Substance abuse assessment and treatment: The current training and practice of APA Division 22 members.

Objective: To determine the preparedness of rehabilitation psychologists to work with people with disabilities with primary or secondary substance-related problems by examining their education, training, and current practice. Design: Mail survey. Participants: 76 (47 men, 29 women) Division 22 members of the American Psychological Association. Results: Although 79% of respondents reported treating individuals with alcohol and other drug issues, over half rated their training in substance abuse treatment as inadequate. Referring to self-help groups and instilling cognitive-behavioral coping skills were common treatments. Participants reported a lack of preparation in substance abuse training in their graduate program coursework, practicum, and internship. Conclusion: Continuing education and changes to curriculum requirements, with linkage to existing certification bodies, should be considered to close the gap between training and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Study of 137Cs transfer across the placenta to the rat fetuses and effect of ferrocin on these processes

The aim of this study was to evaluate the effectiveness of 2 methods of administering a cognitive-behavioral self-help program for binge eating disorder. The study was designed to reproduce many of the conditions that apply in settings in which self-help interventions are most relevant. Seventy-two women with binge eating disorder were randomly assigned to 1 of 3 conditions for 12 weeks: pure self-help (PSH), guided self-help (GSH), or a waiting list (WL) control condition (followed by PSH or GSH). They were then followed up for 6 months. Both PSH and GSH had a substantial and sustained impact with almost half the participants ceasing to binge eat. There was little change in the WL condition. Cognitive-behavioral self-help may be of value both as an initial treatment for binge eating disorder and as a form of secondary prevention.     

Rate of improvement during cognitive-behavioral group treatment for panic disorder

This study examined the rate of symptom improvement in patients receiving cognitive-behavioral group treatment for panic disorder in an outpatient clinic setting. Treatment was a standard program of 12 sessions that emphasized information, interoceptive and situational exposure, and cognitive restructuring, but also included diaphragmatic breathing and relaxation training as elements of treatment. Subjects were 37 patients selected from sequential admissions into an outpatient treatment program; all data were derived from ongoing quality assurance measures that are a standard part of clinical monitoring. Consequently, this study provides data not on the relative efficacy of cognitive-behavioral therapy (CBT), but on rate of improvement and effectiveness of CBT for panic disorder in actual clinical practice. Patients achieved significant treatment gains on all panic disorder dimensions assessed, and the largest reduction in symptoms was during the first third of the treatment program, thereby challenging the notion that CBT delivers its gains slowly over time. Information on rats of symptom improvement is valuable for providing patients with accurate expectations about potential treatment benefits and for helping to maintain motivation during initial treatment sessions.     

Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: A randomized controlled trial.

Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: Results of a 3-year study.

Students (N?=?4,466) attending 56 schools in New York State were involved in a 3-year study testing the effectiveness of a cognitive-behavioral approach to substance abuse prevention. In a randomized block design, schools were assigned to receive (a) the prevention program with formal provider training and implementation feedback, (b) the prevention program with videotaped provider training and no feedback, or (c) no treatment. After pretest equivalence and comparability of conditions with respect to attrition were established, students who received at least 60% of the prevention program (N?=?3,684) were included in analyses of program effectiveness. Significant prevention effects were found for cigarette smoking, marijuana use, and immoderate alcohol use. Prevention effects were also found for normative expectations and knowledge concerning substance use, interpersonal skills, and communication skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a group therapy program for anxious children

In this study 14 children with different anxieties attended in small groups a cognitive-behavioral training program. The groups met once a week over a period of ten weeks. Outcome was evaluated with different questionnares for children and parents and interviews at the beginning and the end of training and ten weeks later. The different measures showed a significant reduction of self-reported anxiety. Anxious, avoident and social insecure behaviour was also reduced. Further the negative self-talk of the children changed into more appropriate positive self-talk. As it was not possible to use an appropriate control group, the results can just be seen as hints for the effectivity of a cognitive-behavioral orientated group therapy program for the treatment of various childhood anxieties. Further research under controlled conditions is necessary.     

Self-help treatment for depression: Who succeeds?

The growing popularity and use of bibliotherapy or "self-help" makes it important to find an empirical basis for determining who will profit from bibliotherapy treatments. Results from the career counseling field, using Holland's {RIASEC} model (Kivlighan & Shapiro, 1987) have characterized the self-help succeeder as Realistic, Investigative, and Conventional. Holland codes, self-psychology variables, generalized self-efficacy, and locus of control were used to predict attrition from treatment, change in depression score, satisfaction with treatment, and preference for treatment. Fifty-two mildly depressed undergraduates (18 men and 34 women) contracted for a 7-week treatment for depression, using an empirically evaluated, cognitive-behavioral, self-help manual. Results suggest that Realistic types are most successful at self-help treatment in terms of reduction of depression scores, whereas Enterprising types are least successful in terms of rate of attrition. Low superiority, high generalized self-efficacy, and an internal locus of control were also related to success in the self-help depression treatment. Implications, limitations, and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supervised relaxation training: A model for greater accessibility of behavioral interventions.

Developed a method of relaxation training—supervised relaxation training—to address (1) problems of cost and availability, which limit the applicability of such training to relatively few individuals, and (2) the inherent limitations of self-help programs. Although this training method required less professional involvement than other methods, it was not intended as a self-help approach to relaxation. Using 55 volunteers (aged 19–67 yrs), 2 treatment groups and 1 control group were formed: One treatment group consisted of self-selected Ss from the community at large; the other represented Ss from a specific work site in the community. The procedure consisted of the use of a self-study manual in conjunction with professional training. Outcome was determined on the basis of changes in blood pressure, scores on the State-Trait Anxiety Inventory, and emotional indicators on human figure drawings. MANOVA indicated a positive effect for both treatment groups. Potential applications of the program are discussed, with recommendations for the use of this procedure as a model for other skill-developing interventions. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating prison inmates with co-occurring disorders: an integrative review of existing programs

The tremendous growth in state and federal correctional populations has focused greater attention on the needs of mentally ill and substance abusing inmates. Although an estimated 3-11% of prison inmates have co-occurring mental health (psychotic and major mood) disorders and substance abuse disorders, few treatment programs are described in the literature and there is little available information regarding effective treatment strategies for this population. The current study provides an integrative review of seven 'dual diagnosis' treatment programs that recently have been developed in state and federal prisons. Many of these have evolved from existing substance abuse treatment programs and approaches. Key program components include an extended assessment period, orientation/motivational activities, psychoeducational groups, cognitive-behavioral interventions such as restructuring of 'criminal thinking errors', self-help groups, medication monitoring, relapse prevention, and transition into institution or community-based aftercare facilities. Many programs use therapeutic community approaches that are modified to provide (a) greater individual counseling and support, (b) less confrontation, (c) smaller staff caseloads, and (d) cross-training of staff. Research is underway in three of the seven sites to examine the effectiveness of these new programs.     

Secondary prevention with college drinkers: Evaluation of an alcohol skills training program.

This study evaluated secondary prevention approaches for young adults (N?=?36, mean age 23 yrs) at risk for alcohol problems. Ss were randomly assigned to cognitive-behavioral alcohol skills training, a didactic alcohol information program, or assessment only. The skills program included training in blood alcohol level estimation, limit setting, and relapse prevention skills. All Ss maintained daily drinking records during the 8-wk intervention and for 1 wk at each follow-up. Repeated measures multivariate analysis of variance (MANOVA) found a significant reduction over 1-yr follow-up in self-reported alcohol consumption for the total sample. For all drinking measures, the directional findings consistently favored skills training. Despite overall reductions, most Ss continued to report occasional heavy drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic taper with or without self-help treatment of insomnia: A randomized clinical trial.

This study aimed to assess the efficacy of a minimal intervention focusing on hypnotic discontinuation and cognitive-behavioral treatment (CBT) for insomnia. Fifty-three adult chronic users of hypnotics were randomly assigned to an 8-week hypnotic taper program, used alone or combined with a self-help CBT. Weekly hypnotic use decreased in both conditions, from a nearly nightly use at baseline to less than once a week at posttreatment. Nightly dosage (in lorazepam equivalent) decreased from 1.67 mg to 0.12 mg. Participants who received CBT improved their sleep efficiency by 8%, whereas those who did not remained stable. Total wake time decreased by 52 min among CBT participants and increased by 13 min among those receiving the taper schedule alone. Total sleep time remained stable throughout withdrawal in both CBT and taper conditions. The present findings suggest that a systematic withdrawal schedule might be sufficient in helping chronic users stop their hypnotic medication. The addition of a self-help treatment focusing on insomnia, a readily available and cost-effective alternative to individual psychotherapy, produced greater sleep improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of anger management training with mentally retarded adults in group treatment.

Conducted a components analysis of a cognitive-behavioral anger management program with 54 mildly or moderately mentally retarded 17–57 yr olds attending vocational training programs. Self-control training was given in 1 of 4 groups: relaxation training, self-instruction, problem solving, or a combined anger management condition. Dependent measures included self-reports, ratings of videotaped role-plays, and supervisor ratings. Results reveal decreases in aggressive responding over time and no significant between-group differences. The study suggests that anger management training with mentally retarded adults may be effective. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Participant reactions to a cognitive-behavioral guided self-help program for binge eating: developing criteria for program evaluation

This article evaluates the effectiveness of a telephone-based guided self-help program for women who binge eat. We report how key program components (e.g., phone sessions, the self-help book) contribute to the four self-help goals identified in the clinical literature: (1) decrease isolation/increase support; (2) increase knowledge of the problem; (3) broaden coping skills; and (4) improve self-esteem. Using the example of our feasibility study, we illustrate that even minimal interventions create a relational context which can promote entry into and engagement with treatment. We conclude that program evaluation should include not only traditional measures of outcome (e.g., reduction in symptomatology), but utilize outcome measures related to the specific goals of minimal interventions (e.g., changes in help-seeking behavior).     

A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents.

30 moderately depressed high school students were randomly assigned to either cognitive-behavioral treatment, relaxation training, or a wait-list control condition. Treatment Ss met in small groups for 10 50-min sessions over 5 wks in a high school setting. Outcome measures included a modified Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the State-Trait Anxiety Inventory. The cognitive-behavioral and relaxation training groups were superior to the wait-list control group in the reduction of depressive symptoms at both posttest and 5-wk follow-up assessments. There was no significant difference between active treatments in their effectiveness for reducing depression. Ss in the cognitive-behavioral and relaxation training conditions went from moderate levels of depression at pretest to nondepressed levels at posttest, and they maintained these levels at follow-up. Improvements in anxiety and academic self-concept were also demonstrated by the active treatments. Findings demonstrate that these short-term group-administered therapies are effective in significantly decreasing depression in adolescents. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of a multicomponent maintenance program on long-term weight loss.

Following a standard regimen of behavioral weight loss treatment, 43 21–60 yr old moderately obese clients received either 6 booster sessions or 6 sessions of training in the use of a maintenance program consisting of self-help group meetings and client–therapist contacts by mail and telephone. Results of 15- and 21-mo follow-up assessments revealed that the multicomponent program significantly enhanced the maintenance of weight loss. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-help interventions for smoking cessation.

Self-help interventions for smoking cessation are an important bridge between the clinical and public health approaches to smoking cessation. The current literature on self-help interventions is encouraging but incomplete. Although their quit rates are lower than those of more intensive programs, self-help interventions could have a large public health impact because of their potential for widespread distribution. Studies comparing self-help to more intensive treatment suggest that long-term cessation rates for self-help programs are potentially as high as rates for face-to-face interventions, with lower quit rates for self-help programs that are likely due to differences in program adherence. Tailored materials and personalized adjuncts (e.g., written feedback or telephone counseling) that promote program adherence may increase cessation rates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral therapy for patients with panic disorder

OBJECTIVE: The primary disadvantage of high-potency benzodiazepine treatment for panic disorder is the difficulty of discontinuing the treatment. During treatment discontinuation, new symptoms may emerge and anxiety may return, preventing many patients from successfully discontinuing their treatment. In this controlled, randomized trial the authors investigated the efficacy of a cognitive-behavioral program for patients with panic disorder who were attempting to discontinue treatment with high-potency benzodiazepines. METHOD: Outpatients treated for panic disorder with alprazolam or clonazepam for a minimum of 6 months and expressing a desire to stop taking the medication (N = 33) were randomly assigned to one of two taper conditions: a slow taper condition alone or a slow taper condition in conjunction with 10 weeks of group cognitive-behavioral therapy. RESULTS: The rate of successful discontinuation of benzodiazepine treatment was significantly higher for the patients receiving the cognitive-behavioral program (13 of 17; 76%) than for the patients receiving the slow taper program alone (four of 16; 25%). There was no difference in the likelihood of discontinuation success between the patients treated with alprazolam and those who received clonazepam. At the 3-month follow-up evaluation, 77% of the patients in the cognitive-behavioral program who successfully discontinued benzodiazepine treatment remained benzodiazepine free. CONCLUSIONS: These findings support the efficacy of cognitive-behavioral interventions in aiding benzodiazepine discontinuation for patients with panic disorder.     

Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: A structural equation model.

Demonstrated that therapeutic empathy has a moderate-to-large causal effect on recovery from depression in a group of 185 patients (aged 18–75 yrs) treated with cognitive-behavioral therapy (CBT). The authors simultaneously estimated the reciprocal effects of depression severity on therapeutic empathy and found that this effect was quite small. In addition, homework compliance had a separate effect on clinical recovery, over and above the effect of therapeutic empathy. The patients of novice therapists improved significantly less than did the patients of more experienced therapists, when controlling for therapeutic empathy and homework compliance. Ss who terminated therapy prematurely were less likely to complete the self-help assignments between sessions, rated their therapists as significantly less empathic, and improved significantly less. Ss with borderline personality disorder improved significantly less, but they rated their therapists as just as empathic and caring as other patients. The significance of these findings for psychotherapy research, treatment, and clinical training is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral self-control therapy for children: A components analysis.

27 non-self-controlled 8–12 yr olds (as measured by the Self-Control Rating Scale) were randomly assigned to a cognitive-behavioral treatment, a behavioral treatment, or an attention-control condition. Ss were administered the Peabody Picture Vocabulary Test, Matching Familiar Figures Test, Piers-Harris Children's Self-Concept Scale, and Wide Range Achievement Test. All Ss received 12 sessions of individual therapist contact focusing on psychoeducational, play, and interpersonal tasks and situations, with the cognitive-behavioral treatment including self-instructional training via modeling and behavioral contingencies and the behavioral treatment involving modeling and contingencies. The cognitive-behavioral intervention improved teachers' blind ratings of self-control, and both the cognitive-behavioral and behavioral treatments improved teachers' blind ratings of hyperactivity. Several performance measures (cognitive style, academic achievement) showed improvements for the cognitive-behavioral and behavioral conditions, whereas only the cognitive-behavioral treatment improved children's self-concept. Normative comparisons and 10-wk follow-up provided additional support for the efficacy of the cognitive-behavioral treatment; 1-yr follow-up did not show significant differences across conditions. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of stress-inoculation training in coping with multiple sclerosis.

Forty multiple sclerosis (MS) patients were randomly assigned to one of two treatment conditions: stress inoculation training (SIT) or current available care (CAC). The SIT treatment included cognitive-behavioral psychotherapy and progressive deep-muscle relaxation training adapted for MS patients. The CAC treatment provided the usual clinic services, and the CAC group was told the SIT treatment would be available in 5 weeks. At posttest, it was found that the SIT group was significantly less depressed, anxious, and distressed than the CAC group and that they were utilizing more problem-focused coping strategies than CAC control subjects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)