Long-term effects of behavior therapy: A 12-month follow-up.

19 female undergraduates who underwent various behavioral treatments designed to reduce a specific fear were paid to return for follow-up 1 yr. later. In general, treated Ss' rat fears were less intense 1 yr. after treatment than they had been prior to treatment, with those treated by systematic desensitization slightly less fearful than those treated with "rational therapy." Subsequently, the desensitized Ss eliminated a snake fear by themselves, but the effects of this self-administered desensitization were not maintained. Additionally, 6 children treated by operant conditioning techniques for various problems were reevaluated 1 yr. later. All behavior change was maintained, but only those who had graduated to social reinforcement showed additional improvement. No evidence for symptom substitution was obtained from either group of Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relaxation versus cognitive therapies for dental fear--A psychophysiological approach.

By separating 127 adult dental-phobic patients according to fear etiology and psychophysiologic response style, the authors investigated the outcome of 2 dental fear treatments. Before and after either relaxation or cognitively oriented treatment, subjects were exposed to neutral and fear-relevant video sequences while the subjects' forehead muscle tension, heart rate, and skin conductance were recorded. Pre- to postintervention differences in self-reported dental fear, general fear, and trait anxiety were analyzed together with psychophysiological data. Both treatments resulted in a significant reduction of dental fear. Despite significant interaction effects of Treatment Modality × Psychophysiological Response Style, it could not be concluded that patients with different fear etiologies or response styles benefit differentially from the 2 treatments given. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of reciprocal inhibition, psychotherapy, and waiting list control for phobic children.

Randomly assigned 67 phobic 6-15 yr. olds to a 2 * 3 factorial, repeated-measures, covariate design which included 2 male therapists and 3 time-limited treatments: reciprocal inhibition, psychotherapy, and waiting list control. Following 24 sessions or 3-mo wait and at 6-wk follow-up, Ss were reassessed by an independent evaluator and by parents. Results indicate a significant effect due to time and S's age. Clinical evaluation, using initial scores as the covariate, showed no effects of treatment or therapist. Parents reported treatment effects for both target fear and general fear behavior. Therapies were equally efficient, and all treatment effects were achieved with Ss aged 6-10. (48 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minimal therapist-assisted cognitive–behavioral therapy interventions in stepped care for childhood anxiety.

New effective, efficient, and accessible service delivery methods for cognitive–behavioral therapies for pediatric anxiety disorders are needed. Many anxious children do not receive needed treatment because of barriers such as limited availability of trained practitioners, costs of treatment, and time. A cognitive–behavioral therapy (CBT) stepped care approach that “steps up” care as needed from less intensive therapies with minimal therapist assistance to therapist-directed treatment may address barriers and provide more accessibility to treatment. A stepped care approach does not necessarily mean that traditional weekly face-to-face therapy sessions will not be needed. However, different service delivery methods that begin with CBT minimal therapist-assisted interventions may be a first line of treatment because not all children may need the full treatment package. This article provides an overview of the current research on CBT minimal therapist-assisted interventions (i.e., modified CBT protocols, computer-based therapy, bibliotherapy, telephone-based therapy, group treatment, and pharmacology) and information on how these first-line treatments may be incorporated into a stepped care model. Minimal therapist-assisted interventions within a stepped care model are in the early stages of development, although there is evidence that these types of treatment may be a viable first step to treating pediatric anxiety disorders. More research on minimal therapist-assisted interventions within stepped care models is needed, and challenges associated with disseminating and implementing stepped care need to be addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Covert and overt rehearsal and homework practice in developing assertiveness.

Evaluated the effects of overt rehearsal and homework practice on covert modeling treatment of social skills. 79 18–73 yr old nonassertive clients received 1 of 4 variations of covert modeling that resulted from a 2?×?2 combination of overt rehearsal and homework practice. Ss who received overt rehearsal engaged in overt enactments (role playing) within the treatment sessions; Ss who received homework practice engaged in extra treatment activities to develop their social skills. A delayed-treatment control group was also included to serve as a no-treatment condition before Ss were randomly assigned to 1 of the 4 treatments. Findings indicate that treatments led to significant improvements on self-report inventories, global ratings, and behavioral measures of assertiveness (the Conflict Resolution Inventory and the Wolpe-Lazarus Assertiveness Questionnaire). Ss who engaged in homework practice and/or overt rehearsal of assertive behavior within the treatment sessions made consistently greater improvements at posttreatment and at an 8-mo follow-up than Ss who did not receive the procedures. Treatment effects extended to novel assessment situations and brought Ss to the level of 45 16–41 yr olds who regarded themselves as adept in social situations. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancy, false galvanic skin response feedback, and systematic desensitization in the modification of phobic behavior.

Compared systematic desensitization and 2 pseudotherapy manipulations with and without false galvanic skin response feedback after every session suggesting improvement in the modification of intense snake and spider fear. Ss were 36 spider- and snake-phobic 18-59 yr old women. Results indicate no consistent differences between the 3 treatment groups, although all treatments were significantly more effective than no treatment in modifying physiological, behavioral, and self-report measures of fear. A 4-mo follow-up showed stability in fear reduction on self-report measures for the 3 treatment groups. Overall results contradict a traditional conditioning explanation of systematic desensitization. An alternate explanation for the operation of systematic desensitization emphasizing the motivational as opposed to conditioning aspects of the procedure is discussed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short-term effects of telephone therapy for breast cancer patients.

The authors report the short-term effects of a clinical trial testing 2 telephone therapies for breast cancer patients. Women (N = 222) with breast cancer were recruited and randomly assigned to cancer education, emotional expression, or standard care. Oncology nurses conducted 6 individual 30-min-therapy phone sessions. Women in the cancer education condition reported greater perceived control than women in the standard care condition. No treatment effects were obtained for mood or quality of life. These are the 1st data from a large-scale study testing telephone therapy, and they suggest that such therapies may be ineffective. Explanations for the results include therapy type and delivery, participant characteristics, short- versus long-term results, therapy content, and whether therapy is necessary for breast cancer patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of film modeling on the reduction of anxiety-related behaviors in individuals varying in level of previous experience in the stress situation.

Evaluated the influence of film preparation on 80 4–11 yr old children undergoing 3 dental sessions (prophylaxis, examination, and restorative treatment) with respect to (a) peer modeling vs demonstration of procedures and (b) amount of information. It was found that, by evaluating self-report (Children's Fear Survey Schedule), and behavioral (Behavior Profile Rating Scale), and visceral-arousal indices in a factorial design, Ss exposed to a peer-model videotape presentation immediately preceding their own restorative treatment exhibited fewer disruptive behaviors and reported less apprehension than those watching a videotaped demonstration without a peer model. The modeling film elicited less heart rate activity in the Ss than the demonstration. 4–6 yr old Ss had lower self-reports of fear after viewing a more complete synopsis of what to expect, whereas the 8–21 yr old Ss had the lowest report of fears after viewing the peer model receiving a local anesthetic and brief intraoral examination. Ss with previous treatment experience benefitted most from viewing the peer model undergoing the entire restorative procedure or a demonstration of the administration of local anesthetic in the absence of a peer model. Ss with no prior experience were sensitized by being shown the demonstration. It is concluded that the age and previous experience of the viewer are important factors in determining childrens' fear-related behaviors after exposure to preparatory stimuli. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral treatment of problem drinkers: A comparative outcome study of three controlled drinking therapies.

Evaluated and compared 3 therapies designed to reduce the alcohol consumption of problem drinkers. 29 self-referred and 89 court-referred clients were randomly assigned to 1 of 3 treatment groups: (a) aversive counterconditioning (AC) using self-administered electrical stimulation; (b) behavioral self-control training (BT) including self-monitoring and instruction in functional analysis; or (c) a controlled drinking composite (CD) including blood alcohol awareness training, discriminated aversive counterconditioning, self-monitoring, and rate-control training. Prior to treatment, all Ss completed the MMPI, Michigan Alcoholism Screening Test, Rotter's Internal-External Locus of Control Scale, and Profile of Mood States. All therapies were conducted by trained paraprofessionals and consisted of 10 weekly sessions. Results show that all 3 therapies produced significant reduction in weekly alcohol consumption and peak blood alcohol concentration. These gains were largely maintained over 1 yr of follow-up. No significant differences among treatments were found, although AC was initially least effective. CD proved least cost effective, requiring 4 times more therapist contact than either AC or BT. A self-control manual was helpful in maintaining controlled drinking. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative evaluation of therapeutic components associated with behavioral marital treatments.

Investigated the relative effectiveness of 3 therapeutic components common to behavioral marital therapies: procedures designed to change behavior, procedures to change attitudes, and nonspecific therapeutic effects. A hierarchical ordering of these components produced 3 treatment conditions—nonspecific, behavioral, and behavioral–attitudinal. 77 20–72 yr old couples experiencing marital distress were randomly assigned to 1 of the 3 treatment conditions and 1 of 5 paraprofessional counselors. After 4 therapy sessions, the groups were compared on measures of self-reported satisfaction (Locke-Wallace Marital Adjustment Test, Areas of Change Questionnaire and Adjective Check List), daily reported pleasing (or displeasing) relationship events (Spouse Observation Checklist), and observations of communication skillfulness (Marital Interaction Coding System). All groups showed significant decreases in negative relationship behaviors. The behavioral–attitudinal group, compared to the other groups, showed significantly greater improvement in reported marital satisfaction, pleasing behaviors, and positive communication responses. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety as a predictor of behavioral therapy outcome for cancer chemotherapy patients.

Studied whether baseline anxiety levels are predictive of outcome on treatments designed to reduce the negative affect and conditioned nausea associated with cancer chemotherapy. 72 18–79 yr old patients classified as having low, moderate, or high anxiety received progressive muscle relaxation training, electromyograph (EMGH) biofeedback, and/or skin temperature biofeedback. Physiological, multiple affect adjective checklist, and postchemotherapy ratings were obtained during baseline, training, and follow-up sessions. Compared with moderate- and high-anxiety Ss, low-anxiety Ss reported less anxiety and depression before behavioral training but nonetheless exhibited significantly greater reductions in anxiety, depression, and diastolic blood pressure as a result of training. Baseline anxiety levels were not related to reduced nausea. Overall, these data suggest that cancer patients who have higher baseline levels of anxiety and who are perhaps most in need of an effective behavioral treatment may be the least likely to benefit from behavioral treatments aimed at reducing the distress associated with chemotherapy. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Carboxyhemoglobin levels in neonatal immune hemolytic jaundice treated with intravenous gammaglobulin

Prior to 1940 the population of Sweden was one of the most homogeneous in Europe, with only 0.5% foreign born. Fifty years later, in 1990, the proportion of immigrants was around 15%. In order to describe and analyze consumption of dental care in different refugee groups in Sweden, data registered by the Department of Immigration and the National Social Insurance Board, on a random sample of 2489 refugees arriving in Sweden 1975-85, were merged. Information on nationality, date of arrival in Sweden, date of granting of permanent resident status and statistics on consumption of dental care were retrieved. During the period studied a total of 50,521 refugees arrived in Sweden. The average interval between arrival in Sweden and the first dental visit was 4.5 yr (95% < 1: 4.2-4.7). The total treatment time during the first course of treatment was 165.5 min (95% < 1: 148.7-182.3). Consumption of dental care did not decrease with an increased number of treatments. Only 38% of the refugees had visited a dentist at all in Sweden. With increasing number of years in Sweden the number of courses of dental treatment increased, but 41% of the refugees who had visited the dentist in Sweden had done so only once. This study shows a low utilization of dental services among refugees in Sweden in general. Refugees with dental visits in Sweden, in particular, had a high dental consumption.     

Changes in caffeine states enhance return of fear in spider phobia.

Treatment of phobias is sometimes followed by a return of fear. Animal and human research has shown that changes in external and internal contexts between the time of treatment and follow-up tests often enhance return of fear. The present study examined whether shifts in caffeine (C) state would enhance return of fear. Participants who were highly afraid of spiders (n=43) were treated in 1-session exposure-based therapy and tested for follow-up 1 week later. Participants were randomly assigned to 1 of 4 groups and received either placebo (P) or C at treatment and follow-up sessions: CC, PP, CP, and PC. Results demonstrated state-dependent learning. Participants experiencing incongruent drug states during treatment and follow-up (CP and PC) exhibited greater return of fear than those experiencing congruent drug states (CC and PP). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior therapy for obesity: A comparative investigation of long-term efficacy.

Both individual and group behavior therapies were compared to a stringent social pressure program in the treatment of 72 obese females (mean age, 41.5 yrs) with a long-standing history of obesity (mean, 15.9 yrs) and inability to lose weight or maintain a weight loss. Following an 8-wk treatment phase, half of each treatment condition received 4 additional booster sessions and the remaining half simply reported for regularly scheduled follow-up weigh-ins at 3, 6, 9, and 12 mo, respectively. Both behavioral treatments were significantly superior to the social-pressure therapy at posttreatment. However, whereas the 2 group treatments resulted in successful maintenance of treatment-produced weight reduction, Ss treated with individual behavior therapy showed substantial relapse at long-term follow-up. It is hypothesized that initial treatment success and subsequent maintenance of weight loss are governed by partially different processes. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How effective and acceptable is a self-treatment manual with concomitant brief therapy in bulimia nervosa

We compared 8 fortnightly sessions plus a self-care manual (guided self change, GSC) with 16 weekly individual sessions of cognitive behaviour therapy (CBT). There were 31 sufferers of DSM-III-R-bulimia nervosa (BN) in each group. Both treatments resulted in significant improvements regarding self and interviewer based measures of bulimia nervosa as well as depression, self-esteem, quality of life and knowledge about nutrition, weight and shape. There were no significant differences between therapies regarding drop-out rate, compliance with follow-up, and the number of patients receiving additional treatment. At none of the assessments was there a significant difference between GSC and CBT regarding severity of BN, Beck Depression Inventory-score, self-esteem, and quality of life. A significantly higher percentage of CBT-patients were abstinent from bingeing for at least one week at the end of treatment. Three months later, the GSC-group had caught up in this respect and knew more about nutition, weight and shape. Only the sum-scores on a BN self-rating scale were worse for GSC than CBT at the end of therapy and at follow-up. There were no significant differences between the two groups in general treatment satisfaction and judgement about the usefulness of the therapies. Thus, guided self change with a selfcare manual can save therapist time without impinging significantly on treatment satisfaction and effectiveness.     

Pulmonary metastases in children and adolescents with well-differentiated thyroid cancer

In this study, 27 patients less than 18 yr old with pulmonary metastases from well-differentiated thyroid carcinoma were evaluated to determine their response to (131)I therapy. METHODS: Of 121 children and adolescents treated with (131)I between 1963 and 1996, 27 patients had pulmonary metastases associated with nodal disease. Treatment response from (131)I was measured by three parameters: chest radiograph, scintigraphic images and serum thyroglobulin levels. Total activity of (131)I administered ranged from 4.6 GBq (125 mCi) to 38.7 GBq (1.05 Ci). Four patients were given one treatment, 8 were given two treatments, 4 were given three treatments and 11 were given more than three treatments. Radiation doses to the lungs were estimated in 14 patients using the MIRD methodology. The minimum duration of follow-up was 6 mo. RESULTS: At the time of initial presentation, diagnostic (131)I studies revealed bilateral radioiodine uptake in the lungs in 19 (70.4%) patients, whereas 12 (44.4%) patients had abnormal chest radiographs. One patient was lost to follow-up and was excluded from the study. Of the 26 patients studied, complete ablation of pulmonary metastases was observed in 8 (30.8%), partial ablation in 17 (65.4%) and there was no response to treatment in 1 (3.8%). Dosimetric parameters such as radioiodine uptake as a percentage of therapeutic activity, effective half-life and radiation dose delivered to the lungs were evaluated with each therapy. There was a progressive decline in each of these parameters with successive therapies. No correlation was observed between the radiation dose delivered and the response of pulmonary metastases to therapy. The number of therapies and amount of radioiodine administered had no influence on the ablation response. Of the 26 patients, 13 had a follow-up duration of less than 5 yr, 7 had 5-10 yr and 6 had more than 10 yr. One patient developed new metastases after 7 yr of diagnosis and treatment. One patient died of the disease after 4 yr. All surviving patients were asymptomatic and leading normal lives. CONCLUSION: Complete response of pulmonary metastases after (131)I therapy is difficult to achieve. A partial response with reduction of metastatic disease is possible and, in general, the patients had a good quality of life with no further disease progression and a low mortality rate.     

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)     

Attrition in worksite weight-loss interventions: The effects of an incentive procedure.

48 20–69 yr old hospital employees were randomly assigned to either an incentive or control group and completed a 14-session behavioral weight-loss program. Results indicate that the incentive procedure significantly decreased attrition. More Ss in the incentive condition completed treatment (60 vs 20%) and attended significantly more of the sessions than did Ss in the control group. Results are discussed with reference to cost effectiveness of behavioral worksite weight-loss interventions. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of relationship dysfunction: An empirical evaluation of group and conjoint behavioral marital therapy.

Fifteen distressed couples were randomly assigned to group, conjoint, or waiting list conditions. A behavioral communication treatment package was administered over eight sessions and was evaluated via multidimensional assessments. Results revealed that behavioral communication therapy was a highly effective modality for the resolution of marital dysfunction. Both group and conjoint treatments were found to be superior to the waiting list condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)