ACCEPTABILITY CRITERIA FOR WORK IN THEOLOGY AND SCIENCE

Abstract. The philosophy of science of Imre Lakatos suggests criteria for acceptability of work in the interdisciplinary area of theology and science: proposals must contribute to scientific (or theological) research programs that lead to prediction and discovery of novel facts. Lakatos's methodology also suggests four legitimate types of theology–and–science interaction: (1) heuristic use of theology in science; (2) incorporation of a theological assertion as an auxiliary hypothesis in a scientific research program, or (3) as the central theory of a research program; and (4) hybrid theology–and–science programs with empirical data. Three recent Zygon articles illustrate these four types.     

Evaluation of a healthy-weight treatment program for bulimia nervosa: a preliminary randomized trial

Objective: Conduct a randomized treatment trial to test whether healthy dieting maintains bulimic symptoms or effectively reduces this eating disturbance.

Methods: Female participants (n=85) with full- and sub-threshold bulimia nervosa were randomly assigned to a 6-session healthy dieting intervention or waitlist condition and assessed through 3-month follow-up.

Results: Relative to control participants, intervention participants showed modest weight loss during treatment and demonstrated significant improvements in bulimic symptoms that persisted through follow-up.

Discussion: These preliminary results suggest that this intervention shows potential for the treatment of bulimia nervosa and may be worthy of future refinement and evaluation. Results also provide experimental evidence that dieting behaviors do not maintain bulimia nervosa, suggesting the need to reconsider maintenance models for this eating disorder.     

Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up

The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.     

Does individualization matter? A randomized trial of standardized (focused) versus individualized (broad) cognitive behavior therapy for bulimia nervosa

Does higher level of individualization increase treatment efficacy? Fifty patients with bulimia nervosa were randomized into either manual-based (focused) or more individualized (broader) cognitive behavioral therapy guided by logical functional analysis. Eating disorders Examination and a series of self-report questionnaires were used for assessment at pre-, and post-treatment as well as at follow-up. Both conditions improved significantly at post-treatment, and the results were maintained at the 6 months follow-up. There were no statistically and clinically significant differences between the two conditions at post-treatment with the exception of abstinence from objective bulimic episodes, eating concerns, and body shape dissatisfaction, all favoring the individualized, broader condition. Both groups improved concerning self-esteem, perceived social support from friends, and depression. The improvements were maintained at follow-up. Ten patients (20%) did not respond to the treatment. Notably, a majority of non-responders (80%) were in the manual-based condition. Non-responders showed extreme dominance of rule-governed behavior, and lack of contact with actual contingencies compared to responders. The study provided preliminary support for the superiority of higher level of individualization (i.e. broader CBT) in terms of the response to treatment, and relapses. However, the magnitude of effects was moderate, and independent replications, with blind assessment procedures, and a larger sample sized are needed before more clear cut conclusions can be drawn.     

Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse

Discontinuation of benzodiazepine (BZD) treatment for insomnia can be a difficult task. Cognitive-behavior therapy (CBT) for insomnia, combined with a supervised medication taper, can facilitate withdrawal but there is limited evidence on long-term outcome after discontinuation. The objective of this study was to examine medication-free survival time and predictors of relapse (i.e., resumed BZD hypnotics) over a 2-year period in 47 older adults (mean age 62.1 years) with persistent insomnia and prolonged BZD use (average duration of 18.9 years), who had successfully discontinued BZD following CBT for insomnia, a supervised medication taper program, or a combined approach. The Kaplan-Meier product-limit method was used to estimate survival time, defined as time between end-of-treatment and relapse or end of follow-up. By the end of the 24-month follow-up, 42.6% of the samples had resumed BZD use. Participants in the Combined (33.3%) and Taper (30.8%) groups relapsed significantly less than their counterparts from the CBT group (69.2%). Survival rates at 3 months were 61.5% (CBT), 100% (Taper), and 80.9% (Combined). At 12 months, they were 38.5%, 83.3%, and 70.8%, respectively; and, at 24 months, they were 28.9%, 64.8% and 64.9%, respectively. Mean survival time was significantly longer for both the Taper (18.6 months, SE = 2.1) and Combined groups (12.6 months, SE = 1.4), relative to the CBT group (8.5 months, SE = 1.8). Significant predictors of relapse included treatment condition, end of treatment insomnia severity, and psychological distress. In conclusion, there is a substantial relapse rate following BZD discontinuation among prolonged users. CBT booster sessions might enhance compliance with CBT and prove useful in preventing relapse.     

Cognitive therapy for post-traumatic stress disorder: development and evaluation

The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.     

Subordinating Truth – Is <Emphasis Type="Italic">Acceptability</Emphasis> Acceptable?

Argumentation logicians have recognized a specter of relativism to haunt their philosophy of argument. However, their attempts to dispel pernicious relativism by invoking notions of a universal audience or a community of model interlocutors have not been entirely successful. In fact, their various discussions of a universal audience invoke the context-eschewing formalism of Kant’s categorical imperative. Moreover, they embrace the Kantian method for resolving the antinomies that continually vacillates between opposing extremes – here between a transcendent universal audience and a context-embedded particular audience. This tack ironically restores the very external mediation they thought to obviate in their aim to ‘dethrone’ the absolutism and totalitarianism of formal logic with a democratic turn to audience adherence, the acceptability of premises and inferential links, and a contextual, or participant-relative, notion of cogency.     

In-vivo rating of treatment acceptability by children: Effects of probability instruction on student's spelling performance under group contingency conditions

In prior studies, Shapiro and Goldberg (1986, 1990) failed to find a relationship between in-vivo ratings by children of treatment acceptability and treatment effectiveness. These studies involved the use of interdependent and dependent group contingencies designed to improve the spelling performance of sixth grade students. To investigate whether the failure to link treatment acceptability and effectiveness may have been due to the subjects' inability to understand the differences in treatment conditions, this study utilized a pre-intervention training package to enhance salient differences between two types of group contingencies. Results of this study showed that both group contingencies were successful at improving the spelling performance of students, particularly the poorer spellers. Prior to treatment, students preferred the interdependent condition, with the higher-achieving students expressing the strongest preference. After implementation of the training package, both conditions were now rated as equally acceptable. Pre- and post-test acceptability ratings of each condition tended to be significantly correlated but correlations between acceptability ratings and treatment effectiveness were negligible at all points in the study. Limitations of the present study and suggestions for further research are discussed.     

Development of a modified treatment evaluation inventory

Kazdin's (1980a) Treatment Evaluation Inventory (TEI) is the major instrument used to assess parents' acceptance of procedures for behavior problem children. The length of the TEI, however, as well as problems with its scaling and wording limits its value as a clinical research instrument. In the present study, three experiments were conducted to develop a modified TEI. In Experiment 1, 153 parents completed the TEI to evaluate a behavioral treatment for noncompliant and oppositional children. A factor analysis of the data was used to obtain a reliable factor structure for the TEI and to construct a 9-item TEI-Short Form (TEI-SF) with a 5-point scale, consistent anchors on the scale, and simplified text and instructions. Experiment 2 evaluated the psychometric characteristics of the TEI and the TEI-SF. These data indicated the TEI-SF is a sound alternative to the original TEI. Experiment 3 compared the readability and completion time of the two instruments.