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Individuals with posttraumatic stress disorder (PTSD) related to a serious motor vehicle accident were randomly assigned to either group cognitive behavioral treatment(GCBT) or a minimum contact comparison group (MCC).Compared to the MCC participants (n=16), individuals who completed GCBT (n=17) showed significant reductions in PTSD symptoms, whether assessed using clinical interview or a self-report measure. Among treatment completers, 88.3% of GCBT participants did not satisfy criteria for PTSD at posttreatment assessment, relative to31.3% of the MCC participants. Examination of anxiety,depression, and pain measures did not show a unique advantage of GCBT. Treatment-related gains were maintained over a 3-month follow-up interval. Patients reported satisfaction with GCBT, and attrition from this treatment was comparable with individually administered CBTs.Results are discussed in light of modifications necessitated by the group treatment format, with suggestions for future study of this group intervention.

We sought to predict posttreatment PTSD symptom scores (Clinician-Administered PTSD Scale scores) among motor vehicle accident (MVA) survivors with PTSD who had received either cognitive behavioral treatment (CBT; n = 30) or supportive psychotherapy (SUPPORT; n = 27) using pretreatment variables. We could account for 43% (CBT) to 70% (SUPPORT) of variance in the measure of PTSD symptoms. The most consistent predictors were pretreatment PTSD symptom scores. Comorbid conditions, especially depression, and degree of initial impairment were also significant predictors.

We have conducted a randomized, controlled trial comparing a combination of cognitive and behavioral treatments (CBT), supportive psychotherapy (SUPPORT), or an assessment-only wait-list (WAITLIST) control. To study psychophysiological reactivity in PTSD we measured heart rate (HR) reactivity to idiosyncratic audiotaped descriptions of the motor vehicle accident (MVA) that the participants had survived, both before and after each of the treatments. Results showed significantly greater reduction in HR reactivity for those receiving CBT (n = 25) than for either those in SUPPORT (n = 26) or WAITLIST (n = 22). The latter two conditions did not differ. There were significant but low-level correlations between changes in CAPS scores and changes in HR reactivity collapsing across all groups.

Thirty-two patients with irritable bowel syndrome were randomly assigned to one of three treatment conditions: cognitive therapy in small groups of 3 to 5 individuals; cognitive therapy in an individual format; or an 8-week symptom-monitoring waitlist control. Treatment consisted of 10 sessions. Pre- to posttreatment evaluations showed significantly greater gastrointestinal symptom reduction on a composite measure for the treated subjects than for the symptom-monitoring condition (p = .01); the group cognitive treatment and individual cognitive treatment conditions did not significantly differ. At posttreatment, 64% of the group cognitive treatment condition and 55% of the individual cognitive treatment condition showed clinically significant improvement (at least a 50% reduction in the composite measure) as compared to 10% of the monitoring group. Treatment gains were maintained for those who responded (12 of 22 treated subjects) to a 3-month follow-up study.

Fifty victims of recent motor vehicle accidents (MVAs) and 40 non-MVA controls participated in a psychophysiological assessment in which heart rate (HR), systolic and diastolic blood pressures, forehead EMG and electrodermal activity were measured during mental arithmetic, idiosyncratic audiotaped descriptions of the victim's own MVA, and a standard videotape of MVAs. The MVA victims were subdivided into 23 with full posttraumatic stress disorder (PTSD), 10 with sub-syndromal PTSD, and 17 without PTSD. HR response to the idiosyncratic audiotape reliably ( p

The effects of a 12-session program combining relaxation training, cognitive therapy, and biofeedback, specifically tailored for an older population, were evaluated, using 14 elderly chronic headache (HA) patients (age range: 61–80) in 7 multiple-baseline-across-subjects design experiments. At the idiographic level, treatment was more effective than HA monitoring in 5 of 7 experiments. At the nomothetic level, tailored treatment was also significantly (p=.05) more effective than HA monitoring in reducing HA activity as measured by daily diary. Patients consumed significantly less HA medication after treatment and were significantly less depressed and less anxious at one-month follow-up.

Chronic tension headache sufferers were randomized in the approximate ratio of 2:2:1 to one of three regimens: (1) progressive muscle relaxation (PMR) training delivered as a largely home-based treatment; (2) PMR plus selected cognitive stress coping techniques, again delivered as a largely home-based treatment; or (3) a headache monitoring, wait-list control condition. All patients monitored headaches daily for at least 4 weeks before and after treatment. In general, the two active treatment groups were significantly improved relative to the wait-list control group on measures of reduction in headache activity and reduction in headache medication, derived from a daily headache diary, and on measures of clinically significant improvement. The two active treatment groups did not differ from each other on any measure. Thus, it appears that the addition of limited cognitive stress-coping techniques to PMR did not add significantly to treatment outcome utilizing the protocol described.

We compared cognitive behavioral treatment with a symptom monitoring control condition for a sample of veterans with (Stages II and III) rheumatoid arthritis. After baseline pain and sleep monitoring, physical therapist and self-report assessment ratings, patients were randomly assigned to active treatment (progressive relaxation training, thermal biofeedback, and cognitive pain management strategies), or symptom monitoring only. Posttreatment comparisons showed that the active therapy group improved, relative to the symptom monitoring controls on their perceptions of pain on the McGill Pain Questionnaire (MPQ), rated themselves as coping better with pain, reduced their pain diary ratings, and reported less difficulty with functional tasks. Treated patients also improved more on range of motion indices. No differences were found on standardized psychological tests or sleep measures. However, after 18 months, follow-up data from half of the sample showed no lasting differences between the treated and control groups.

Ten reports of prospective follow-ups of at least 12 months duration for behavioral treatment of chronic headache are summarized and reviewed. The available data support two tentative conclusions for tension headache: headache relief from cognitive therapy or relaxation training (possibly followed by frontal EMG biofeedback) is maintained for 2 and 4 years, respectively, while the initial headache reduction obtained with frontal EMG biofeedback alone deteriorates progressively (but not back to pretreatment level_ at 2 and 3 years. For migraine headache, there is good maintenance of headache reduction at 12 months. However, for vascular headache (migraine and combined migraine and tension) treated with relaxation and thermal biofeedback, there is tentative support for a persistent, progressive deterioration, year-by-year, to a four-year follow-up point.

Fourteen patients suffering from irritable bowel syndrome (IBS) and who had completed a multicomponent treatment involving thermal biofeedback, progressive muscle relaxation, IBS education, and cognitive therapy were evaluated 2 years posttreatment. Eight of the 14 patients (57%) who completed symptom monitoring diaries met our criteria for clinical improvement, i.e., achieving at least 50% reduction in primary symptom scores. When follow-up symptom means were compared with pretreatment means, significant (one-tailed) reductions were obtained on abdominal pain/tenderness, constipation, diarrhea, nausea, and flatulence; the means on all measures at two-year follow-up were better than those obtained prior to treatment.

Psychophysiological assessment procedures have begun to play an important adjunctive role in the diagnosis of post-traumatic stress disorder (PTSD). The present study sought to examine the ability of Vietnam veterans with and without PTSD to fake the psychophysiological assessment. The study replicated previous findings in demonstrating that PTSD veterans respond to combat stimuli with significantly greater increases in psychophysiology than veterans without the disorder. When subjects were instructed to alter their psychophysiological responses to the combat stimuli, subjects with PTSD were unable to do so. However, subjects without PTSD were able to increase certain psychophysiological responses to appear more like the PTSD veterans. Despite the ability of some non-PTSD veterans to control these responses, PTSD and non-PTSD subjects were still discriminated at a high rate. This study also found relatively good short-term test-retest reliability for heart rate and skin conductance in subjects given no instructions to fake.

The utility of measurement of heart rate (HR) responses to relevant auditory cues(combat sounds) in distinguishing between Vietnam veterans with PTSD and those with combat experience but without PTSD was replicated in a new sample of 59 PTSDs and 12 non-PTSD combat veterans. Although the new sample of PTSDs remained responsive to the relevant stimuli, HR values were consistently about 6 BPM lower than the values observed in the original sample. Psychological measures of anxiety and/or depression failed to discriminate among the PTSD samples between subjects who show HR responses to combat sounds and those who do not respond

The cardiac responses of 91 Vietnam combat veterans, who either met (n=57) or did not meet (n=34) the DSM-III criteria for post-traumatic stress disorder (PTSD), were examined to a neutral stressor of mental arithmetic or to a relevant stressor of progressively louder (40 to 80 db) combat sounds. Examination of individual subject data reveals that one can accurately identify 70.2% of PTSD veterans and 88.2% of combat veterans, with only 9.7% false positives, using a single cutoff score on the highest heart rate response to combat sounds.

In the first of two studies, four individuals, diagnosed by their physician as suffering from irritable bowel syndrome (IBS), were treated in individual A-B designs. The 12-session treatment program included progressive relaxation therapy, thermal biofeedback, educational information, and training in stress-coping strategies. Participants were asked to make daily ratings of the severity of gastrointestinal symptoms throughout the program. As measured by these ratings, treatment was effective in markedly reducing the symptoms in two of the four participants. Phone contacts two years following treatment revealed treatment gains had been maintained. Given these promising results, Study 2 compared, in a randomized trial, the results of the same multi-component treatment program to a symptom-monitoring condition in 19 additional IBS sufferers. Treatment was effective in reducing gastrointestinal symptoms in 6 out of the 10 treated individuals, while individuals in the symptom-monitoring condition showed little change. The symptom-monitoring group was then offered treatment, and more than half of this group improved.

A relatively simple, open-loop feedback system for use in teaching patients with elevated blood pressure to lower their blood pressure is described. It is based on once per minute determinations of blood pressure which are read by the experimenter and then presented to the patient by closed circuit television. The procedure is reliable and trouble free. Four single subject design experiments are described in which the elevated systolic blood pressures of four patients suffering from essential hypertension or borderline hypertension were lowered to the normal range. Decrease in blood pressure ranged from 9 to 55 millimeters of mercury. Control conditions in each experiment indicate that the feedback procedure was responsible for the lowering of blood pressure.

Social skills necessary to function heterosexually (heterosocial skills) include at least three overlapping categories of social behavior: initiating a heterosocial relationship, initiating sexual beahvior, and maintaing the heteroscoial relationship over a period of time. The purpose of this experiment was to pinpoint social behaviors important in initiating a heterosocial relationship in males. Ten white and ten black high school and college males, judged socially attractive by a panel of popular females in their schools, were videotaped interacting with female research assistants. Ten patients with sexually variant behaviors who reported and were judged to be heterosocially inadequate were also videotaped interacting with a female. Behaviors in three categories, form of conversation, affect, and voice, significantly discriminated the adequate from inadequate males. The relationship of these data to general social skills training and the importance of investigating other aspects of heterosocial behavior are discussed.

A battery of psychophysiological responses including forehead EMG, skin temperature, skin resistance level and heart rate, measured under several conditions including baseline, self-relaxation, and self-control, and stresses such as mental arithmetic and cold pressor, was collected on patients with three types of headache prior to any treatment. With this battery we can predict from 31.5 to 70.2% of the variance in posttreatment headache activity level scores for patients treated with relaxation and biofeedback. Moreover, we can correctly classify as successful or unsuccessful, after either relaxation training or biofeedback training, from 72.7 to 89.7% of subsamples based on headache type and treatment regimen.

Two studies, one involving 21 normal volunteers and the other involving 13 sexual deviates, were performed in which subjects' penile and verbal response to various sexual cues were measured. Penile responses were measured by the maximum amplitude of the response to each stimulus and the total response to each stimulus (area under response curve). The two methods of quantifying the penile response were compared in terms of predicting a subject's self-report of sexual arousal, both for individual subjects and for the two populations as a whole. These comparisons revealed that both methods yield strong relationships between penile response and self-report of sexual arousal and no consistent advantage was shown for the maximum amplitude or total response method of measuring penile response. Since the maximum amplitude measure is easier and cheaper to obtain, we recommend its use.

Two studies are presented in which potentially adaptive “free world” behaviors were increased among a group of male prisoners participating in a token economy on a county penal farm. In the first, percentage of time watching television news and comprehension of the content of the news were targeted behaviors which were experimentally analyzed using instruction, noncontingent quizzes, and quizzes on which correct answers earned points in the token economy. The last condition proved to be the most effective over a prolonged period. In the second, attending a remedial education center during evening free time was the targeted response. Manipulation of the token economy, primarily through awarding additional points for attendance, was experimentally analyzed and shown to be effective in increasing this target behavior.

Traditional accounts of headache attribute migraine to an unstable vasomotor system and tension to prolonged contraction of skeletal muscles. Investigations of the psychophysiology of headache testing these assumptions have produced conflicting results, however. Review of investigations conducted since 1970 reveals that certain methodological shortcomings may account, in part, for this confusion. Data are reported for a study which attempted to control these methodological deficiencies. Headache subjects, diagnosed as migraine, tension, or combined migraine and tension, were compared to nonheadache control participants who were matched on the basis of sex, income, marital status, age, and life events. All subjects were exposed to a variety of experimental conditions (rest, self-control, and stress) while physiological recordings were obtained for forehead and forearm EMG, temporal artery blood flow, hand surface temperature, heart rate, and skin resistance level. No main effects for groups were found for any measures, and group by condition interactions revealed no consistent pattern of results. The data do not support the traditional notions of headache.

Seventy-seven hypertensive patients, whose blood pressure [BP] on entry into the study was controlled on a regimen of two drugs (diuretic plus sympatholytic), participated in either progressive muscle relaxation or thermal biofeedback prior to attempting to discontinue the second stage drug. Although a discriminant function, containing 9 predictors, correctly classified 78% of short-term (6 weeks) successes and failures, no variables from standard psychological tests, several biochemical assays (plasma nor-epinephrine), or baseline home BPs entered the final equation. Overall, the value of prediction from the variables studied seems weak.

Reinforcer item selections of two inmate groups (new, inmates incarcerated less than 3 months; old, inmates incarcerated more than 6 months) were determined with a 10-item questionnaire. Using the same questionnaire, four predictor groups (prison administrators, college students, mental health workers with penal experience, and mental health workers without penal experience) were asked to indicate the order in which they thought the prisoners would select the reinforcers. There were marked similarities in the reinforcer choices of new and old prison inmates. Three major clusters evolved from the prisoner selections of the 10 reinforcer items reflecting a preference for (1) early release from prison, (2) contact with the “free world” while incarcerated, and (3) in-prison privileges in the order listed. Of the four predictor groups, prison administrators were the most accurate in predicting the rank order in which prisoners selected the reinforcers. Education and training did not seem to help the mental health workers make more accurate predictions than either the students or prison administrators. Moreover, work experience in a penal setting did not significantly improve the accuracy of prediction of mental health professionals. Implications for mental health workers engaged in consulting to prison behavioral programs are discussed.

The results from the behavioral treatment (relaxation and/or biofeedback) of 250 chronic headache patients are presented along with information on individual predictors of treatment outcome. Relaxation alone leads to improvement in 41% of tension headache patients while a combination of relaxation and thermal biofeedback leads to improvement in 52% of migraine and combined headache patients. Predictor variables which frequently appear include age, Trait Anxiety, and MMPI scales 1 and 3.

This study compared the clinical utility and cost-effectiveness of a standard, therapist-delivered relaxation treatment of tension headache to a comparable procedure administered with minimal therapist contact and based chiefly at home. Both procedures were highly effective and nearly equivalent for reducing headache complaints, as assessed by measures of headache index, intensity, frequency, and of medication consumption. The minimal contact, home-based treatment was shown to be more cost-effective when relating total amount of therapist contact to headache improvement. These findings suggest that the home-based relaxation treatment may constitute a viable, low-cost alternative to the more typical, but expensive, clinic-based procedures in the treatment of tension headache.

Eighty-seven patients whose blood pressures (BPs) were controlled on a regimen of at least two antihypertensive medications were randomly assigned to either thermal biofeedback or progressive relaxation to see if patients could be withdrawn from the second-stage antihypertensive medication while BPs remained under control. Results on this clinical end point significantly favored thermal biofeedback both in the short-term (1-month posttreatment) and in the long-term (1-year posttreatment) with 35% of those patients who were initially assigned to thermal biofeedback and completed treatment remaining off the second-stage medication for over 12 months.

Eleven patients meeting DSM-III criteria for panic disorder and nine meeting the criteria for generalized anxiety disorder were assessed comprehensively and divided into a treatment and a wait list control group. The assessment revealed significant differences between PD and GAD patients, with PD patients showing higher somatic responding on both questionnaire and psychophysiological assessment measures. Treatment consisted of somatically oriented (EMG biofeedback and relaxation) and cognitive treatments. Five GAD and five PD patients were treated, with the remainder assigned to the wait list control group. Compared to controls, treated patients improved on not only clinical ratings of improvement, but also psychophysiological measures, daily self-monitored measures of background anxiety and panic, and questionnaire measures of anxiety. GAD and PD patients responded equally well to treatment; the wait list group did not improve. At follow-up, the treated group continued to improve.

The relative efficacy of several psychological treatments for headache were compared to each other and to the effects of medication placebo using a procedure known as meta-analysis. Results showed that, for migraine headache, temperature biofeedback alone, relaxation training alone, or temperature biofeedback combined with autogenic training were equally effective and significantly superior to medication placebo. For tension headache, the results showed that frontal EMG biofeedback alone, or combined with relaxation training, or relaxation training alone were equally effective and significantly superior to medication placebo or psychological placebo. The latter two do not differ but are significantly superior to continued headache monitoring only.

Several previously reported operant procedures for changing classroom behavior were applied to five “behavior-problem” students in each of two 7th grades. In addition to recording frequency of target behaviors of the subjects in the class in which the operant procedures were applied, concurrent measurement of the same behaviors was made in a second, different class being conducted in the usual manner. For these older children, tangible rewards and punishments were generally effective in improving behavior whereas the efficacy of teacher attentional variables was specific to the teacher. Although there was no generalization of improvement due to manipulations of teacher attention, there was significant generalization of improvement resulting from the contingent administration of tangible rewards and punishments.

The efficacy of Cautela's covert reinforcement treatment procedure was tested in a single subject experiment with a clinically disabling phobia. The experiment confirmed the overall efficacy of the procedure; however, imaginal reinforcement following imaginal exposure was not necessary for improvement in approach behavior. On several other, more global self-report measures of fear, the imaginal reinforcement was found to be either facilitative or necessary to improvement.