The Relation of Severity and Comorbidity to Treatment Outcome with Cognitive Behavioral Therapy for Childhood Anxiety Disorders

The present study investigated the impact of comorbidity over and above the impact of symptom severity on treatment outcome of Cognitive Behavioral Therapy for children with anxiety disorders. Children (aged 8–12, n = 124) diagnosed with an anxiety disorder were treated with a short-term CBT protocol. Severity was assessed with a composite measure of parent-reported behavior problems. Two approaches to comorbidity were examined; “total comorbidity” which differentiated anxiety disordered children with (n = 69) or without (n = 55) a co-occurring disorder and “non-anxiety comorbidity’ which differentiated anxious children with (n = 22) or without a non-anxiety comorbid disorder (n = 102). Treatment outcome was assessed in terms of Recovery, represented by post-treatment diagnostic status, and Reliable Change, a score reflecting changes in pre- to post-treatment symptom levels. Severity contributed to the prediction of (no) Recovery and (more) Reliable Change in parent-reported internalizing and externalizing symptoms and self-reported depressive symptoms. Total and non-anxiety comorbidity added to the prediction of diagnostic recovery. Non-anxiety comorbidity added to the prediction of Reliable Change in parent reported measures by acting as a suppressor variable. Non-anxiety comorbidity operated as a strong predictor that explained all of the variance associated with severity for self-reported depressive symptoms. The results support the need for further research on mechanisms by which treatment gains in children with higher symptom severity and non-anxiety comorbidity can be achieved.     

Dyscontrol Experiences Questionnaire: Development, Reliability and Validity

This paper describes development of a retrospective measure of childhood exposure to parental dyscontrol related to specific conditions such as a parent's drinking, anger, or other negative emotional states (e.g., stress, anxiety, depression). A 45-item questionnaire, the Dyscontrol Experiences Questionnaire (DEQ), was designed to assess individuals' childhood experiences with parental loss of control. Two student samples (n = 465 and n = 536) completed a battery of self-report measures. Responses were used to examine the psychometric properties of the DEQ. Factor analysis revealed three lower-order factors accounting for 54.4% of the variance in DEQ item scores. Cronbach's coefficient alphas indicated acceptable internal consistency. Moderate intercorrelations with two other retrospective measures of childhood experiences suggested construct validity. Moderate intercorrelations with two measures of psychological distress suggested predictive validity. In summary, initial psychometric testing of the DEQ suggests it is a reliable and valid tool for investigating an important developmental antecedent of adult psychological distress.     

A social validation explanation for mutual enhancement

Group members experience mutual enhancement when they evaluate one another’s task capabilities more positively because they are discussing shared as compared to unshared information. Two experiments investigated a social validation explanation for mutual enhancement. In Experiment 1, members of dyads read and discussed either shared or unshared information and collectively recalled this information under conditions where accuracy was important or not. Mutual enhancement occurred when need for accuracy was higher, but not when it was lower. In Experiment 2, members of dyads read validating or non-validating information from an outsider after they collectively recalled shared or unshared information. Members who discussed unshared information and received no validating communication from the outsider gave one another the lowest task capability ratings compared to members who discussed shared information and/or received validating communication from the outsider. All of these results are consistent with a social validation explanation for mutual enhancement.     

Rhesus plasma cortisol response at four dominance positions

Adrenocortical function and social behaviors were measured in 48 laboratory-born juvenile monkeys in stable (original) groupings at rest, in the same groupings in competition for drinking water, in newly formed groupings each composed of animals from the same original dominance position, and upon return to the original groupings, always in groups of four. In newly formed groupings, plasma cortisol measured higher with each step down in the new dominance hierarchy, the effect attenuating by day 8. Although the partial correlation between frequencies of hostility behavior and plasma cortisol level was low (r = 0.05) when holding fear constant, the partial correlation between cortisol and fear behaviors, holding hostility behavior constant, was 0.86. The data provide evidence that corticosteroid elevations during social stress are related to behavior suggestive of fear and not aggression and are dependent upon dominance rank, the level of dominance competition, and previous dominance history.     

Response to the Lazarus and Beutler Article “On Technical Eclecticism”

The article titled “On Technical Eclecticism,” by Lazarus and Beutler (Journal of Counseling & Development, March/April 1993), distorted the work of Gilliland, James, and Bowman (1989) by using an incomplete contextual quotation. This article represents a reply to set the record straight. A discussion of key elements of a modern eclectic system of counseling and psychotherapy is presented.     

ASSESSMENT OF PREFERENCE FOR VARIED VERSUS CONSTANT REINFORCERS

One method that has been demonstrated to improve the effectiveness of reinforcement is stimulus (reinforcer) variation (Egel, 1980). Egel found that bar pressing increased and responding occurred more rapidly during varied reinforcement than during constant reinforcement when identical stimuli were used across phases for 10 individuals with autism. The purpose of the current investigation was to assess the preferences of 7 individuals for varied presentation of slightly lower quality stimuli relative to constant access to the highest quality stimulus. Varied presentation was preferred over constant reinforcer presentation with 4 participants, and the opposite was true for 2 participants. One participant did not demonstrate a preference. These results suggest that stimulus variation may allow less preferred reinforcers to compete effectively with a more highly preferred reinforcer for some individuals.     

The effects of a discriminative cue and an incompatible activity on generalized imitation

Four noncompliant retardates were observed in a generalized imitation study. Two variables were studied: provision of a competing reinforced activity, and use of a cue to aid discrimination between reinforced and nonreinforced imitations. Both variables were found to increase the rate of discrimination between the two sets of stimuli. Greatest discrimination occurred when both cue and alternative task were present. Discrimination decreased when the variables were removed. Results are interpreted as implying that imitation of nonreinforced cues in generalized imitation procedures varies with the degree to which reinforcement is available for other activity, as well as with the complexity of the discrimination problem. These results help indicate conditions under which the generalized imitation effect may be observed in more naturalistic settings.     

Learned safety and the CS-US delay gradient in taste-aversion learning

Decrements in taste-aversion learning produced by extensions of the interval between the CS flavor and poisoning (the US) may be attributed to decay of the CS trace during long CS-US intervals. Kalat and Rozin (1973) alternatively proposed that such decrements occur because during extended CS-US intervals subjects learn that the CS is safe. They sought to show that trace decay is not responsible for the CS-US delay gradient by demonstrating that learning is disrupted even if the CS is reintroduced during extended CS-US intervals. The present experiments show that such a second CS presentation during conditioning may (1) enhance subsequent intakes of the CS solution whether or not subjects are poisoned, and/or (2) facilitate aversion learning, the facilitation being greater the closer the second CS exposure is to poisoning. These results question the adequacy of previous evidence for the contribution of learned safety to the CS-US delay gradient and suggest that some other process is also involved.     

Dissociating local and global levels of perceptuo-motor control in masked priming

Masked prime stimuli presented near the threshold of conscious awareness affect responses to subsequent targets. The direction of these priming effects depends on the interval between masked prime and target. With short intervals, benefits for compatible trials (primes and targets mapped to the same response) and costs for incompatible trials are observed. This pattern reverses with longer intervals. We argue (a) that these effects reflect the initial activation and subsequent self-inhibition of the primed response, and the corresponding inhibition and subsequent disinhibition of the nonprimed response, and (b) that they are generated at dissociable local (within response channels) and global (between channels) levels of motor control. In two experiments, global-level priming effects were modulated by changing the number of response alternatives, whereas local-level effects remained unaffected. These experiments suggest that low-level motor control mechanisms can be successfully decomposed into separable subcomponents, operating at different levels within the motor system.     

Relations Between Anxiety Sensitivity and Attachment Style Dimensions

This study replicated and extended the work of C. F. Weems, S. L. Berman, W. K. Silverman, and E. T. Rodriquez (2002) by investigating relations between anxiety sensitivity (AS) and attachment dimensions in a sample of young adults. Two hundred and twenty-six undergraduate students completed self-report measures including the Anxiety Sensitivity Index and the measure of adult romantic attachment used by C. F. Weems et al. (2002). In order to investigate the association between AS and a different domain of attachment, a measure of adult attachment referring to close relationships was included. As defined by both measures, insecurely attached individuals, specifically those classified as preoccupied and fearful (i.e., those with negative Models of Self), reported significantly higher levels of AS than those with secure and dismissing attachment styles (i.e., those with positive Models of Self). Results indicated that across both measures the Model of Self attachment dimension accounted for unique variance in AS levels beyond that contributed by trait anxiety. The Model of Others attachment dimension had a more limited association with AS.