Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes

Journal of Child and Family Studies - To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work....     

An Evaluation of the Effects of Diagnostic Composition on Individual Treatment Outcome Within Transdiagnostic Cognitive–Behavioral Group Therapy for Anxiety

Recently, studies have supported the efficacy of treating anxiety disorders utilizing a transdiagnostic, or non-diagnosis-specific, framework (Erickson, D. H. (2003). Group cognitive behavioural therapy for heterogeneous anxiety disorders. Cognitive Behaviour Therapy, 32, 179–186; Garcia, M. S. (2004). Effectiveness of cognitive-behavioural group therapy in patients with anxiety disorders. Psychology in Spain, 8, 89–97; Norton, P. J., & Hope, D. A. (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36, 79–97). Transdiagnostic group treatment packages focus on the common aspects inherent across the anxiety disorders such as behavioral and cognitive avoidance, and faulty cognitive appraisals of threat potential or meaning (Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230). Although research supports the overall efficacy of transdiagnostic cognitive behavior therapy (CBT) for anxiety disorders (Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy: Theory, Research, Practice and Training, 45, 214–226), the effect of diagnostically mixed group composition on individual outcomes is less clear. This study investigated the relationship between group composition and treatment outcome within diagnostically heterogeneous groups with the purpose of determining if diagnostic heterogeneity differentially impacted treatment outcome for 84 individuals during a 12-week transdiagnostic cognitive–behavioral group anxiety treatment program (Norton, P. J. (2012a). Group cognitive-behavioral therapy of anxiety: A transdiagnostic treatment manual. New York: Guilford). The diagnostic makeup of the treatment group was examined at the beginning of treatment and at the end of treatment, and the results indicated that the diagnostic makeup of the treatment group had no significant impact on individual treatment outcome. These findings have direct implications for the delivery of transdiagnostic treatments, and are discussed in terms of their global implications for the transdiagnostic approach to the treatment of anxiety disorders.     

Confirmatory Factor Analysis of the Behavioral and Emotional Rating Scale–2 (BERS-2) Parent and Youth Rating Scales

We confirmed the factor structure of the Behavioral and Emotional Rating Scale – 2nd Edition (BERS-2) with a normative parent and youth sample. The BERS-2, based on the Behavioral and Emotional Rating Scale (BERS), is a standardized instrument that assesses children's emotional and behavioral strengths. The original BERS was renormed to create a separate parent scale (Parent Rating Scale) and a youth self-report scale (Youth Rating Scale). In this study, we investigated whether the five-factor structure of the original BERS (i.e., interpersonal strengths, family involvement, intrapersonal strengths, school functioning, and affective strengths) could be replicated with normative parent and youth respondents. A total of 927 parents of students with and without disabilities and 1301 youth with and without disabilities volunteered to participate in the study. Confirmatory factor analysis was used to determine the extent to which the normative parent and youth data fit the original five-factor BERS structure. Results indicated that the five-factor structure demonstrated an acceptable fit with the normative parent and youth samples. Practical implications and future research ideas are discussed.     

The Attention Training Technique as an Attempt to Decrease Intrusive Thoughts in Obsessive–Compulsive Disorder (OCD): From Cognitive Theory to Practice and Back

The attention training technique (ATT) is a cognitive treatment method that is aimed at ameliorating intrusive thoughts in anxiety disorders. To the best of our knowledge, no randomized controlled study has yet been conducted on individuals with obsessive–compulsive disorder (OCD). For the present study, we recruited 80 participants with OCD over the internet and allocated them to an experimental (ATT implemented as bibliotherapy) or a wait-list condition. Assessments were made at baseline and four weeks later. Groups performed similar at both time points on the self-report version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Obsessive Compulsive Inventory-revised (OCI-R). The present study speaks against the effectiveness of ATT as a stand-alone bibliotherapeutical approach for OCD. From our data and increasing evidence that OCD patients do not suffer from severe attention or executive deficits we consider an approach targeting attentional biases for certain OCD-related events more useful than a generic (i.e., OCD-unspecific) cognitive remediation approach.     

Response to Nadler's Commentary on Arch and Craske's (2011) “Addressing Relapse in Cognitive Behavioral Therapy for Panic Disorder: Methods for Optimizing Long-Term Treatment Outcomes”

Nadler (this issue), in his commentary of our article, “Addressing Relapse in Cognitive Behavioral Therapy for Panic Disorder: Methods for Optimizing Long-Term Treatment Outcomes” (Arch & Craske, 2011), argues that we misrepresent the role of panic attacks within learning theory and overlook cognitive treatment targets. He presents several case studies that he argues demonstrate how to target fears regarding the consequences of panic itself. We appreciate his raising these issues and creating the opportunity for discussion. We take issue, however, with two aspects of his commentary. First, his case studies beautifully illustrate a central point we make in our article regarding the importance of violating patient expectancies, and as such, exemplify our recommendations rather than illustrate what we may have overlooked. Second, Nadler's argument that we misidentify the role of panic attacks contradicts itself in ways that reveal his misunderstanding of the complexity of panic attacks from the perspective of learning theory (e.g., Bouton, Mineka, & Barlow, 2001), and disregard an important point we make in our article.     

Erratum to “Confirmation as partial entailment” [Journal of Applied Logic 11 (2013) 364–372]

We provide a correction to the proof of the main result in Crupi and Tentori (2013).     

Food Cravings Questionnaire–Trait (FCQ–T) Discriminates Between Obese and Overweight Patients With and Without Binge Eating Tendencies: The Italian Version of the FCQ–T

Food craving (FC) might play an important role in the course of eating disorders and obesity. The question of its measurement has particular importance in relation to the dramatic growth in obesity rates and its relevance for public health. The aim of this study was to investigate the psychometric properties of the Italian version of the Food Cravings Questionnaire–Trait (FCQ–T) in overweight and obese patients who were attending weight loss programs, and its efficiency in discriminating patients with binge eating. Participants were 497 (411 women, 86 men) overweight and obese patients in treatment with low-energy diet therapy. We used structural equation modeling to compare 3 factor models tested in previous studies (a 6-factor model, an 8-factor model, and a 9-factor model), which indicated that the 9-factor model has a better fit over the competing models. The FCQ–T had good internal consistency (Cronbach's α of.96 for the total score, and between.76 and.92 for subfactors), and was able to discriminate patients with clinical-level binge eating from those with probable and without binge eating with an efficiency of.74 (sensitivity =.64, specificity =.78). FCQ–T scores were sensitive to changes associated with treatment only for patients who started dietary restriction between the baseline and the follow-up assessment, but not for patients who were already observing dietary restrictions at the time of the baseline assessment. These results suggest that the FCQ–T could be a potentially useful measure for the screening of binge eating problems in overweight and obese patients while in treatment.