The Meaning vs. The Medical Model in the Empirically Supported Treatment Program: A Consideration of The Empirical Evidence

A review of the debate on the Empirically Supported Treatment Program is presented. It is argued that underlying the specifics of the debate are fundamentally incompatible paradigms: a meaning vs. a medical model. The findings from two gold standard multi-site studies are reviewed to conclude that the control condition meets requirements for an empirically supported treatment. The empirical finding of the failure of clinical training to improve treatment outcomes is explained by the focus on rational factors in training. It is recommended that training of therapists focus on enhancing experiential capacity rather than mastery of manualized treatment approaches.     

Intervention Groups for Adolescents With Conduct Problems: Is Aggregation Harmful or Helpful?

Past research has suggested that the aggregation of deviant peers during treatment may cause harmful effects (T. J. Dishion, J. McCord, & F. Poulin, 1999). This study compared the effectiveness of problem-solving skills training groups in which all members had conduct problems (pure group condition) with groups that consisted of adolescents with and without behavior problems (mixed group condition). Participants were 139 sixth- and seventh-graders (mean age = 12.7; 63% male; 55% White) enrolled at public middle schools. Pre-, post-, and 6-month follow-up data were collected, along with intervention process variables. Results showed that, contrary to the deviancy training hypothesis, adolescents in the pure-group condition engaged in more adaptive in-session behavior and received lower scores on the parent and teacher ratings of externalizing behavior at postintervention than those in the mixed-group condition. Mediation analyses showed that the deviancy training that occurred in the mixed-group condition accounted for their worse postintervention scores, findings consistent with the deviancy training hypothesis.     

A Review of Self-Management Interventions Targeting Academic Outcomes for Students with Emotional and Behavioral Disorders

The purpose of this review was to report on the effectiveness and focus of academic self-management interventions for children and adolescents with emotional and behavioral disorders. Twenty-two studies published in 20 articles and involving 78 participants met inclusionary criteria. The overall mean effect size (ES) across those studies was 1.80 (range –0.46 to 3.00), indicating effects were generally large in magnitude and educationally meaningful. Self-monitoring interventions were the predominant type of self-management technique used by researchers. The mean ES for intervention types were self-evaluation (1.13), self-monitoring (1.90), strategy instruction techniques (1.75), self-instruction techniques (2.71), and multiple-component interventions (2.11). Interventions targeted improvement in math calculation skills more than any other area. The mean ES by academic area were math interventions (1.97), writing (1.13), reading (2.28), and social studies (2.66). There was evidence to support a claim of the generalization and maintenance of findings. Implications, limitations, and areas for future research are discussed.     

A Comparison of Results and Acceptability of Functional Behavioral Assessment Procedures with a Group of Middle School Students with Emotional/Behavioral Disorders (E/BD)

There is currently controversy over the validity and applicability of functional behavioral assessment (FBA) procedures with students with emotional/behavioral disorders (E/BD). A set of FBA procedures, including teacher and student interviews and direct classroom observations, were carried out with eight students with disabilities (7 classified E/BD, one classified LD). Results indicated that when all three methods (teacher/student interviews, classroom observations) yielded a ranking for a function they agreed 64% of those occasions. For those situations in which there was overall disagreement there was agreement between teacher interview and classroom observations most of the time. Social validity data indicated that both students and teachers felt that the assessment procedures were a useful and productive process.     

Racial Differences in Responses to the Caregiver Strain Questionnaire

The aim of this study was to examine differences in responses to the Caregiver Strain Questionnaire (CGSQ) between African American and White caregivers of children with emotional and behavioral challenges. Significant item- and scale-level differences were detected across groups with African Americans consistently reporting less strain. We examined whether these differences were more likely due to nonequivalent measurement than to real differences in the experience of caregiver strain. Confirmatory factor analysis showed that the model fit the data well for both racial groups, but there were some differences in structural components. Internal consistency was equivalent across the groups. In an examination of criterion validity, regression analyses showed that African American caregivers experienced a slower rate of increase in objective caregiver strain at a given increase in child internalizing problems. No other race differences were found in the regression analyses. In general, we conclude that the CGSQ can be useful for detecting caregiver strain and identifying family support needs for both White and African American caregivers. Differences across groups in reports of caregiver strain, however, call for more research on racial differences in the impact on the family of caring for a child with emotional and behavioral disorders.     

School Mobility and Students with Emotional Disturbance

We examined the school mobility of a cross-sectional sample of 70 secondary-age youth with emotional disturbance (ED). Data were collected through an archival review of school records. Students’ school mobility histories were examined in terms of the overall number of schools attended in the elementary school years, as well as the timing of the moves that were made. Findings indicate that sample students experienced high rates of school mobility with 66% having changed schools at least once by the end of 2nd grade and 89% having changed schools at least once by the end of 5th grade. Strategies for minimizing school mobility and the impact of high rates of school mobility are reviewed.     

Successive reversal of concurrent discriminations by macaques (Macaca mulatta): proactive interference effects

Rhesus monkeys received concurrent within-session training on eight, two-choice object pairs and then underwent successive reversals of these problems. Initially, reversals required about six times more training than acquisition with no improvement over seven successive reversals. Surprisingly, performance on these eight problems was unimpaired if they were embedded in different eight-problem tasks, thereby indicating a release from proactive interference. When the original eight problems again underwent successive reversal, no improvement was seen over seven reversals, although there was significantly less error-per-reversal than in the initial test. Subsequently, monkeys appeared to be developing a learning set for successive reversal because performance on successive reversal of eight novel problems was not different from that seen with the old familiar task. Set acquisition was confirmed when proficient reversal was eventually achieved on both old and new concurrent tasks. Thus, concurrent reversal set did develop, but it required arduous training to overcome proactive interference effects on memory. The ubiquitous influence of measurement context on organization of monkey memory was noted.     

Women's exposure to thin-and-beautiful media images: body image effects of media-ideal internalization and impact-reduction interventions

Exposure to media images of thin-and-beautiful women negatively affects the body image and mood states of young women. However, not all women are equally susceptible to these effects. The present experimental investigation with 123 young college women evaluated the moderating effects of the extent of internalization of media ideals. It also examined the preventative impact of two brief interventions (i.e., media literacy information with and without a dissonance-induction procedure). Results indicated that relative to a control group, the exposure to thin-and-beautiful media images adversely influenced the state body image of participants with high internalization levels. Media-literacy psychoeducation prior to the media exposure prevented this adverse effect. Adding a pre-exposure dissonance-induction procedure did not significantly enhance the preventative effects relative to psychoeducation alone. These results and their implications for the treatment and prevention of body image disturbances are discussed in the context of the empirical literature on the media's effects on body image.     

Linguistic Analysis of Written Narratives of Caregivers of Children and Adolescents with Chronic Illness: Cognitive and Emotional Processes and Physical and Psychological Health Outcomes

Used linguistic analysis of written narratives of caregivers of hospitalized youth with chronic illness to identify emotional and cognitive processes related to physical and psychological health outcomes following writing. Measures were administered at baseline and 4 months. Experimental group (n = 29) wrote about traumas whereas the control group (n = 24) wrote about summer activities for 20 min on three different days. Compared groups on negative emotion- and cognition-related word use. Tested change in negative emotion- and cognition-related word use as predictors of outcomes in experimental group. Consistent with hypotheses, experimental group used more negative emotion words [F(1, 53) = 77.55, p < .001] and cognition-related words than control group [F(1, 53) = 19.09, p < .001] and an increase in cognition words predicted Physical Health Summary Score on SF-36 (standardized = .37, p < .05). A decrease in negative emotion words was related to Physical Health Summary Score on SF-36 only when entered into regression with change in cognition words (standardized = –.31, p < .05). A decrease in negative emotion together with an increase in cognitive processing facilitated by written emotional disclosure has beneficial effects on physical health-related quality of life.     

Identity, narcissism and the emotional core

This paper describes the course of an analysis which demonstrates how borderline and narcissistic functioning can be understood in terms of a struggle with issues of identity. It shows how such functioning can come to exert a profound hold on the individual and why it seems, at times, a matter of life and death to the patient to avoid states of separation from the analyst. The paper suggests that these complex phenomena can be understood, perhaps surprisingly, in the simple terms of the nature of affect itself. The concept of the emotional core is introduced to embody and highlight that which lies beneath both Jungian and Freudian models (offering a potential bridge between the two models)--namely the psyche's essentially affective nature. It is suggested that the emotional core can serve as an organ of perception giving the individual both their primary relation to reality and an emotional attachment to others. This emotional core is understood to function in a narcissistic manner to preference experiences of sameness and in aversion to experiences of difference--a view consonant with Stern's understanding of infant development where the infant is able to distinguish self from other from the beginning of life (as Fordham also held); taking up Stern's terminology, it gives the individual a 'core' sense of being. There is, however, no stable, on-going sense of 'I' associated with this form of functioning as the individual is immersed in the latest affect to enter consciousness (as in the borderline state of mind) and consequently the individual comes to rely intensely on the other to determine their sense of being (the other becomes a self-regulating other in Stern's terms). The development of ego-functioning gives a more stable and on-going sense of 'I' to the individual, giving contact with the broader personality, allowing the individual to be less reliant on the other and orientating them to reality in a way more fitting to their overall needs. The paper describes how consciousness, which is not seen as identical with the ego, moves between the mode of functioning of the ego and that of the emotional core, i.e., shifting in and out of states where projective identification predominates. It elaborates the range of self-experience encompassing spiritual experience and states of disintegration (which are understood to have a similar structure) on one side, to ego-based experience (which can itself be defensive and rigid at times) on the other. It explores the consequences of such a view for analytic technique and relates it to the Jungian view of the self and the Freudian unconscious.