post-assessment. The implications from these findings for communication skills training for a subset of couples who enter couples treatment for agoraphobia are discussed.     

One-session cognitive treatment of dental phobia: preparing dental phobics for treatment by restructuring negative cognitions

The purpose of this study was to investigate the effectiveness of a single session of cognitive restructuring in a sample of phobic dental patients. Fifty-two patients were randomly assigned to one of three conditions: cognitive restructuring (modification of negative cognitions), provision of information (about oral health and dental treatment), and a waiting list control condition. Both interventions maximally lasted one hour. In comparison with the waiting list control condition and the information intervention condition, the cognitive intervention condition not only showed a large decrease in frequency and believability of negative cognitions, but also exhibited a clear decline in dental trait anxiety. Analysis at a follow-up of one year demonstrated a further, drastic reduction in dental anxiety in both intervention conditions, wherein the difference among these conditions was not maintained. It is concluded that it is possible to obtain substantial reductions of dental trait anxiety through a single session of cognitive restructuring. Nevertheless, repeated exposure to the dental situation seems necessary for a further reduction of anxiety.     

Efficacy of brief telephone psychotherapy with callers to a suicide hotline

The efficacy of two types of theapy conducted exclusively over the telephone was studied. Clients (N=55) were recruited from a pool of callers to a suicide hotline and were randomly assigned to a waiting list control (WC) or Solution Focused Brief Therapy (SFBT) or Common Factors Therapy (CFT). It was hypothesized that improvements would be significantly higher in the two therapy conditions compared to the waitlist control and SFBT would be significantly more efficacious than CFT. Results confirmed that improvement was significantly higher in the two treatment conditions compared to the waitlist control, but no difference in improvement was found between SFBT and CFT. The implications of these findings for suicide hotlines are discussed.     

Decoding affective communication in intimate relationships

Situational and personality variables influencing the accurate understanding of partners' communications in intimate couples were studied. The situation was varied by inducing either partner-focused or self-focused attention. The personality variables were gender-role attitudes, control orientation, and empathy. Thirty couples who had been living together for at least 12 months discussed an issue which was important to both partners. Afterwards, each selected their partner's most ‘important’ statement from their videotaped discussion. The two statements were then rated by each of the partners in respect of their own and their partner's emotional reaction to them (intentionally sent and actually experienced emotions). Analyses of variance with correctness of decoding as a dependent variable demonstrated strong effects of other-focused attention and gender as independent variables. Femininity and secondary control correlated positively with correct decoding. These results are interpreted in a theoretical framework of empathy and communication.     

Assessing Couple Therapy as a Treatment for Individual Distress: When is Referral to Couple Therapy Contraindicated?

In order to better understand the effects of initial level of psychological disturbance on treatment outcome, a retrospective case control study of 95 couples who received couple therapy was conducted by sorting couples into one of four groups based on the degree of distress reported by individuals at intake: Neither distressed; both distressed; male distressed, female not distressed; female distressed, male not distressed. When partners started treatment with similar levels of disturbance both responded well in couple therapy. However, if the female reported clinical levels of disturbance at intake but her partner did not, outcome for the female was especially poor in contrast to outcomes for females receiving individual therapy. Clinically disturbed males showed significant gains in treatment even when their partners were not disturbed. These suggestive results argue for the possible value of conducting controlled studies of treatment assignment decisions that maximize positive outcomes.     

Training of conversational skills with institutionalized elderly: a preliminary study

16 residents in a Residential Care Home for elderly people volunteered and were trained in a social skills program aimed at increasing conversational skills. Subjects were assigned randomly to three groups, one experimental and two control groups (placebo and waiting list). The techniques used in the experimental group were behavior rehearsal, feedback, modeling, discriminative reinforcement, verbal instructions, and homework. Relative to control groups, experimental subjects showed significant increases in conversational skills, such as receiving information, speaking-up, and giving information. They also showed a significant decrease in their scores on Zung's Self-rating Scale of Depression compared with the two control groups. They showed an increase in assertive responses and a decrease in aggressive and inhibited responses. These changes remained when follow-up was made 3 mo. later, suggesting the potential utility of this training program with elderly persons residing in old people's homes.     

Cultural similarities in psychological reactions to infertility

A 74-item especially developed and validated questionnaire for Iranian culture was administered three times to 37 Iranian infertile couples and 10 fertile couples acting as control group, namely, initial consultation, during treatment, and on completion of treatment. In view of parallel data also reported for Western patients interest centered on the results of two out of the five factors measured by the questionnaire, i.e., Psychological Stress and Social Behaviour. Analysis generally showed significantly high stress and social withdrawal for the patient group, particularly at initial consultation and after an unsuccessful treatment cycle as compared to the control group. Moreover, men whose partners eventually conceived scored significantly lower on stress than men whose partners did not conceive. Similar results have also been reported for Western infertile patients. The implications of the findings are discussed.     

Cognitive behavioral therapy for compulsive buying disorder

To our knowledge, no psychotherapy treatment studies for compulsive buying have been published. The authors conducted a pilot trial comparing the efficacy of a group cognitive behavioral intervention designed for the treatment of compulsive buying to a waiting list control. Twenty-eight subjects were assigned to receive active treatment and 11 to the waiting list control group. The results at the end of treatment showed significant advantages for cognitive behavioral therapy (CBT) over the waiting list in reductions in the number of compulsive buying episodes and time spent buying, as well as scores on the Yale–Brown Obsessive Compulsive Scale—Shopping Version and the Compulsive Buying Scale. Improvement was well-maintained at 6-month follow-up. The pilot data suggests that a cognitive behavioral intervention can be quite effective in the treatment of compulsive buying disorder. This model requires further testing.     

The Effectiveness of Emotionally Focused Couples Therapy With Veterans With PTSD: A Pilot Study

The current study is a pilot project conducted at Baltimore VA Medical Center investigating the use of emotionally focused couples therapy (EFT) for couples in which one partner is a veteran who has been diagnosed with posttraumatic stress disorder (PTSD). Fifteen couples enrolled in the study and seven of these couples completed treatment (26 to 36 weekly sessions of EFT). Both partners were assessed on measures of relationship satisfaction, psychological distress, depression, and quality of life, and veterans were assessed on measures of PTSD symptoms at baseline and 2 weeks after the intervention. Paired t-tests were used to compare scores before and after EFT. In terms of results, the veterans' partners reported significant improvements in relationship and life satisfaction and in decreased depression and a decrease in psychological distress. Veterans demonstrated a significant decrease in self-reported symptoms of PTSD. These results provide preliminary evidence for the usefulness of EFT to help foster improved relationship satisfaction, and psychological well-being for veterans with PTSD and their partners who completed treatment.     

Adult attachment and emotional control

The connection between attachment style and affect regulation, proposed by attachment theorists, was explored in the context of long-term dating relationships. Seventy-two couples completed questionnaire measures of attachment (using a four-group forced-choice item, together with scales tapping Comfort with closeness, and Anxiety over relationships) and emotional control (in which subjects rated own and partner's control of anger, sadness, and anxiety, and the extent to which partners wanted them to control these emotions). Couples in which both partners endorsed insecure attachment styles (using the forced-choice measure) reported greater emotional control than did couples with two secure partners. Data from the attachment scales also supported the link between insecure attachment and emotional control: Comfort with closeness was negatively related both to one's own emotional control and to perceptions that partners wanted subjects to control their sadness; Anxiety over relationships was associated with perceptions that partners controlled sadness and wanted subjects to control their anger and sadness. The link between insecure attachment and the control of negative emotion remained significant when the frequency of experiencing such emotion was controlled. The association between attachment dimensions and other responses to negative emotions was also explored, and was consistent with attachment theory.