Pretherapy Cognitive Dispositions and Treatment Outcome in Cognitive Behavior Therapy for Insomnia

This study consisted of secondary analyses of data from 2 randomized clinical trials to test whether pretherapy cognitions predict CBT outcomes. The sample consisted of 155 primary insomnia patients with sleep maintenance complaints. Of these, 98 were randomized to CBT, 23 were assigned to progressive muscle relaxation training (PMR), and 34 were assigned to a control (sham therapy or wait-list) condition (CON). All patients completed the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), a sleep-related Self-Efficacy Scale (SES) and nightly sleep diaries for 2 weeks prior to receiving their assigned treatment. They then completed sleep diaries throughout an 8-week acute treatment period and during a 2-week period at a posttherapy follow-up. A subset of the sample (n = 67) also completed polysomnography immediately before and after completing their assigned treatment. Preliminary regression analyses conducted with a small subset (n = 15) of the patients receiving CBT showed those with relatively high levels of unhelpful sleep-related beliefs (Type 1 patients), as reflected by their pretherapy responses to the DBAS and SES questionnaires, showed markedly greater reductions in nocturnal wakefulness in response to CBT than did those (Type 2 patients) reporting less pronounced sleep-related beliefs. Given these findings, we used the regression equation derived from our initial analyses to dichotomize our entire sample into Type 1 (n = 82; 52.9%) and Type 2 (n = 73; 47.1%) subgroups. Subsequent comparisons showed CBT-treated Type 1 patients had significantly less wake time after sleep onset during most of the 8-week treatment phase than did the Type 1 and 2 individuals assigned to either PMR or CON. Relative to patients assigned to the PMR and CON conditions, CBT-treated Type 1 patients showed better performance across multiple subjective and objective benchmarks of clinically significant improvement, whereas the CBT-treated Type 2 patients did not. Results suggest that insomnia patients' pretherapy cognitive dispositions predict CBT outcome, and those with a pronounced sense of sleep-related helplessness are best suited for this treatment which targets this cognitive stance.     

The Roles of Risk Perception and Borderline and Antisocial Personality Characteristics in College Alcohol Use and Abuse1

This study examined the relationships among risk perceptions, alcohol use and abuse, and borderline and antisocial personality characteristics in college students. College students who perceived themselves less able to avoid negative consequences reported drinking more and having more substance abuse symptoms than those who perceived themselves as more able to avoid negative consequences. College students who scored higher on borderline or antisocial personality tended to rate personal avoidability of negative consequences lower than those who scored lower on these personality characteristics. A multiple regression model accounted for 50% of the variance in self‐reported substance abuse symptoms. Low perceived personal avoidability of negative drinking consequences and high borderline or antisocial personality characteristics are risk factors for substance abuse problems.     

The Token Activity: Generating Awareness of Power in Counseling Relationships

The authors present an experiential activity, the token activity, that increases student awareness of power and privilege dynamics. Student feedback is incorporated to offer perceptions and knowledge gained from their experience. Los autores presentan una actividad experiencial, la actividad simbólica, que incrementa la conciencia los estudiantes sobre poder y dinámica de privilegios. Se incluyen las reacciones de los estudiantes para ofrecer las percepciones y el conocimiento que adquirieron durante su experiencia.     

Interrater reliability of the DSM-III-R with preschool children

Little attention has been paid to evaluating the use of DSM-III-R with preschool children. Children (N = 510) ages 2 to 5 years who were screened at the time of a pediatric visit were selected to participate in an evaluation which included questionnaires, a semistructured interview, developmental testing, and a play observation. Following the evaluation, two clinical child psychologists independently assigned DSM-III-R diagnoses. For each diagnostic category, kappa and Ycoefficients were calculated; Ycoefficients are less sensitive to base rates of disorders. For overall agreement, the weighted mean kappa (.61), and mean Y(.66) were moderately high. Overall agreement that the child had at least one of the disruptive disorders was substantial (kappa =.64; Y =.65);agreement that there was at least one of the emotional disorders was moderate for kappa (.54), but substantial for Y(.70). Kappa coefficients were higher for major categories of disorder than for specific disorders; however, Ycoefficients did not show a decline for specific disorders. Interrater reliability of DSM-III-R appears to be similar for preschoolers and older children.This study was supported by grant MH46089 from the National Institute of Mental Health.A preliminary report was presented at the Fifth Annual NIMH International Research Conference on the Classification and Treatment of Mental Disorders in General Medical Settings, Bethesda, Maryland, September 1991. We gratefully acknowledge the members of the Pediatric Practice Research Group who participated in this study.     

Characterizing the intuitive representation in problem solving: Evidence from evaluating mathematical strategies

Two experiments were conducted to investigate the nature of the intuitive problem representation used in evaluating mathematical strategies. The first experiment tested between two representations: a representation composed of principles and an integrated representation. Subjects judged the correctness of unseen math strategies based only on the answers they produced for a set of temperature mixture problems. The distance of the given answers from the correct answers and whether the answers violated one of the principles of temperature mixture were manipulated. The results supported the principle representation hypothesis. In the second experiment we manipulated subjects’ understanding of an acid mixture task with a brief paragraph of instruction on one of the principles. Subjects then completed an estimation task intended to measure their understanding of the problem domain. The evaluation task from the first experiment was then presented, but with acid mixture instead of temperature mixture. The results showed that intuitive understanding of the domain mediates the effect of instruction on evaluating problems. Additionally, the results supported the hypothesis that subjects perform a mapping process between their intuitive understanding and math strategies.     

Component Integrity of Teacher Intervention Management Behavior Using a Student Self-Monitoring Treatment: An Experimental Analysis

This investigation was undertaken to determine the effects of differing levels of treatment integrity resulting from implementation of varying numbers of intervention components. The self-monitoring program was conducted over 4 weeks and targeted positive and negative classroom behaviors. The independent variable included three levels: 100% integrity, that included reward and graphing of behavior; 83.3% integrity, that included the reward component; and 66.7% integrity, that employed self-monitoring with recording only. Participants included 49 elementary school students, mean age of 10.4 years, 36.7% female, 93.9% Anglo. Results of treatment on teacher and student ratings from the Social Skills Rating System, teacher ratings from the Abbreviated Symptom Questionnaire, ratings of the child-specific target behaviors, and student frequency counts of target behaviors were analyzed using Multivariate Analyses of Variance. The changes in rating measures from pre-test to post-test did not significantly differ between groups. Students in the two more inclusive treatment programs recorded more positive behaviors.     

Behavioral contrast as a function of the duration of an immediately preceding period of extinction

For four pigeons key-peck responding was reinforced on a variable-interval reinforcement schedule in the presence of a vertical white line. When response rates had stabilized a horizontal white line was introduced, in the presence of which reinforcement was not available (extinction). The horizontal line was presented once per session, immediately before the vertical line was presented. The duration of the horizontal line varied randomly from session to session, being either 0 sec (i.e., no presentation), 10 sec, 30 sec, 2 min, 10 min, 40 min, or 120 min. When the horizontal line was present for more than 0 sec, behavioral contrast was obtained in the presence of the following vertical line. Contrast increased with increasing durations of the horizontal line, asymptoting when the horizontal line was present for 40 min.     

The sense of life time in human development

The subjective sense oflife time is the medium within which issues of identity and growth take place. Youth, middle age, early old age, and old age are each presented as developmental stages with dominant experiences oflife time. Directivity, or purposeful movement toward a goal, is then related to the experience of future and occurs in the gap between present and future. The sense of now in old age is viewed as a stage in the life cycle with the potential for unique personal creativity and growth, being free from bondages found at other points in the life cycle.