The Therapeutic Factors Inventory: Development of a Scale

Although Yalom's (1995) framework of the therapeutic factors facilitating outcome in group has been accepted by group specialists, no empirically based instrument assesses all of these factors. The Therapeutic Factors Inventory (TFI), with 11 scales based on the therapeutic factors, has been designed to fill this gap. This article summarizes the development and preliminary reliability testing of the TFI. Each scale of the instrument demonstrated high internal consistency; however, one scale obtained unacceptably low test-retest reliability. Further validity testing is needed. Implications of these findings are discussed.     

Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.     

Sustained efficacy of dialectical behaviour therapy for borderline personality disorder

Dialectical Behaviour Therapy (DBT) is considered one of the most promising treatments for borderline personality disorder (BPD). Recently, we reported significantly positive effects of 12 months DBT on parasuicidal behaviour and impulsivity in a mixed group of female BPD patients with and without substance abuse. Fifty-eight women with BPD were randomly assigned to either 52 weeks of DBT or treatment as usual (TAU). Follow-up assessment took place at 78 weeks, i.e., 6 months after discontinuation of DBT. Participants were clinical referrals from addiction treatment and psychiatric services. Outcome measures included parasuicidal behaviour, impulsivity and substance abuse. Six months after treatment discontinuation, the benefits of DBT over TAU in terms of lower levels of parasuicidal and impulsive behaviours, and in alcohol use, sustained. No differences between the treatment conditions were found for drug abuse. In conclusion, DBT seems to have a sustained effect on some of the core symptoms of BPD and on alcohol problems in a mixed population of female borderline patients with and without substance abuse problems.     

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.     

Tailoring Cognitive Behavioral Therapy for Individuals Diagnosed with Bulimia Nervosa

There is a wealth of data indicating the effectiveness of cognitive behavioral therapy in the treatment of bulimia nervosa. However, the best evidence indicates a treatment success rate of 50%. The purpose of this paper is to briefly describe cognitive behavioral treatment of bulimia nervosa and to offer suggestions on how this therapy approach may be tailored to best serve the needs of individual clients. Such tailoring should ultimately lead to even greater treatment success.     

A Multitrait–Multisource Confirmatory Factor Analytic Approach to the Construct Validity of ADHD and ODD Rating Scales with Malaysian Children

Confirmatory factor analysis (CFA) was used to model a multitrait by multisource matrix to determine the convergent and discriminant validity of measures of attention-deficit hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and oppositional defiant disorder (ODD) in 917 Malaysian elementary school children. The three trait factors were ADHD-IN, ADHD-HI, and ODD. The two source factors were parents and teachers. Similar to earlier studies with Australian and Brazilian children, the parent and teacher measures failed to show convergent and discriminant validity with Malaysian children. The study outlines the implications of such strong source effects in ADHD-IN, ADHD-HI, and ODD measures for the use of such parent and teacher scales to study the symptom dimensions.     

Selective Mutism in Children: Comparison to Youths With and Without Anxiety Disorders

Fifteen children with selective mutism (SM), 15 children with anxiety disorders (AD) without selective mutism, and 15 children without anxiety disorders or selective mutism (CN) were compared to examine the relationship between selective mutism and anxiety. Data were collected from children (age 4–10 years), parents, teachers, and clinicians. Results indicated that children with SM closely resemble children with AD. All children with SM received a diagnosis of social anxiety disorder and 53% received a diagnosis for an additional anxiety disorder. In addition, the SM and AD groups differed substantially from controls with respect to parent- and teacher-rated internalizing behavior problems. No differences among the groups were found with respect to parent-and teacher-reported externalizing behavior problems. The results are consistent with prior research emphasizing the association between selective mutism and anxiety disorders, and suggest that selective mutism may be conceptualized, assessed, and treated as an anxiety-related problem.     

Predictive Genetic Testing for Hereditary Breast and Ovarian Cancer: Psychological Distress and Illness Representations 1 Year Following Disclosure

This prospective study evaluates emotional functioning and illness representations in 68 unaffected women (34 carriers/34 noncarriers) 1 year after predictive testing for BRCA1/2 mutations when offered within a multidisciplinary approach. Carriers had higher subjective risk perception of breast cancer than noncarriers. Carriers who did not have prophylactic oophorectomy had the highest risk perception of ovarian cancer. No differences were found between carriers and noncarriers regarding perceived seriousness and perceived control of breast and ovarian cancer. Mean levels of distress were within normal ranges. Only few women showed an overall pattern of clinically elevated distress. Cancer-specific distress and state-anxiety significantly decreased in noncarriers from pre- to posttest while general distress remained about the same. There were no significant changes in distress in the group of carriers except for ovarian cancer distress which significantly decreased from pre- to posttest. Our study did not reveal adverse effects of predictive testing when offered in the context of a multidisciplinary approach.     

Evaluating Genetic Counseling: Client Expectations,Psychological Adjustment and Satisfaction with Service

Periodic evaluations of genetic counseling services are useful for determining the effectiveness of counseling in meetings its psycho-educational aims, as well as identifying where improvements to the service may be made. This study aimed to evaluate the genetic counseling services provided by Genetic Services of Western Australia (GSWA) to determine the impact of counseling on client expectations, satisfaction with the service, and psychological adjustment, defined as wellbeing and perceived personal control (PPC). A total of 122 clients participated in a self-administered survey conducted pre- and post-counseling. Client expectations of the service as a means of providing information were met, and opportunities for counselors to meet client’s expectations of psychological support were identified. Furthermore, counseling was found to maintain and enhance psychological wellbeing of clients. The role of counseling in facilitating the development of PPC was a key contributor to a high sense of satisfaction in clients.     

Significance of Childhood Conduct Problems to Later Development of Conduct Disorder Among Children With ADHD: A Prospective Follow-Up Study

This study investigates whether low to moderate levels of childhood oppositional defiant disorder (ODD) and conduct disorder (CD) behaviors contribute to the development of clinically diagnosed CD in adolescence, in children with attention deficit hyperactivity disorder (ADHD). Participants were 207 White boys (ages 6-12) with ADHD free of conduct disorder diagnoses. Parent and teacher ratings were obtained. Participants were assessed at mean age 18 by clinicians blind to childhood status. A non-ADHD group (recruited in adolescence) was also studied. ODD behavior ratings did not predict CD in adolescence, whereas CD behavior ratings did. No single ODD or CD behavior predicted adolescent outcome. ADHD probands with very low ratings (Not at all, Just a little) by parents and teachers on all CD behaviors were still at significantly increased risk for CD in adolescence, compared to non-ADHD controls. The same relationships were found between childhood ODD and CD behaviors, and antisocial personality disorder in adulthood (mean age, 25). We conclude that childhood ADHD is a developmental precursor of later antisocial disorder, even in the absence of comorbid ODD or CD in childhood. However, low levels of CD-type problems are not innocuous, because they predict later CD among children with ADHD without comorbid CD.