Acceptability of alternative treatments for children: Evaluations by inpatient children, parents, and staff.

32 child psychiatric inpatients (7–13 yrs), 32 parents, and 32 staff evaluated the acceptability of alternative treatments for children. Clinical cases of children who displayed severe behavioral problems at home and at school were described along with 4 different treatments. The treatments included positive reinforcement of incompatible behavior, positive practice, medication, and time out from reinforcement. Results show that reinforcement of incompatible behavior was more acceptable than other treatments that followed, in order, positive practice, medication, and time out from reinforcement. Positive practice and medication were no different from each other in acceptability but significantly more acceptable than time out. Although children rated treatments as less acceptable than did parents, the relative standing of different treatments was identical for children, parents, and staff. Results indicate that disturbed children and their parents can readily distinguish the acceptability of alternative treatments. The implications and relevance of acceptability as an important dimension for treatment selection and evaluation are highlighted. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer-assisted cognitive behavioral therapy for child anxiety: Results of a randomized clinical trial.

Objective: This study examined the feasibility, acceptability, and effects of Camp Cope-A-Lot (CCAL), a computer-assisted cognitive behavioral therapy (CBT) for anxiety in youth. Method: Children (49; 33 males) ages 7–13 (M = 10.1 ± 1.6; 83.7% Caucasian, 14.2% African American, 2% Hispanic) with a principal anxiety disorder were randomly assigned to (a) CCAL, (b) individual CBT (ICBT), or (c) a computer-assisted education, support, and attention (CESA) condition. All therapists were from the community (school or counseling psychologists, clinical psychologist) or were PsyD or PhD trainees with no experience or training in CBT for child anxiety. Independent diagnostic interviews and self-report measures were completed at pre- and posttreatment and 3-month follow-up. Results: At posttreatment, ICBT or CCAL children showed significantly better gains than CESA children; 70%, 81%, and 19%, respectively, no longer met criteria for their principal anxiety diagnosis. Gains were maintained at follow-up, with no significant differences between ICBT and CCAL. Parents and children rated all treatments acceptable, with CCAL and ICBT children rating higher satisfaction than CESA children. Conclusions: Findings support the feasibility, acceptability and beneficial effects of CCAL for anxious youth. Discussion considers the potential of computer-assisted treatments in the dissemination of empirically supported treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investigating the acceptability of behavioral interventions in applied conjoint behavioral consultation: Moving from analog conditions to naturalistic settings.

Whereas there exists a vast literature investigating consumer satisfaction ratings of various behavioral interventions, the majority of these studies have been limited to analogue conditions, which may compromise utility and generalization. Additionally, most research has failed to explore multiple-source, multiple-setting data in the investigation of treatment acceptability. This study investigated parent, teacher, and child treatment acceptability ratings derived from field-based conjoint behavioral consultation cases. Data indicate that overall, 67 parents (aged 23-54 yrs), 67 teachers (aged 22-57 yrs), and 67 children (aged 5-15 yrs) rated conjoint behavioral consultation-based behavioral interventions as very to highly acceptable. For parents, interventions with a reductive component were rated as more acceptable than interventions using both positive and negative components; no significant differences were found among teacher and child group ratings. For teachers, there was a positive relationship between (a) intervention complexity and treatment acceptability ratings and (b) problem severity ratings and treatment acceptability ratings... (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Children's involvement in intervention selection: Acceptability of interventions for misbehaving peers.

Examined children's acceptance of a variety of common school-based methods for dealing with misbehaving peers in 2 experiments in which 102 6th-graders served as Ss. Ss were surveyed for their suggestions for treating peers' classroom misbehaviors and their acceptance of different teacher-implemented interventions for modifying 2 behavior problems. The main finding was that Ss differentially rated the acceptability of 12 common interventions. From among 3 categories of interventions, Ss rated private teacher–student interactions, group reinforcement, and negative sanctions for the misbehaving children as most acceptable. Public reprimand and negative group contingencies were rated as unacceptable interventions. Behavior problem severity did not have a significant impact on Ss' ratings of intervention acceptability except for traditional interventions. Methodological, theoretical, and developmental considerations in treatment acceptability are discussed. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional and paraprofessional group treatments for depression: A comparison of cognitive-behavioral and mutual support interventions.

The relative efficacy of professional and paraprofessional therapists in providing group cognitive-behavioral therapy (CBT) and mutual support group therapy (MSG) was examined. Depressed outpatients (N?=?98) were randomly assigned to CBT or MSG led by either 2 professional or 2 paraprofessional therapists. Results suggest that nonprofessionals were as effective as professionals in reducing depressive symptoms and that clients in the CBT and MSG conditions improved equally. Clinically significant improvement was demonstrated for both conditions. However, following treatment, more patients in the professionally led CBT groups were classified as nondepressed and alleviated than in the paraprofessionally led CBT groups. Additionally, therapist adherence to manual-based treatments was associated with greater improvement in clinician-rated depressive symptoms in both conditions and skills in cognitive restructuring were associated with greater improvement among clients in CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A component analysis of behavioral marital therapy: The relative effectiveness of behavior exchange and communication/problem-solving training.

Compared the relative effectiveness of behavioral marital therapy (BMT) with 2 of its major components, behavior exchange (BE) and communication/problem-solving training (CPT), each presented in isolation. 33 married couples seeking therapy were randomly assigned to 1 of these 3 treatments or to a waiting-list control group. Three doctoral candidates and 1 masters-level counselor served as therapists. All treatments involved 12–26 therapy sessions. The effects of therapy were evaluated using measures of global marital satisfaction (Dyadic Adjustment Scale), presenting problem checklists, and spouse reports of behavior at home. Treated couples showed significant improvement, relative to untreated couples. Complete BMT was no more effective than either BE or CPT at posttest. BE led to significantly greater increases in positive behavior than CPT. At a 6-mo follow-up, there was a tendency for BE couples to reverse their progress, whereas couples receiving CPT—either alone or in conjunction with BE—generally maintained their treatment gains or continued to improve. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teachers’ perceptions of Kinder Training: Acceptability, integrity, and effectiveness.

Kinder Training is a play-based professional development training model designed for early elementary school teachers (kindergarten through Grade 2). The goals of Kinder Training include strengthening the teacher-child relationship, developing students’ adaptive skills, increasing academic engagement, and enhancing teachers’ classroom management skills (White et al., 1997). There has been limited research on the effectiveness of Kinder Training, but studies that have been conducted showed promising results. The current study utilized a qualitative approach to examine the acceptability, integrity, and perceived effectiveness of Kinder Training. Findings indicated that the elementary school teachers perceived the Kinder Training model to be acceptable and effective (e.g., improved classroom management skills, improved student behavior, and enhanced teacher-child relationships). In addition, observations were used to document that the intervention was implemented with integrity. Future research may further examine the cross-relationships among acceptability, integrity, and effectiveness of Kinder Training interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of new valproate derivatives on epileptiform discharges induced by pentylenetetrazole or low Mg2+ in rat entorhinal cortex-hippocampus slices

This study examined physician and non-physician prescribed medication use of a growing segment of Brazilian society--the elderly. Personal interviews were conducted with 436 subjects in a stratified random sampling of elderly respondents to the previously completed 1990 Brazilian Old Age Survey (BOAS). The BOAS sample had been stratified according to the socioeconomic status (SES) of three communities within Rio de Janeiro. This study focused on medication use of these subjects as a function of the predisposing, enabling, and need variables which have been found in previous research to predict other types of health services utilization (HSU). The enabling variables of access to care were measured as patient perceived availability, affordability, and acceptability of both medical and pharmacy services. ANOVA results found differences among the different communities in perceived availability and affordability of medical and pharmacy services and acceptability of pharmacy services. Subjects from Santa Cruz, the lowest SES area, consistently reported lesser availability of services, more difficulties with affordability but greater perceived acceptability of pharmacy services than those from the highest SES area. Multivariate regressions modeling both prescribed and non-prescribed medication use for the three areas found that the access-oriented HSU framework was much more effective in explaining the variance in medication use for the lowest SES area (45% and 48% for prescribed and non-prescribed use, respectively) than for the highest SES area where only 16% and 18% of prescribed and non-prescribed medication use was explained.     

The acceptability of organizational consultation with prereferral intervention teams.

Presents 3 studies of the acceptability of an extended organizational consultation project featuring collaborative, qualitative research methods as consultation tools, and a focus on facilitating the development of 1 school district's Prereferral Intervention Teams (PITs). Each study investigated 1 component of the acceptability of the project, including (a) the acceptability of the organizational consultation project, (b) the relationship between changes the PITs adopted to improve their team functioning and the acceptability of these changes, and (c) the acceptability of the adopted changes 1 yr later. Results suggest that the consultation methods were highly acceptable to team members, influenced the teams to alter their goals and practices, and changes were acceptable 1 yr after implementation. Previous models delineating the relationship between treatment acceptability and treatment efficacy were supported. Results also suggest that acceptability is a complex construct that changes over time and can be modified through the consultation process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic intervention with terminally ill children: A review.

Reviews the literature of psychological treatment strategies used with terminally ill children to provide a framework for psychological intervention in a pediatric setting. Topics discussed include the responsibilities of the professional role, the emotional and developmental impacts of long-term hospitalization, and therapeutic goals—which involve normalization, developing mastery and self-esteem, enhancement of social support, and the provision of information about symptoms, complications, and treatments. Interventions include individual, group, and play therapies, and consulting with other hospital personnel. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investigation of the effectiveness and social validity of the Triple P Positive Parenting Program in Japanese society.

A pilot trial provided some evidence that the Triple P Positive Parenting Program is effective with and acceptable to a Japanese population in Australia (Matsumoto, Sofronoff, & Sanders, 2007). This effectiveness study aimed to address theoretical and practical concerns related to the parent training program in community settings in Japan. The research used community resources within an ecological framework. Fifty-four Japanese families living in a Tokyo metropolitan area were randomly assigned to either a treatment or a wait-list control group. Program effects and acceptability were examined and then compared with the outcomes from the trial with Japanese parents living in Australia. The results showed significant program effects and high levels of acceptability of the program and core parenting skills, which was consistent with the pilot trial. The findings provided support for the effectiveness and sociocultural validation of Triple P in Japanese society. Intervention effects and program acceptability as well as limitations and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in the hemostatic system indices of patients with chronic kidney failure under the influence of enterosorption and plasmapheresis

A total of 83 patients with chronic renal failure (CRF) at azotemia stage (S. I. Riabov's classification) complicating pyelonephritis were treated: 19 patients received symptomatic standard therapy (group 1), 29 patients received combined therapy with enterosorption (group 2), 35 patients received combined treatment with plasmapheresis (group 3). The efficacy of the treatments was controlled by platelet tests (platelet, coagulative hemostasis, fibrinolytic plasma activity) and parameters of kallikrein-kinin system. Treatment results in group 1 are characterized as poor: insignificant improvement of uremia, DIC syndrome against unchanged inhibition of kallikrein-kinin system. Group 2 patients achieved moderate response: uremia reduced to normal azotemia values, DIC syndrome and inhibition of kallikrein-kinin system reduced. Patients of group 3 got disappeared DIC syndrome and normal kallikrein-kinin system against high azotemia.     

The effects of sleep on circulating catecholamines and aqueous flow in human subjects

OBJECTIVE: To compare the safety, efficacy and acceptability of a continuous low dose oestradiol releasing vaginal ring with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy. DESIGN: An open, parallel, comparative multicentre trial. SETTING: Sydney and Melbourne, Australia. PARTICIPANTS AND INTERVENTIONS: One hundred and ninety-four postmenopausal women with symptoms and signs of urogenital atrophy were randomised on a 2:1 basis to 12 weeks of treatment with an oestrogen vaginal ring versus an oestrogen cream. MAIN OUTCOME MEASURES AND RESULTS: Equivalence (95% CI) was demonstrated between the two treatments for relief of vaginal dryness and dyspareunia, resolution of atrophic signs, improvement in vaginal mucosal maturation indices and reduction in vaginal pH. No significant difference was demonstrated in endometrial response to a progestogen challenge test and equivalence was demonstrated in the incidence of intercurrent bleeding episodes. The vaginal ring was significantly more acceptable than the cream P < 0.0001), and was preferred to the cream (P < 0.001). CONCLUSION: With equivalent efficacy and safety and superior acceptability to vaginal cream, the low dose oestradiol vaginal ring is an advance in vaginal delivery systems for the treatment of urogenital atrophy.     

Cognitive-behavioral and pharmacologic interventions for hyperactive boys: Comparative and combined effects.

Assessed the effects of 2 interventions—reinforcement and reinforced self-evaluation—on the positive social behavior of 24 8–13 yr old hyperactive males to test the hypothesis that reinforced self-evaluation would produce greater positive social behavior in Ss. Comparisons between Ss receiving methylphenidate (5–40 mg/day) and Ss receiving placebo were also conducted to clarify the effects of stimulant medication on Ss' social behavior. The primary outcome measures were direct observations of appropriate and negative social interactions. Results indicate that both methylphenidate and reinforced self-evaluation were superior to the contrast treatments. When the effects of the 4 treatment combinations were rank ordered, medication plus cognitive-behavioral self-evaluation proved optimal; placebo plus reinforcement alone was significantly worse than all other conditions. Medication enhanced the accuracy of Ss' self-evaluation. Findings are discussed in the context of the need for intervention with the social and interpersonal difficulties of hyperactive children. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapy with nasal CPAP (continuous positive airway pressure) in patients with obstructive sleep apnea syndrome (OSAS). I: Long-term acceptance of nasal CPAP

BACKGROUND: Nocturnal ventilation with nCPAP has been established as the safest and most efficient nonsurgical treatment for OSAS. Long-term results, however, are determined by the patients' compliance with therapy. The aim of this study was the objective measurement of long-term acceptability of nCPAP therapy in all patients receiving this treatment in our sleep laboratory between January 1990 and March 1995. METHODS: We prospectively investigated 41 patients (36 male, 5 female) with moderate to severe OSAS who received nCPAP therapy. Mean time of follow-up was 20.6 months, ranging from 1.2 to 53.5 months. Therapy was indicated when OSAS was confirmed by cardiorespiratory polygraphy and either (1) the patient complained of daytime sleepiness or (2) the patient possessed an apnea-hypopnea index greater than 30/h or when the mean oxygen desaturation was below 80% regardless of the presenting symptoms. The compliance with treatment was defined as a mean rate of use of over 5 hours per night calculated from the time counter on the nCPAP machine. RESULTS: 33 patients (88.5%) have continued using nCPAP until the present time but only 24 patients (59%) met our criteria for long-term acceptance and this group was identified as responders. We found no significant differences in age, body mass index, apnea-hypopnea index, and nCPAP-pressure between responders and non-responders. CONCLUSION: Although nCPAP is the safest treatment for OSAS, there is still a large group of patients with moderate to severe OSAS who are not efficiently treated with nCPAP because of the low long-term acceptability of this therapy. With respect to this group of patients, surgical approaches have to be considered as an alternative therapy.     

Meta-analysis of psychological assessment as a therapeutic intervention.

This study entails the use of meta-analytic techniques to calculate and analyze 18 independent and 52 nonindependent effect sizes across 17 published studies of psychological assessment as a therapeutic intervention. In this sample of studies, which involves 1,496 participants, a significant overall Cohen's d effect size of 0.423 (95% CI [0.321, 0.525]) was found, whereby 66% of treatment group means fell above the control and comparison group means. When categorical variables were taken into account, significant treatment group effects were found for therapy process variables (d = 1.117, [0.679, 1.555]), therapy outcomes (d = 0.367, [0.256, 0.478]), and combined process/outcome variables (d = 0.547, [0.193, 0.901]). These findings appear to be robust on the basis of fail-safe N calculations. Taken together, they suggest that psychological assessment procedures—when combined with personalized, collaborative, and highly involving test feedback—have positive, clinically meaningful effects on treatment, especially regarding treatment processes. They also have important implications for assessment practice, training, and policy making, as well as future research, which are discussed in the conclusion of the article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)