Therapist Awareness of Appropriate Intervention in Treatment of Domestic Violence

SUMMARY

Given the widespread nature of relationship violence, psychotherapists must recognize the probability that at some point they will treat a violent couple or someone involved in a violent relationship, even if they do not specialize in the treatment of family violence. Two analogue studies reported in this chapter were designed to investigate how therapists conceptualize cases involving domestic violence families and the types of interventions they indicate they would make. The first study surveyed 362 members of the American Association for Marriage and Family Therapy (AAMFT). Respondents were asked to conceptualize and provide interventions for one of two actual cases that involved family violence. The second study surveyed 402 members of the American Psychological Association (APA). Respondents were asked to give a diagnosis based on a case presentation. After being informed the case resulted in a homicide, respondents were asked what interventions they would have made prior to the outcome, had they been given the opportunity to provide counseling. Results from both analogue studies indicate that a large number of respondents were unable to properly assess the danger inherent in cases of domestic violence, and many more would not have intervened in a timely and appropriate manner.     

Chaos and Trauma in the Lives of Adolescent Females with Antisocial Behavior and Delinquency

Summary

Female adolescents entering the juvenile justice system have complex and serious problems in multiple areas of adjustment. Literature is reviewed on the prevalence and form of antisocial behavior in girls and on the long-term implications of such problems in adolescence. Risk factor characteristics, including family fragmentation, physical and sexual trauma, mental health problems, official arrest and self-report offending histories of a population of girls referred for out-of-home placement because of repeated and chronic juvenile offending are presented. In addition, with the exception of sexual trauma histories, these sample characteristics are compared to a similar sample of chronically offending boys. A treatment approach is described and pilot data are presented on its feasibility. Implications for designing empirically-based, gender-related treatment models are discussed.     

The Lazarus Project: a longitudinal study of spiritual transformation among substance abusers

This is a longitudinal study of spiritual transformation at the Lazarus Project (LP), a 12-month Pentecostal-Charismatic residency program for substance abuse. In 2006, we began administering to residents an assessment protocol consisting of psychological (depression, self-esteem, psychopathology, Big 5 personality markers) and religiosity (fundamentalism, religious orientation, spiritual well-being, mysticism) measures. Assessments were at: (T1) induction; (T2) six months; (T3) graduation; and (T4) one-year post-graduation. We also assessed a membership group from the sponsoring church using the same protocol. Analyses found that general change in graduate scores occurred from T1 to T2 and persisted to T3 and T4. Comparative analyses found that LP graduate score patterns generally agreed with those of LP dropouts at T1, but diverged at T2, becoming more similar to score patterns of church members. Using all measures, a regression analysis found that the personality marker of (less) openness was the most powerful predictor of resident dropout. The preliminary findings suggest that, among chronic substance abusers, the LP helps to facilitate conversion as a form of spiritual transformation that persists at least one-year post-graduation.     

The predictive capacity of self-reported motivation vs. early observed motivational language in cognitive behavioural therapy for generalized anxiety disorder

ABSTRACT

Client motivation to change is often considered a key factor in psychotherapy. To date, research on this client construct has largely relied on self-report, which is prone to response bias and ceiling effects. Moreover, self-reported motivation has been inconsistently related to treatment outcome. Early observed client in-session language may be a more valid measure of initial motivation and thus a promising predictor of outcome. The predictive ability of motivational factors has been examined in addiction treatment but has been limited in other populations. Addressing this lack, the present study investigated 85 clients undergoing cognitive behavioural therapy (CBT) alone and CBT infused with motivational interviewing (MI-CBT) for severe generalized anxiety disorder. There were two aims: (1) to compare the predictive capacity of motivational language vs. two self-report measures of motivation on worry reduction and (2) to examine the influence of treatment condition on motivational language. Findings indicated that motivational language explained up to 35% of outcome variance, event 1-year post-treatment. Self-reported motivation did not predict treatment outcome. Moreover, MI-CBT was associated with a significant decrease in the most detrimental type of motivational language compared to CBT alone. These findings support the importance of attending to in-session motivational language in CBT and learning to respond to these markers using motivational interviewing.     

Investigating Treatment Outcomes Across OCD Symptom Dimensions in a Clinical Sample of OCD Patients

Despite the heterogeneous nature of obsessive-compulsive disorder (OCD), many self-report assessments do not adequately capture the clinical picture presenting within each symptom dimension, particularly unacceptable thoughts (UTs). In addition, obsessions and ordering/arranging compulsions are often underrepresented in samples of treatment outcome studies for OCD. Such methodological discrepancies may obscure research findings comparing treatment outcomes across OCD symptom dimensions. This study aimed to improve upon previous research by investigating treatment outcomes across OCD symptom dimensions using the Dimensional Obsessive-Compulsive Scale, which offers a more comprehensive assessment of UTs. The study included a primarily residential sample of 134 OCD patients. Results indicated that there were no significant differences in treatment outcomes across symptom dimensions. However, the severity of UTs remained significantly greater than other symptom dimensions at both admission and discharge. Thus, it is possible that UTs may exhibit uniquely impairing features, compared with other symptom dimensions. It is also possible that these findings may reflect the characteristics of the residential OCD samples. These speculations as well as implications for OCD treatment and future research are discussed.     

Internet-Based Treatment of Pathological Gambling with a Three-Year Follow-Up

Effective therapies for pathological gambling exist, but their use is limited to about 10% of the target population. In an attempt to lower the barriers for help, Internet-based cognitive behavioural therapy (ICBT) has been shown to be effective when delivered to a non-depressed sample with pathological gambling. This study sought to extend this finding to a larger, more representative population, and also test a model to predict responder status. Following advertisement, a total of 284 participants started an 8-week ICBT programme with minimal therapist contact via e-mail and weekly telephone calls of less than 15 min. The average time spent on each participant, including telephone conversations, e-mail, and administration, was 4 h. In addition to a mixed effects model to evaluate the effectiveness of the treatment, two logistic regression analyses were performed with the following eight pre-defined response predictor variables: work-life satisfaction, primary gambling activity, debts due to gambling, social support, personal yearly salary, alcohol consumption, stage of change, and dissociative gambling. ICBT resulted in statistically significant reductions in the scores of pathological gambling, anxiety, and depression as well as an increase in quality of life compared to pre-treatment levels. Follow-ups carried out in the treatment group at 6, 18, and 36 months indicated that treatment effects were sustained. Using the eight predictor variable model rendered an acceptable predictive ability to identify responders both at post-test (AUC = .72, p < .01) and at 36-month follow-up (AUC = .70, p < .01). We conclude that ICBT for pathological gamblers, even if depressed, can be effective and that outcome can partly be predicted by pre-treatment characteristics.     

Internet-Based Exposure Treatment Versus One-Session Exposure Treatment of Snake Phobia: A Randomized Controlled Trial

In this study, the authors compared guided Internet-delivered self-help with one-session exposure treatment (OST) in a sample of snake phobic patients. A total of 30 patients were included following a screening on the Internet and a structured clinical interview. The Internet treatment consisted of four weekly text modules which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The OST was delivered in a three-hour session following a brief orientation session. The main outcome was the behavioural approach test (BAT), and as secondary measures questionnaires measuring anxiety symptoms and depression were used. Results showed that the groups did not differ at post-treatment or follow-up, with the exception of a significant interaction for the BAT in favour of the OST. At post-treatment, 61.5% of the Internet group and 84.6% of the OST group achieved a clinically significant improvement on the BAT. At follow-up, the corresponding figures were 90% for the Internet group and 100% for the OST group (completer sample). Within-group effect sizes for the Snake Phobia Questionnaire were large (d = 1.63 and d = 2.31 for the Internet and OST groups, respectively, at post-treatment). It is concluded that guided Internet-delivered exposure treatment is a potential treatment option in the treatment of snake phobia, but that OST probably is better.     

Standardized Web-Based Cognitive Behavioural Therapy of Mild to Moderate Depression: A Randomized Controlled Trial with a Long-Term Follow-Up

Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment (web-CBT) of mild to moderate depression. Fifty-four individuals with chronic, moderate depression participated in a randomized wait-list controlled trial, with an 18-month follow-up (immediate treatment: n = 36, wait-list control: n = 18). Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Checklist-90-Revised (SCL-90-R. DEP). Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Questionnaire. Five participants (9%) dropped out. Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects (d) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP. Posttest SCL-90- R DEP scores indicated recovery of 49% of the participants in the treatment group compared with 6% in the control group (odds ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions.