Family-Based Therapy for Adolescent Drug Abuse: Knowns and Unknowns

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate knowns and unknowns regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.     

Taxonicity of anxiety sensitivity: an empirical test among youth

Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity (AS) among 371 youth. Anxiety sensitivity was indexed by the 18-item Childhood Anxiety Sensitivity Index (CASI; Silverman et al., J. Clin. Child Psychol. (1991), 20, 162-168). Two sets of manifest indicators of AS were constructed using the CASI: (1) three item-parcel manifest indicators: disease concerns, unsteady concerns, and mental illness concerns; and (2) nine single-item indicators representing each of these three facets of AS. Results from standard and short-scale MAXCOV procedures, internal consistency tests, analyses of simulated Monte Carlo data, and MAMBAC external consistency tests indicated that the latent structure of anxiety sensitivity among youth was taxonic. Estimated base rate of the observed AS taxon ranged between 13.6 and 16.5%. The present findings are discussed in terms of theoretical implications for the study of AS and vulnerability for anxiety psychopathology.     

Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms

The purpose of the present study was to examine the potential efficacy, patient acceptability, and feasibility of a novel, cognitive-behavioral therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD) who have been stabilized on medications but still show clinically significant symptoms. Thirty-one adults with ADHD and stable psychopharmacology for ADHD were randomized to CBT plus continued psychopharmacology or continued psychopharmacology alone. Assessments included ADHD severity and associated anxiety and depression rated by an independent evaluator (IE) and by self-report. At the outcome assessment, those who were randomized to CBT had lower IE-rated ADHD symptoms (p < .01) and global severity (p < .002), as well as self-reported ADHD symptoms (p < .0001) than those randomized to continued psychopharmacology alone. Those in the CBT group also had lower IE-rated and self-report anxiety (p's < .04), lower IE-rated depression (p < .01), and a trend to have lower self-reported depression (p = .06). CBT continued to show superiority over continued psychopharmacology alone when statistically controlling levels of depression in analyses of core ADHD symptoms. There were significantly more treatment responders among patients who received CBT (56%) compared to those who did not (13%) (p < .02). These data support the hypothesis that CBT for adults with ADHD with residual symptoms is a feasible, acceptable, and potentially efficacious next-step treatment approach, worthy of further testing.     

Goal regulation across time: the effects of feedback and affect

This research focused on the processes individuals use to regulate their goals across time. Two studies examined goal regulation following task performance with 6 samples of participants in a series of 8-trial task performance experiments. The experiments involved: (a) 3 task types, (b) 2 goal types, and (c) actual or manipulated performance feedback referring to the focal participant's own performance or to the participant's performance compared with others' performance. Applying multilevel methods, the authors examined (a) how performance feedback influences subsequent goals within individuals across both negative and positive performance feedback ranges, and (b) the mediating role of affect in explaining the relationship between feedback and subsequent goal setting. Results showed that participants adjusted their goals downwardly following negative feedback and created positive goal-performance discrepancies by raising their goals following positive feedback. In each sample, affect mediated substantial proportions of the feedback-goals relationship within individuals.     

Rate of conditioned reinforcement affects observing rate but not resistance to change

The effects of rate of conditioned reinforcement on the resistance to change of operant behavior have not been examined. In addition, the effects of rate of conditioned reinforcement on the rate of observing have not been adequately examined. In two experiments, a multiple schedule of observing-response procedures was used to examine the effects of rate of conditioned reinforcement on observing rates and resistance to change. In a rich component, observing responses produced a higher frequency of stimuli correlated with alternating periods of random-interval schedule primary reinforcement or extinction. In a lean component, observing responses produced similar schedule-correlated stimuli but at a lower frequency. The rate of primary reinforcement in both components was the same. In Experiment 1, a 4:1 ratio of stimulus production was arranged by the rich and lean components. In Experiment 2, the ratio of stimulus production rates was increased to 6:1. In both experiments, observing rates were higher in the rich component than in the lean component. Disruptions in observing produced by presession feeding, extinction of observing responses, and response-independent food deliveries during intercomponent intervals usually were similar in the rich and lean components. When differences in resistance to change did occur, observing tended to be more resistant to change in the lean component. If resistance to change is accepted as a more appropriate measure of response strength than absolute response rates, then the present results provide no evidence that higher rates of stimuli generally considered to function as conditioned reinforcers engender greater response strength.     

Modeling behavior in a clinically diagnostic sequential risk-taking task

This article models the cognitive processes underlying learning and sequential choice in a risk-taking task for the purposes of understanding how they occur in this moderately complex environment and how behavior in it relates to self-reported real-world risk taking. The best stochastic model assumes that participants incorrectly treat outcome probabilities as stationary, update probabilities in a Bayesian fashion, evaluate choice policies prior to rather than during responding, and maintain constant response sensitivity. The model parameter associated with subjective value of gains correlates well with external risk taking. Both the overall approach, which can be expanded as the basic paradigm is varied, and the specific results provide direction for theories of risky choice and for understanding risk taking as a public health problem.     

Especial skills: their emergence with massive amounts of practice

Differing viewpoints concerning the specificity and generality of motor skill representations in memory were compared by contrasting versions of a skill having either extensive or minimal specific practice. In Experiments 1 and 2, skilled basketball players more accurately performed set shots at the foul line than would be predicted on the basis of the performance at the nearby locations, suggesting considerable specificity at this distance. This effect was replicated even when the lines on the court were obscured (in Experiment 2). However, the effect was absent when jump shots were executed in Experiment 3. The authors argue that massive levels of practice at 1 particular member of a class of actions produce specific effects that allow this skill to stand out from the other members of the class, giving it the status of an especial skill. Various theoretical views are proposed to account for the development of these skills.     

Borderline personality features predict alcohol use problems

This study assessed the relation between BPD features and problems associated with alcohol use 2 years later in young adults. Approximately 5,000 nonclinical young adults were screened for BPD features, and two cohorts of participants completed the laboratory phase of the study at Time 1 (total N = 421) and then again 2 years later at Time 2 (total N = 356). Measures included self-report and interview-based assessments of personality disorders, psychopathology in biological parents, Axis I psychopathology, and alcohol use problems. BPD features were found to significantly predict alcohol use problems 2 years later after controlling for parents' substance use disorders, Axis I psycho-pathology (including alcohol abuse/dependence), and non-BPD personality disorders. In addition, the BPD subscale that assesses impulsivity was found to be significantly associated with alcohol use problems once all predictors were entered into the model.     

When elaboration leads to appropriation: unconscious plagiarism in a creative task

Brown and Murphy's (1989) three-stage paradigm (generation, recall-own, generate-new) was used to assess the effects of participant elaboration on rates of unconscious plagiarism in two experiments using a creative task. Following the generation phase, participants imagined and rated a quarter of the ideas (imagery elaboration), generated improvements to another quarter (generative elaboration), and listened to a quarter of the ideas again without elaboration, with the remaining ideas acting as control. A week later, participants attempted to recall their own ideas, and generate new solutions to the same cues. In Experiment 1 both forms of elaboration equally increased correct recall, and decreased plagiarism in the generate-new task. However, generative elaboration led to significantly greater plagiarism in the recall-own task, but imagery elaboration did not. Participants in Experiment 2 were encouraged not to plagiarise by means of a financial incentive. However, they showed the same pattern as seen in Experiment 1. Therefore, contrary to a simple strength account, the probability of a person plagiarising another's ideas is linked to the particular nature of the elaboration carried out on that idea, rather than its familiarity.