Cognitive-Behavioral Therapy: The Truth Behind the Allegations

In response to several pejorative statements about Cognitive Behavioral Therapy in a recent issue of Psychotherapy (Silverman, 1999), a point by point counter argument to these criticisms are presented. Among other contentions, Silverman (1999) disparaged empirically validated methods as being simplistic and scientifically impoverished. The validity of these statements are challenged and empirical evidence is presented to support each counter argument. The efficacy of Cognitive Behavioral Therapy for a broad range of disturbances and presenting problems is presented. The future of Cognitive Behavioral Therapy and other empirically validated protocols are discussed, as well as recommendations for their use.     

Behavioral Interventions and Families: A Medical Rehabilitation Perspective

Behavioral interventions are pertinent to many issues faced by medical rehabilitation patients and their families in late adulthood. Despite their utility in managing chronic illnesses and reducing problematic behaviors related to cognitive impairment, behavioral interventions can be difficult to implement and maintain in a family setting. Problems resulting from countercontrol, caregiver fatigue, conflicting priorities, and impact on family relationships must be anticipated and addressed. These issues are illustrated through references to pertinent research and case examples. Recommendations are offered to reduce caregiver stress and to minimize shifts in relationships when family caregivers act to alter a member's behavior.     

正念训练对冲动性不同要素的影响：基于双加工理论

正念是指对当下身心体验不带有评判地觉察。基于双加工理论,以正念为核心的训练对个体冲动性不同要素均具有明显干预效果。一方面,有助于降低因情感系统引发的冲动驱力：通过调整个体的奖赏评估与预期,缓和诱发冲动的压力与负性情绪反应,减弱自动化反应的联结和强度;另一方面,提升个体由认知控制系统调节的冲动控制力：增强个体的认知控制和行为抑制能力。由于冲动性驱动因素和控制因素二者加工时序的先后差异和作用方向对抗性特点,正念训练促进两类要素的积极交互影响,缩小冲动性“驱动”与“控制”力量之间的不平衡,为个体更好地回应自身反应与外界刺激提供了有利缓冲,是降低个体冲动性的有效干预手段。     

Behavioral Outcomes of Parent-Child Interaction Therapy and Triple P—Positive Parenting Program: A Review and Meta-Analysis

We conducted a review and meta-analyses of 24 studies to evaluate and compare the outcomes of two widely disseminated parenting interventions—Parent-Child Interaction Therapy and Triple P-Positive Parenting Program. Participants in all studies were caregivers and 3- to 12-year-old children. In general, our analyses revealed positive effects of both interventions, but effects varied depending on intervention length, components, and source of outcome data. Both interventions reduced parent-reported child behavior and parenting problems. The effect sizes for PCIT were large when outcomes of child and parent behaviors were assessed with parent-report, with the exclusion of Abbreviated PCIT, which had moderate effect sizes. All forms of Triple P had moderate to large effects when outcomes were parent-reported child behaviors and parenting, with the exception of Media Triple P, which had small effects. PCIT and an enhanced version of Triple P were associated with improvements in observed child behaviors. These findings provide information about the relative efficacy of two programs that have received substantial funding in the USA and Australia, and findings should assist in making decisions about allocations of funding and dissemination of these parenting interventions in the future.

Involving Family in Psychosocial Interventions for Chronic Illness

ABSTRACT— Interactions with close family members have consequences for the emotional and physical well-being of individuals who are dealing with a chronic physical illness. Therefore, inclusion of a close family member in psychosocial interventions for chronic illnesses is a logical treatment approach that has the potential to boost the effects of intervention on the patient and also benefit the family member. However, randomized, controlled studies indicate that such family-oriented interventions generally have small effects. The efficacy of these treatment approaches might be enhanced by targeting specific interactions that emerging research identifies as promoting or derailing healthy behaviors and by better incorporating strategies from family caregiver interventions. In addition, family-oriented interventions should be more fully evaluated, by assessing the benefits for both patients and family members. Future research in this area can tell us much about how and when to involve family in treatment of specific chronic illnesses and, in turn, may inform conceptual models of the impact of family interactions on health.     

The Effects of Positive Peer Reporting as a Class-Wide Positive Behavior Support

School-wide, selective, and individual positive behavioral supports are critical elements of a comprehensive, tiered model of service delivery. Positive peer reporting (PPR) involves brief, highly structured sessions during which peers are provided the opportunity to praise the behavior of target students. PPR procedures were modified in this study to provide all children in a classroom the opportunity to provide or receive peer praise. The effects of class-wide PPR on teacher-recorded critical events were evaluated using a multiple baseline design across two classrooms. Results indicated marginal improvement across the two settings, as well as supplemental measures of behavior outside of the classroom and class-wide sociometric nominations. Implications for future research and emerging models of school-wide PBS are discussed.     

Randomized trial of a brief depression prevention program: an elusive search for a psychosocial placebo control condition

This trial compared a brief group cognitive-behavioral (CBT) depression prevention program to a waitlist control condition and four placebo or alternative interventions. High-risk adolescents with elevated depressive symptoms (N=225, M age=18, 70% female) were randomized to CBT, supportive-expressive group intervention, bibliotherapy, expressive writing, journaling, or waitlist conditions and completed assessments at baseline, termination, and 1- and 6-month follow-up. All five active interventions showed significantly greater reductions in depressive symptoms at termination than waitlist controls; effects for CBT and bibliotherapy persisted into follow-up. CBT, supportive-expressive, and bibliotherapy participants also showed significantly greater decreases in depressive symptoms than expressive writing and journaling participants at certain follow-up points. Findings suggest there may be multiple ways to reduce depressive symptoms in high-risk adolescents, although expectancies, demand characteristics, and attention may have contributed to the observed effects.     

Supportive interventions and nonsymbolic mental functioning

The author aims to show how supportive interventions are the analyst's most relevant therapeutic means to helping patients with a feeble symbolic system transform nonsymbolic episodes and reestablish symbolic mental functioning. Symbolic and nonsymbolic modes of mental functioning are first outlined. Supportive interventions are redefined as an analyst's effort at improving a patient's nonsymbolic mental functioning, by using principally pragmatic or interactive aspects of communication to deal with her or his patient's nonsymbolic in-session experiences. These interventions are psychoanalytic when transference focused, in so far as they foster the symbolization and transformation of more primitive (nonsymbolic) layers of the transference. Some probable mechanisms underlying the effect of supportive interventions on nonsymbolic functioning include the modification of mental procedures. Supportive interventions also help restore symbolic mental elaboration through the gratification of a basic ego or self-need, bringing about a temporary relief from psychic pain, with increased affect tolerance and a renewed capacity to use symbols. This soothing effect accounts for a missing link in Bion's model of the elaborative effect of the analyst's reverie.     

The Ethnic Context of Child and Adolescent Problem Behavior: Implications for Child and Family Interventions

This article links the empirical literature on race and ethnicity in developmental psychopathology with interventions designed to reduce adolescent problem behavior. We present a conceptual framework in which culture is endogenous to the socialization of youth and the development of specific self-regulatory strategies. The importance of cultural influence is identified at three levels: (a) intrapersonal developmental processes (e.g., ethnic identity development, development of coping modifies mechanisms and self-regulatory mechanisms), (b) family socialization processes (e.g., racial and ethnic socialization), and (c) interaction with larger societal contexts (e.g., maintenance of bicultural competence in adapting to mainstream and ethnic cultures). We discuss limitations of current assessment and intervention practices that focus on reducing adolescent problem behavior with respect to the cultural issues identified above. We propose that empirically supported adaptive and tailored interventions for adolescent problem behavior are optimal for serving multicultural children and families. To empower such interventions to better serve children and families of color, it is essential that assessments that guide the adaptation and tailoring process include culturally salient dynamics such as ethnic identity, racial socialization, and culturally informed parenting practices. This work is supported by an NRSA grant to the first author, and the following for the second author: grants DA07031, DA13773, and DA16110 from the National Institute on Drug Abuse.