Charting the process of change: A primer on survival analysis

Survival analysis is a powerful and useful technique for understanding qualitative change. This article provides a practical, nontechnical introduction to the use of survival analysis for social scientists. Important issues in using survival analysis are discussed, including research design, data preparation and management, and data analysis. Attendance data from a self-helf organization are used to illustrate common survival analysis tasks such as describing the overall survival and hazard functions, examining covariate effects, and modeling the form of the hazard function over time. An appendix that discusses the strengths and weaknesses of current survival analysis computer programs is included. Editor's note: Edward Seidman served as action editor for this article while serving as Associate Editor for Methodology.I thank William Davidson, Susan Englund, Bruce Rapkin, Kurt Ribisl, and three anonymous reviewers for their helpful comments on earlier drafts. The example data presented here were collected with the support of an NIMH grant (MH37390) awarded to Julian Rappaport and Ed Seidman.     

Community applications of instructional technology: teaching writers of instructional packages

A community education program, to develop a variety of performance competencies in large numbers of neighborhood residents, requires a technology for preparing learning units administerable by community members themselves. The effects of a writing manual, designed to teach nonprofessionals to prepare such instructional packages, were analyzed in two experiments. Experiment I employed a multiple-baseline design across three university student trainees. The results showed that appropriate program writing increased by 75% after completion of the manual. The results of Experiment II, with two low-income neighborhood residents serving as trainees, showed that packages produced by trained writers resulted in a greater increase in skill activities than sets of training stimuli produced by untrained writers.     

The Role of Referent and Expert Power in Mutual Help

This study explored the roles of referent power (i.e., influence based on sense of identification) and expert power (i.e., influence based on knowledge and expertise) in Schizophrenics Anonymous (SA), a mutual-help group for persons experiencing a schizophrenia-related illness. The study describes SA participants' experience of referent and expert power with SA members, SA leaders, and with mental health professionals. It also examines whether or not referent and expert power ascribed to fellow SA participants predicts the perceived helpfulness of the group. One hundred fifty-six SA participants were surveyed. Participants reported experiencing higher levels of referent power with fellow SA members and leaders than with mental health professionals. They reported higher levels of expert power for mental health professionals and SA leaders than for SA members. The respondents' ratings of their SA group's helpfulness was significantly correlated with ratings of referent and expert power. Although expert power was the best independent predictor of helpfulness, a significant interaction between referent and expert power indicated that when members reported high referent power, expert power was not related to helpfulness. These results are interpreted to suggest that there are multiple forms of social influence at work in mutual help.     

Swimming against the mainstream: the early years from chilly tributary to transformative mainstream

This article traces the transformative paradigm shift in the theory and practice of personal change. Within a decade, new conceptual models, analytic methodologies and modes of treatment were created. Treatments were altered in the content, locus, and agents of change. This enterprising period also witnessed a sweeping shift in the public acceptance of behaviorally oriented treatments. The present article also analyzes the evolving theorizing and applications of social cognitive theory rooted in modeling, self-regulatory, and self-efficacy mechanisms of psychosocial change. This model of change is implemented from an agentic perspective to promote personal, institutional, and society-wide changes that address some of the most urgent global problems.     

Patient preference as a predictor of outcomes in a pilot trial of person-centred counselling versus low-intensity cognitive behavioural therapy for persistent sub-threshold and mild depression

The aim of this analysis was to explore whether pre-treatment intervention preferences were related to outcomes for patients with persistent sub-threshold and mild depression who received one of two treatment types. Thirty-six patients took part in a two-arm, parallel group, pilot randomized controlled trial that compared short term (3 month and 6 month) outcomes of person-centred counselling (PCC) compared with low-intensity, CBT-based guided self-help (LICBT). Patient preferences for the two interventions were assessed at baseline assessment, and analysed as two independent linear variables (pro-PCC, pro-LICBT). Eight out of 30 interactions between baseline treatment preferences and treatment type were found to be significant at the p < .05 level. All were in the predicted direction, with patients who showed a stronger preference for a treatment achieving better outcomes in that treatment compared with the alternative. However, pro-LICBT was a stronger predictor of outcomes than pro-PCC. The findings provide preliminary support that treatment preferences should be taken into account when providing interventions for patients with persistent sub-threshold and mild depression. It is recommended that further research analyses preferences for different treatment types as independent variables, and examines preferences for format of treatment (e.g. guided self-help vs. face-to-face).     

Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression

Internet-delivered psychological treatment of major depression has been investigated in several trials, but the role of personalized treatment is less investigated. Studies suggest that guidance is important and that automated computerized programmes without therapist support are less effective. Individualized e-mail therapy for depression has not been studied in a controlled trial. Eighty-eight individuals with major depression were randomized to two different forms of Internet-delivered cognitive behaviour therapy (CBT), or to a waiting-list control group. One form of Internet treatment consisted of guided self-help, with weekly modules and homework assignments. Standard CBT components were presented and brief support was provided during the treatment. The other group received e-mail therapy, which was tailored and did not use the self-help texts i.e., all e-mails were written for the unique patient. Both treatments lasted for 8 weeks. In the guided self-help 93% completed (27/29) and in the e-mail therapy 96% (29/30) completed the posttreatment assessment. Results showed significant symptom reductions in both treatment groups with moderate to large effect sizes. At posttreatment 34.5% of the guided self-help group and 30% of the e-mail therapy group reached the criteria of high-end-state functioning (Beck Depression Inventory score below 9). At six-month follow-up the corresponding figures were 47.4% and 43.3%. Overall, the difference between guided self-help and e-mail therapy was small, but in favour of the latter. These findings indicate that both guided self-help and individualized e-mail therapy can be effective.     

Gender Issues in the Diagnosis of Mental Disorder

No abstract available for this article.     

A Systematic Review and Meta-Analysis on the Efficacy of Self-Help Interventions in Tinnitus

This study is a review and meta-analysis on the efficacy of cognitive-behavioural therapy (CBT) self-help interventions for tinnitus. Randomized controlled trials were identified by searching in databases (e.g. ISI Web of Knowledge, PubMed, Cochrane Library, and PSYNDEX) and by manual search. Ten studies with 1188 participants in total were included in the meta-analysis. Participants were 49.2 years old and had tinnitus for 5.2 years. Self-help interventions significantly reduced tinnitus distress (d = 0.48) and depressiveness (d = 0.25) when compared with a passive control (e.g. information only and discussion forums) at post-assessment. There was no difference to the face-to-face controls (group treatment). The presence of therapists and the methodological quality of the studies did not influence the results. Sensitivity analysis revealed that there might be a publication bias regarding the comparison to the face-to-face control. However, the results suggest that CBT self-help interventions are an effective treatment for tinnitus distress. Since few studies were identified, this conclusion must be supported by future meta-analyses.     

The Efficacy of Minimal Contact Interventions for Acute Tinnitus: A Randomised Controlled Study

Acute tinnitus can lead to substantial distress and eventually result in long-lasting impairment. The aim of this study was to compare the efficacy of a cognitive-behavioural intervention (delivered as Internet self-management, bibliotherapy or group training) to the information-only control condition.

Applicants suffered from subjective tinnitus for up to six months, were between 18 and 75 years old and received no other tinnitus-related psychological treatment. A total of 304 participants were randomly assigned to one of the four study arms. Tinnitus distress, depressive symptoms, psychosomatic discomfort and treatment satisfaction were assessed.

At the post-assessment tinnitus distress was significantly lower in the Internet and the group training conditions compared to the control condition. Inter-group effect sizes were moderate to large. At follow-up, all active training conditions showed significantly reduced tinnitus distress compared to the control condition (intention-to-treat analysis). An additional completer analysis showed a significant reduction in tinnitus distress only for the group condition. All effect sizes were moderate. There were no differences regarding psychosomatic discomfort, but depressive symptoms were reduced in the group condition at the post-assessment (intention-to-treat analysis). Treatment satisfaction was significantly higher in the training conditions. The dropout rate was 39%.

The present study shows that distress can be reduced as early as the acute stadium and that minimal-contact interventions are a promising way to do this. In particular, the Internet and group conditions led to a large, immediate decrease in distress, and the participants were highly satisfied with the training.