Brief report: The development of superstitious beliefs in the effectiveness of treatment of anger: Evidence for the importance of experimental program evaluation in applied settings

Many youth placed in out of home care have serious anger and aggression problems. These youth create much administrative and staff frustration. This frustration can cause program administrators to look to new treatment modalities whether inside or outside of their specific milieu for the therapeutic solutions to these problems. This randomized control group study provides an example of the importance of experimental program evaluation when an applied setting begins a drift towards the use of new treatment modalities. The results showed that both treatment and control groups improved over time but that there was no differences between groups in the daily number of angry incidents, the number of youth negatively terminated from the program, or self-report of state-trait anger expression. The results also suggest that without this research the noneffective intervention would have continued to be funded and given causative status for the observed improvements in referred youth behavior into the foreseeable future. Moreover, the development of these types of superstitious beliefs may lead child care organizations to spend scarce dollars on expensive treatments that do not increase the efficacy of the treatment as usual. Thus, this study shows that there are potential economic and treatment efficacy reasons for the use of experimental program evaluation when new treatments are implemented.     

The Efficacy of an Integrated Theoretical Approach to Group Psychotherapy for Male Inmates

To assess the efficacy of an interpersonal process-oriented and cognitive-behavioral group psychotherapy program, 36 incarcerated male adults were assigned to either a treatment group (n = 20) or a no treatment control group (n = 16). Outcome measures consisted of paper-pencil self-report instruments, institutional behavioral data, and structured interviews with the group therapists (n = 3). Results indicated no significant changes in inmates' level of defensiveness, empathy, or institutional behavior; however, the inmates reported universally positive reactions to the treatment program. The group therapists also perceived the treatment program as efficacious, particularly in fostering a cohesive group atmosphere and increasing inmate responsibility for group leadership. Implications for practice and research are discussed.     

Smoking Prevention and the Concept of Risk1

Sixth-grade children in 22 schools received either a social-influences smoking-prevention program or routine health education. The social-influences program was designed to teach youth about peer, parent, and media influences affecting smoking onset and to provide them with skills in resisting these influences. Comparison schools were given no program, but were permitted to continue their usual provision of health education. Program impact was evaluated as a function of pretreatment risk of future smoking. Risk was defined with respect to both (a) the prevalence of social models who smoked and (b) previous smoking experience. Two-and-a-half-year results show program impact to vary with both kinds of risk. Smoking-experience risk interacted such that, at first, there was greater impact on children with experience, but on later follow-up the pattern reversed, with the greater treatment effects seen for those initially with limited experience. Social-models risk showed a direct relationship, with greater risk being associated with greater program impact. Implications both for evaluation research and prevention programs are discussed.     

Overcoming destructive societal values in the treatment of anorexia nervosa: An intensive day treatment model

Sociocultural contributions to the development of anorexia nervosa are examined, and a treatment approach for counteracting these factors are presented. An intensive day treatment program serves as a prototype of such an approach, designed to help overcome the destructive effects of certain values prevalent in North America. This treatment program is outlined and evaluated. The program includes expressive therapies (art, dance, music, and drama), skill-focused activities (stress management, assertiveness training and nutrition programs) and a fitness/recreation program. Significant psychological changes in the participants were found on 10 of the 11 measures employed for evaluatio—the eight scales of the Eating Disorder Inventory, the two clinical scales of the Eysenck Personality Inventory, and the Self-Control Scale of the Reid-Ware Multidimensional Internal-External Scale. The value of such a program as one component of an overall treatment strategy is discussed.     

Use of an Orientation Session May Help Decrease Attrition in a Pediatric Weight Management Program for Low-Income Minority Adolescents

This study examined predictors of attrition from a pediatric weight-control program in a low-income minority community and the potential usefulness of an orientation session to increase length of treatment. Participants were 342 children and adolescents (M age=13.0 years old; 54% female; 89% African American; M BMI=44.2, M BMI z-score=6.0) and their caregivers who attended FitMatters, a multidisciplinary cognitive-behavioral program focused on long-term participation. Those who attended an orientation session stayed in treatment significantly longer, but attrition was not affected by demographic factors, weight status, or psychological functioning. These results indicate that an orientation session that clearly delineates the structure of a program and expected attitudinal and behavioral requirements for the families may help align expectations, as well as more effectively identify families who are ready to make concerted efforts to change the family lifestyle in support of their obese children's efforts.     

The Application of Latent Curve Analysis to Testing Developmental Theories in Intervention Research

The effectiveness of a prevention or intervention program has traditionally been assessed using time-specific comparisons of mean levels between the treatment and the control groups. However, many times the behavior targeted by the intervention is naturally developing over time, and the goal of the treatment is to alter this natural or normative developmental trajectory. Examining time-specific mean levels can be both limiting and potentially misleading when the behavior of interest is developing systematically over time. It is argued here that there are both theoretical and statistical advantages associated with recasting intervention treatment effects in terms of normative and altered developmental trajectories. The recently developed technique of latent curve (LC) analysis is reviewed and extended to a true experimental design setting in which subjects are randomly assigned to a treatment intervention or a control condition. LC models are applied to both artificially generated and real intervention data sets to evaluate the efficacy of an intervention program. Not only do the LC models provide a more comprehensive understanding of the treatment and control group developmental processes compared to more traditional fixed-effects models, but LC models have greater statistical power to detect a given treatment effect. Finally, the LC models are modified to allow for the computation of specific power estimates under a variety of conditions and assumptions that can provide much needed information for the planning and design of more powerful but cost-efficient intervention programs for the future.     

Social Construction of Intimate Partner Violence: A Brief Report on Quantitative Grammatical Analysis

This pilot study uses a quantitative linguistic analysis to assess evidence of agency and control, as well as treatment engagement, in letters written by men (N = 46, 37% Latino) participating in a batterer intervention program. At the program’s conclusion, men were asked to imagine their situation in 5 years and write a letter from their “future self” to their “present self.” Letters were scored for grammatical representations of agency and objectification, and temporal complexity. Results showed that the men tended to grant themselves the subject position (conferring agency) and to grant others the object position (deferring or denying agency) by almost equal margins, both rhetorical maneuvers suggesting an objectifying stance toward others. Moreover, they employed several strategies to address temporality, with more complex strategies suggesting greater treatment engagement. Findings suggest that quantitative linguistic analysis is a promising tool for assessing participants’ progress in and engagement with treatment.     

Usability and Utility of a Computerized Cognitive-Behavioral Self-Help Program for Public Speaking Anxiety

This study describes the use of a cognitive-behavioral computer-administered self-help program with minimal therapist contact for public speaking anxiety. Participants (N = 10) with social phobia, as measured by a structured clinical interview, completed the self-help program in an open clinical trial. The program was delivered via a CD-ROM during individual sessions at an outpatient clinic, including 4 sessions of psychoeducation/cognitive therapy and 4 sessions of exposure therapy using a virtual audience presented on a computer screen. A therapist was available in another room to answer questions and to debrief for up to 10 minutes after each session. Participants completed standardized self-report questionnaires assessing social anxiety at pretreatment, posttreatment, and 3-month follow-up. Participants also completed measures of computer usability. Results showed decreases on all self-report measures of social anxiety from pre- to posttreatment, which were maintained at follow-up (n = 8). Participants also reported that they were satisfied with treatment, that they felt improved after treatment, and that the computer program was user-friendly. This study provides preliminary evidence that a computer-administered cognitive-behavioral-based program that includes minimal therapist contact may reduce public speaking anxiety and suggests that further research with a controlled design is needed.     

Peer-Enhanced Weight Management Treatment for Overweight Adolescents: Some Preliminary Findings

The purpose of this study was to evaluate the utility of adding a peer-based intervention (peer-based skills training [PBST]) to a traditional cognitive–behavioral weight management intervention for overweight adolescents. Sixteen adolescents between the ages of 13 and 16 years and between 30 and 80$percnt; overweight participated in a 16-week group-based weight management program with the addition of peer-based skills training. Adolescents and parents separately attended 60-min group sessions addressing diet, physical activity, and behavior modification techniques. In addition, adolescents attended a 90-min PBST session each week. Group activities included both mental and physical challenges that fostered development of trust, social skills, and self-confidence. Measures of height and weight, as well as questionnaires assessing self-concept, physical self-worth, and social functioning, were obtained prior to treatment, immediately following the 16-week intervention, and 6 months after completion of active treatment. Paired t tests revealed significant improvements over time in measures of physical self-worth, physical appearance and romantic appeal. Adolescents lost an average of 14.73 pounds from the start to end of treatment, and this was maintained at 6-month follow-up. These preliminary findings provide some support for the application of a novel peer-based program as an adjunctive treatment for adolescent weight management intervention.     

Program of the 18th Annual Institute and the 31st Annual Conference of the A.G.P.A.

Exercise groups form an integral part of an insight-oriented, psychodynamic evening treatment program for a patient population characterized predominantly by mood and personality disorders. Clinical examples illustrate how the exercise groups are integrated with other therapy groups in the program. Therapists, who lead and participate in the exercise groups, attempt to maintain professional boundaries while they facilitate permissive activities where enactment of patient conflicts can occur. Events from the exercise groups frequently provide material for work in the more traditional psychodynamic groups of the program. A number of benefits of exercise groups are highlighted.     

Group cognitive-behavioral therapy for anxiety in a clinic setting: does child involvement predict outcome?

The current study examined the relationship between child involvement and treatment outcome in a group cognitive–behavioral treatment (GCBT) program for children with anxiety, using an adapted version of the Child Involvement Rating Scale (CIRS). Thirty-four children with a primary diagnosis of an anxiety disorder, referred for outpatient treatment at a hospital, and their parents participated in a manualized 12-session GCBT program. The Multidimensional Anxiety Scale for Children (MASC), administered at pretreatment, posttreatment, and at 4-month follow-up, served as the outcome measure. The psychometric properties of the adapted CIRS were good. Early involvement (EI) was calculated as the average score from Sessions 1 to 6 and late involvement (LI), the average score from Sessions 7 to 12. EI predicted lower MASC scores at posttreatment, after controlling for pretreatment MASC scores and for LI, B = – 1.05, t(3) = – 2.34, p < .05. EI did not predict outcomes at follow-up. Results were replicated using the original CIRS measure. Exploratory analyses suggested that the relationship between LI and treatment outcomes was moderated by medication. Involvement in therapy prior to exposures might be an important predictor of posttreatment outcomes in GCBT in a community setting.     

Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial

Previous studies on Internet-based treatment with minimal to moderate therapist guidance have shown promising results for a number of specific diagnoses. The aim of this study was to test a new approach to Internet treatment that involves tailoring the treatment according to the patient’s unique characteristics and comorbidities.A total of 54 participants, regardless of specific anxiety diagnosis, were included after an in-person, semi-structured diagnostic interview and randomized to a 10 week treatment program or to a control group. Treatment consisted of a number of individually-prescribed modules in conjunction with online therapist guidance. Significant results were found for all dependent measures both immediately following treatment and at 1 and 2 year intervals. Mean between-group effect size including measures of anxiety, depression and quality of life was Cohen’s d = 0.69 at post-treatment, while the mean within-group effect size was d = 1.15 at post-treatment and d = 1.13 and d = 1.04 at 1 and 2 year follow-up respectively.The tentative conclusion drawn from these results is that tailoring the Internet-based therapy can be a feasible approach in the treatment of anxiety in a homogeneous population.     

Effects of Brief Interventions on Internalizing Symptoms and Substance Use in Youth: A Systematic Review

Internalizing problems (e.g., depression, anxiety) and substance use are common among young people and often co-occur. However, youths face myriad barriers to access needed treatment, and existing evidence-based interventions tend to focus on internalizing problems or substance use, rather than both simultaneously. Brief interventions that target both problems may, therefore, be an efficient and accessible resource for alleviating youth difficulties; however, this possibility has been insufficiently evaluated. This systematic review evaluated the intervention characteristics and quality of six studies spanning 2015 to 2019 that examined intervention effects on internalizing and substance use outcomes. Based on independent calculations and author reports (respectively), 3–4 interventions significantly reduced youth internalizing symptoms; 3–5 reduced youth substance use; and 2–3 reduced symptoms in both domains. All six interventions identified substance use as a primary target. Four interventions were administered by interventionists to youths in inpatient, outpatient, primary care, or school settings. The remaining two studies delivered content through voicemail messages or an online design. Interventions ranged from?~?15 to 240 min. Results highlight the sparsity and heterogeneity of youth-focused brief interventions that have evaluated program effects on both internalizing problems and substance use outcomes, suggesting a clear need for integrated supports that are also designed for accessibility. Future investigations of brief youth-focused interventions should assess program effects on both internalizing and substance use outcomes; examine mechanisms driving the varied efficacy of identified interventions; and create, refine, and test interventions with potential to address co-occurring internalizing problems and substance use in young people.

     

It Pays to Pay Attention: A Mindfulness-Based Program for Injury Prevention With Soccer Players

The aim of this study was to examine the extent to which a mindfulness-based program could reduce the number of sport injuries in a sample of soccer players. A total of 41 junior elite soccer players were randomly assigned to the treatment or the attentional control group. The treatment group took part in a 7-session program based on the mindfulness, acceptance, and commitment approach. The attentional control group was offered 7 sessions of sport psychology presentations with a particular focus on soccer. There were no statistically significant differences in injury rates between the two groups, U(39) = 149.50, z = ?1.77, p =.077, but there was a medium effect size (adjusted Cohen's d = ? 0.59), approx. 80% confidence interval for d [?0.37, ?0.74]. Moreover, 67% of the players in the mindfulness group remained injury free in comparison to 40% in the control group. This result implies that an intervention program focusing on strategies for improving attention could decrease injury risk. Recommendations include applying mindfulness exercises in athletes’ daily training to help lower injury risk.     

Rehabilitating civilian victims of war through psychosocial intervention in Sierra Leone

This research assessed an intervention (involving drug therapy and psychoeducational counseling) for war trauma in Sierra Leone. We examine the impact of the intervention on symptoms of post‐traumatic stress disorder (PTSD) and indicators of intergroup emotions and attitudes. Civilian war victims were drawn from a rehabilitation program (Intervention, N=50) or a waiting list Control group (N=50). The rehabilitation program combined general psychiatric treatment with additional life skills support. Those in the Intervention group had significantly lower PTSD symptoms and also scored lower on Intergroup Anxiety and Outgroup Blame, than those in Control. The intervention had an indirect effect on PTSD symptoms through Intergroup Anxiety. The reduction in PTSD in the intervention was greater for participants with a stronger identification with Sierra Leone.     

Relative Cost Effectiveness of In-Person and Internet Interventions for Relationship Distress

While the efficacy of couple therapy has been repeatedly demonstrated, most distressed couples do not seek treatment. To improve reach and overcome barriers to therapy, Integrative Behavioral Couple Therapy (IBCT) was translated into a web-based program, OurRelationship (OR). While both IBCT and OR have been shown to improve relationship and individual functioning, the goal of the present study was to compare the relative cost effectiveness of these two treatment modalities. In IBCT, 74% of couples experienced reliable improvement, compared to 55% of couples in OR. Within-group Cohen's d effect sizes during treatment for relationship satisfaction were d = 0.87 for IBCT and d = 0.96 for OR. Relative cost effectiveness analyses revealed that even at the highest expense estimates for OR and the lowest expense estimates for IBCT, OR was more cost effective in creating reliable improvement once at least 229 couples were served and was more cost effective in creating large-size effects once at least 153 couples were served. Cost-effectiveness increases for both IBCT and OR as more couples are served; however, this cost savings occurs at a much more rapid rate for OR. These findings demonstrate that despite higher initial development costs, Internet programs are a cost-effective option for dissemination either as a stand-alone service or as an initial intervention in a stepped care model with more intensive in-person services.     

Couples psychotherapy group: Treatment of the married alcoholic

As part of an intramural research program of the National Institute of Alcohol Abuse and Alcoholism focused on the psychobiogenetics of familial alcoholism, a psychodynamically oriented married couples psychotherapy group was formed. Its purpose was to determine whether this modality could be utilized as an outpatient treatment approach to identify and modify interpersonal interactions that affect both drinking behavior and the quality of family and marital life. This paper, a clinical case report, presents follow-up data and disusses both themes that emerged in the therapy process and the usefulness of this modality in the treatment of the married alcoholic.She was formerly Chief, Unit of Family Studies, Laboratory of Clinical Studies, National Institute of Alcohol Abuse and Alcoholism (NIAAA).At the time this paper was written, she was a Research Social Worker, Laboratory, of Clinical Studies, NIAAA, Bethesda, Maryland.     

Telepsychology and Self-help: The Treatment of Fear of Public Speaking

This work presents a self-help, Internet-based telepsychology program for the treatment of public speaking fears. The system is comprised of 3 parts: The assessment protocol gives the patient information about his or her problem (i.e., amount of interference it creates in his or her life, severity, degree of fear and avoidance). The system also includes a structured treatment protocol, organized into separate blocks, reflecting the patient’s progress. This ensures that the patient does not skip any steps in the treatment (something quite common in traditional self-help manuals), which provides more control over the process. The treatment protocol is a cognitive-behavioral program that provides exposure to the feared situation using videos of real audiences. Finally, the control protocol assesses treatment efficacy, not only at closure, but also at every intermediate step. Efficacy data from 12 social phobia patients are presented from pretreatment to posttreatment and at 1-month follow-up. These preliminary data support the efficacy of our telepsychology program for the treatment of fear of public speaking. This is a preliminary work in a promising research path that examines the possibility of using the Internet for the treatment of psychological disorders.     

The Future Problem Solving Program International: An Intervention to Promote Creative Skills in Portuguese Adolescents

The Future Problem Solving Program International (FPSPI) is an internationally applied educational program that involves young people. Its theoretical foundation is both the Creative Problem Solving Model and the Futurist Thinking. It aims to promote creative and critical thinking through a futurist approach to problems. This study intended to analyze the effects of the program on creative skills evaluated by the Torrance Tests of Creative Thinking (Figural Version). The participants’ perceptions of the efficacy of the program were also assessed. This intervention was carried out with 131 adolescents over a period of 7 months in an extra‐curricular context. The evaluation of the program takes into account periods both before and after interventions, using similar experimental and control groups. The results showed significant statistical differences for the all skills studied and very positive perceptions of the efficacy of FPSPI. Two significant gender differences in creative performance were also found. The results are described and discussed in order to promote awareness for future research concerning this program.     

Multimethod Psychoeducational Intervention for Preschool Children with Disruptive Behavior: Two-Year Post-Treatment Follow-up

This paper describes the 2-year post-treatment follow-up of preschool children identified as having high levels of disruptive behavior at kindergarten entry. They were assigned to four treatment conditions: A no-treatment group, parent-training only, treatment classroom only, and the combination of parent training with the treatment classroom. Interventions lasted the entire kindergarten academic year. Initial post-treatment results reported previously indicated no effects for the parent-training program but some efficacy for the classroom intervention program. For this report, the disruptive behavior (DB) children were subdivided into those who did (n = 74) and did not (n = 77) receive the treatment classroom. Two-year post-treatment follow-up results indicated no differences between the classroom treated and untreated DB groups. These groups also failed to differ in the percentage of children using available treatments across the follow-up period. The DB children in both groups had significantly more symptoms of ADHD and ODD than a community control group (N = 47) at follow-up. They also received higher ratings of externalizing problems on the parent Child Behavior Checklist, more severe ratings of behavior problems at home, and ratings of more pervasive behavior problems at school, and had poorer academic skills. Results suggested that early intervention classrooms for DB children may not produce enduring effects once treatment is withdrawn, and that better approaches are needed for identifying those DB children at greatest risk for later maladjustment.