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African American women with systemic lupus erythematosus (SLE) have worse disease outcomes compared to their White counterparts. Stressors associated with race may contribute to poorer health in this population through maladaptive behavioral pathways. This study investigated relationships between stress associated with anticipating racism, smoking, and SLE disease activity. Data were from 432 African American women with SLE in the Black Women's Experiences Living with Lupus (BeWELL) Study. Controlling for sociodemographic and health-related covariates, multivariable regression analyses revealed a significant association between anticipatory racism stress (ARS) and disease activity (p = 0.00, b = 1.13, 95% CI [0.43, 1.82]). A significant interaction between ARS and smoking also indicated that smoking exacerbated the effect of ARS on disease activity (p = 0.04, b = 1.95, CI = 0.04, 3.96). Test for evidence of smoking mediating the effect of ARS on disease activity were not statistically significant (z = 1.77, p = 0.08). Findings have implications for future SLE disparities research among African American women with SLE., Author(s): Erica C. Spears [sup.1] , Amani M. Allen [sup.2] , Kara W. Chung [sup.3] , Connor D. Martz [sup.3] , Evelyn A. Hunter [sup.4] , Thomas E. Fuller-Rowell [sup.3] [...]

Executive function (EF) is a concept widely used to describe higher order cognitive functioning. However, the concept seems to lack a precise definition upon which even experts in the area can agree. Examples of existing definitions describe EF as capacities for independent self-serving behavior and aspects of working memory, planning and organizational skills. It has been argued that the definition of EF is too imprecise, in terms of informing effective interventions. To possibly understand the range of behaviors termed EF in a more workable way, we administered a well-known computerized test (the Wisconsin Card Sorting Test; WCST) of EF to a sample of normal functioning participants (n =11). During administration, they were asked questions about their ways of thinking. Transcriptions of questions and answers were analyzed in search of common patterns, using a behavioral theory of language and cognition (relational frame theory; RFT). The analysis suggested that a specific relationship between deictic and temporal framing, on the one hand, and coordination and spatial framing, on the other, was in effect when participants performed well on the WCST. At critical time points during the test (i.e., when need for EF was arguably most acute), deictic and temporal framing dominated participants' behavior, whereas coordination and spatial framing were used relatively less. Keywords Executive function * Relational frame theory - Wisconsin Card Sorting Test * Behavior therapy, In an article dealing with the central tenets of contextual behavioral science, Wilson (2016) makes a statement that is deceivingly simple: 'Terms are merely ways of speaking' (p. 62). Indeed, [...]

When individuals with autism and intellectual and developmental disabilities exhibit severe problem behavior, assessment and treatment are often warranted. Parents of such individuals are at high risk for developing parenting stress. In this study, 194 parents completed the Parenting Stress Index-Short Form at their child's time of admission to and discharge from inpatient or outpatient treatment for severe problem behavior. Parent stress was examined in relation to rate and function of child problem behavior as determined via functional analysis. Repeated measures analyses of variance were conducted, and differential effects were observed when child participants exhibited an attention, automatic, or mands function for problem behavior. These findings highlight the importance of considering function of problem behavior in relation to parenting stress., Author(s): Patricia F. Kurtz [sup.1] [sup.2] , Craig W. Strohmeier [sup.1] [sup.2] , Jessica L. Becraft [sup.1] [sup.2] , Michelle D. Chin [sup.1] Author Affiliations: (1) grid.240023.7, 0000 0004 0427 [...]

Services for children with autism spectrum disorder (ASD) and their families have evolved with the advent of the Medicaid waiver, leading to more family-based coordination of care. Evaluating family involvement, the current investigation compared 230 families of children with ASD receiving Medicaid waiver services to a propensity-score matched group of 230 families who were waiting for such services (i.e., registry families). Compared to the registry, waiver families reported more involvement in service planning tasks, but not activities related to future-planning, managing crisis situations, or searching for and securing funding. Additional analyses characterize waiver families as engaging in high levels of coordinating and delivering behavioral interventions for their child. Implications for family burden and future programming for waiver programs are discussed., Author(s): Gregory S. Chasson [sup.1] , Karen Goldrich Eskow [sup.2] , Jean Ann Summers [sup.3] , Taylor M. Dreher [sup.1] Author Affiliations: (1) grid.62813.3e, 0000 0004 1936 7806, Department of [...]

We introduce interpersonal behavior therapy (IBT) in the context of a brief history of evolving paradigms of psychotherapy research and the rise of the third-wave behavior therapies facing the challenges of the introduction of middle-level terms in the service of their dissemination. The article focuses on IBT as a response to the evolution of functional analytic psychotherapy (FAP) and its movement away from behavioral principles and functional assessment. IBT is proposed as a contemporary behavioral treatment whose focus is on interpersonal distress, emphasizes the need for a functional assessment to conceptualize client problems, and utilizes behavioral principles to specify the mechanisms of the problem and mechanisms of clinical change. Largely a retooling of the original proposals in FAP, IBT explicates the mechanism responsible for clinical problems and the corresponding mechanism of clinical change. Moreover, as a behavioral therapy, IBT emphasizes the need for functional assessment in conceptualizing client problems and determining clinical treatments. Finally, we call for a unified return to behavioral assessment across the third-wave therapies. This unified approach may help advance principle-driven treatments for complex forms of human suffering as well as offer a path forward to a program of behavioral science and preserve the longevity of behavioral therapies. Keywords Functional analysis * Clinical behavior analysis * Interpersonal * Functional assessment * Distress * Mechanism * Research * Behavior therapy, In fits and starts, the progress in psychotherapy research and development has evolved. The important events along the way could be parsed in a variety of ways. One notable period [...]

Introduction: Although behavioral health treatment can improve distress and pain functioning for patients with chronic pain, few who are referred by their primary care physician will see a behavioral health specialist. Given the benefits of integrating behavioral health into primary care, this may be an avenue for delivering a psychological intervention for chronic pain. The purpose of this study was to optimize a psychological intervention for patients with chronic pain to be delivered in primary care, utilizing the perspectives of providers and patients. Method: Psychologists (n = 9), primary care providers (n = 9), and patients with chronic pain (n = 9) participated in separate focus groups. Participants reviewed the proposed 4-session intervention, provided feedback prompted by a set of open-ended questions, and completed a survey. Results: Statements from focus groups were transcribed and coded into 2 thematic categories: (a) content of the intervention and (b) logistics and design. Participants believed that offering a brief, behavioral intervention for chronic pain in a primary care clinic was feasible and useful. All providers (100%) agreed or strongly agreed that they would refer a patient to this intervention, and 100% of patients agreed or strongly agreed that they would participate. Discussion: Feedback solicited from the focus groups led to alterations to the treatment manual, such as adding a fifth session, using different psychological strategies, and logistical changes in delivery (i.e., meeting biweekly and intervisit contacts). The modified version of this intervention will be evaluated with a pilot randomized controlled clinical trial. Keywords: chronic pain, primary care, behavioral intervention, psychology, Approximately 100 million Americans suffer from chronic pain (American Academy of Pain Medicine, 2011). The biopsychosocial model, which posits that pain is affected by social and psychological components, suggests that [...]

Behavioral weight loss interventions are often delivered in groups. Group cohesion may enhance program attendance and, thereby, weight loss. In this secondary analysis, our goals were to: (1a) assess whether group cohesion measured early in a behavioral weight loss intervention predicts program attendance and weight loss outcomes and, if so, (1b) explore whether attendance mediates the link between group cohesion and weight loss; (2) characterize the association between change in group cohesion and weight loss throughout the intervention. Veterans (n = 324) initiated a 16-week, group-based behavioral weight loss program involving biweekly in-person group visits. In linear regression models, early group cohesion was unrelated to group attendance or weight loss. Although group cohesion significantly increased during the intervention, this change was not associated with weight loss. These findings are consistent with the limited literature; however, they are inconsistent with theoretical assertions and clinical observations of the influence of group factors on outcomes., Author(s): Shannon S. Taylor [sup.1] [sup.2] , Maren K. Olsen [sup.3] [sup.4] , Megan A. McVay [sup.5] , Janet Grubber [sup.3] , Jennifer M. Gierisch [sup.3] [sup.6] , William S. [...]

This study examined the associations between sleep and challenging behaviors for average and night-to-night fluctuations in sleep, in 39 children with autism spectrum disorder (ASD) receiving intensive behavioral intervention (IBI). Child sleep was recorded (via actigraphy) for five nights in conjunction with clinician-reported observations of challenging behaviors. Results indicated that on average, poor sleep was associated with higher rates of repetitive behavior, negative affect, and a composite of overall challenging behaviors. These findings suggest that average sleep patterns are important within the context of IBI (rather than night-to-night fluctuations). Interventions aimed at improving overall patterns of sleep may have important cascading effects on challenging behaviors and developmental outcomes for children with ASD and their families., Author(s): Emily A. Abel [sup.1] , A. J. Schwichtenberg [sup.1] , Matthew T. Brodhead [sup.2] [sup.3] , Sharon L. Christ [sup.1] Author Affiliations: (Aff1) 0000 0004 1937 2197, grid.169077.e, Department [...]

Background Older adults, including those with long-term conditions (LTCs), are vulnerable to social isolation. They are likely to have become more socially isolated during the Coronavirus Disease 2019 (COVID-19) pandemic, often due to advice to 'shield' to protect them from infection. This places them at particular risk of depression and loneliness. There is a need for brief scalable psychosocial interventions to mitigate the psychological impacts of social isolation. Behavioural activation (BA) is a credible candidate intervention, but a trial is needed. Methods and findings We undertook an external pilot parallel randomised trial (ISRCTN94091479) designed to test recruitment, retention and engagement with, and the acceptability and preliminary effects of the intervention. Participants aged [greater than or equal to]65 years with 2 or more LTCs were recruited in primary care and randomised by computer and with concealed allocation between June and October 2020. BA was offered to intervention participants (n = 47), and control participants received usual primary care (n = 49). Assessment of outcome was made blind to treatment allocation. The primary outcome was depression severity (measured using the Patient Health Questionnaire 9 (PHQ-9)). We also measured health-related quality of life (measured by the Short Form (SF)-12v2 mental component scale (MCS) and physical component scale (PCS)), anxiety (measured by the Generalised Anxiety Disorder 7 (GAD-7)), perceived social and emotional loneliness (measured by the De Jong Gierveld Scale: 11-item loneliness scale). Outcome was measured at 1 and 3 months. The mean age of participants was aged 74 years (standard deviation (SD) 5.5) and they were mostly White (n = 92, 95.8%), and approximately two-thirds of the sample were female (n = 59, 61.5%). Remote recruitment was possible, and 45/47 (95.7%) randomised to the intervention completed 1 or more sessions (median 6 sessions) out of 8. A total of 90 (93.8%) completed the 1-month follow-up, and 86 (89.6%) completed the 3-month follow-up, with similar rates for control (1 month: 45/49 and 3 months 44/49) and intervention (1 month: 45/47and 3 months: 42/47) follow-up. Between-group comparisons were made using a confidence interval (CI) approach, and by adjusting for the covariate of interest at baseline. At 1 month (the primary clinical outcome point), the median number of completed sessions for people receiving the BA intervention was 3, and almost all participants were still receiving the BA intervention. The between-group comparison for the primary clinical outcome at 1 month was an adjusted between-group mean difference of -0.50 PHQ-9 points (95% CI -2.01 to 1.01), but only a small number of participants had completed the intervention at this point. At 3 months, the PHQ-9 adjusted mean difference (AMD) was 0.19 (95% CI -1.36 to 1.75). When we examined loneliness, the adjusted between-group difference in the De Jong Gierveld Loneliness Scale at 1 month was 0.28 (95% CI -0.51 to 1.06) and at 3 months -0.87 (95% CI -1.56 to -0.18), suggesting evidence of benefit of the intervention at this time point. For anxiety, the GAD adjusted between-group difference at 1 month was 0.20 (-1.33, 1.73) and at 3 months 0.31 (-1.08, 1.70). For the SF-12 (physical component score), the adjusted between-group difference at 1 month was 0.34 (-4.17, 4.85) and at 3 months 0.11 (-4.46, 4.67). For the SF-12 (mental component score), the adjusted between-group difference at 1 month was 1.91 (-2.64, 5.15) and at 3 months 1.26 (-2.64, 5.15). Participants who withdrew had minimal depressive symptoms at entry. There were no adverse events. The Behavioural Activation in Social Isolation (BASIL) study had 2 main limitations. First, we found that the intervention was still being delivered at the prespecified primary outcome point, and this fed into the design of the main trial where a primary outcome of 3 months is now collected. Second, this was a pilot trial and was not designed to test between-group differences with high levels of statistical power. Type 2 errors are likely to have occurred, and a larger trial is now underway to test for robust effects and replicate signals of effectiveness in important secondary outcomes such as loneliness. Conclusions In this study, we observed that BA is a credible intervention to mitigate the psychological impacts of COVID-19 isolation for older adults. We demonstrated that it is feasible to undertake a trial of BA. The intervention can be delivered remotely and at scale, but should be reserved for older adults with evidence of depressive symptoms. The significant reduction in loneliness is unlikely to be a chance finding, and replication will be explored in a fully powered randomised controlled trial (RCT). Trial registration ISRCTN94091479., Author(s): Simon Gilbody 1,2,*, Elizabeth Littlewood 1, Dean McMillan 1,2, Carolyn A. Chew-Graham 3, Della Bailey 1, Samantha Gascoyne 1, Claire Sloan 1, Lauren Burke 1, Peter Coventry 1, Suzanne [...]

Demand fading, a schedule thinning procedure for escape-maintained behaviors, typically includes an escape extinction component. The purpose of this study was to examine the effectiveness of demand fading with alternative reinforcement utilizing concurrent reinforcement schedules without extinction. During demand fading, aggression and requests emitted prior to meeting the task completion criterion were reinforced with short, low-quality breaks, but requests emitted following the task completion criterion were reinforced with long, high-quality breaks. Results suggest that concurrent schedules of reinforcement may be an effective alternative to extinction as a component of demand fading., Author(s): Tonya N. Davis [sup.1] , Regan Weston [sup.1] , Abby Hodges [sup.1] , Lauren Uptegrove [sup.1] , Kristen Williams [sup.1] , Kelly M. Schieltz [sup.2] Author Affiliations: (Aff1) 0000 [...]

Background: Electroconvulsive therapy (ECT) is a highly effective brain stimulation treatment for severe depression. Identifying neurochemical changes linked with ECT may point to biomarkers and predictors of successful treatment response. Methods: We used proton magnetic resonance spectroscopy (¹H-MRS) to measure longitudinal changes in glutamate/glutamine (Glx), creatine (Cre), choline (Cho) and W-acetylaspartate (NAA) in the dorsal (dACC) and subgenual anterior cingulate cortex (sgACC) and bilateral hippocampus in patients receiving ECT scanned at baseline, after the second ECT session and after the ECT treatment series. Patients were compared with demographically similar controls at baseline. Controls were assessed twice to establish normative values and variance. Results: We included 50 patients (mean age 43.78 ± 14 yr) and 33 controls (mean age 39. 33 ± 12 yr) in our study. Patients underwent a mean of 9 ± 4.1 sessions of ECT. At baseline, patients showed reduced Glx in the sgACC, reduced NAA in the left hippocampus and increased Glx in the left hippocampus relative to controls. ECT was associated with significant increases in Cre in the dACC and sgACC and decreases in NAA in the dACC and right hippocampus. Lower NAA levels in the dACC at baseline predicted reductions in depressive symptoms. Both ECT and symptom improvement were associated with decreased Glx in the left hippocampus and increased Glx in the sgACC. Limitations: Attrition and clinical heterogeneity may have masked more subtle findings. Conclusion: ECT elicits robust effects on brain chemistry, impacting Cre, NAA and Glx, which suggests restorative and neurotrophic processes. Differential effects of Glx in the sgACC and hippocampus, which approach control values with treatment, may reflect previously implicated underactive cortical and overactive subcortical limbic circuitry in patients with major depression. NAA levels at baseline are predictive of therapeutic outcome and could inform future treatment strategies., Introduction Major depressive disorder (MDD) is a debilitating illness that affects approximately 350 million people worldwide. (1) There is accumulating evidence to support that the pathophysiology of MDD involves multiple [...]

We conducted two experiments to evaluate the effects of errors of omission and commission during alternative reinforcement of compliance in young children. In Experiment 1, we evaluated errors of omission by examining two levels of integrity during alternative reinforcement (20 and 60%) for child compliance following no treatment (baseline) versus treatment at full (i.e., 100%) integrity. Results indicated that compliance varied according to the level of integrity in place. In addition, compliance in the 60% integrity condition was high and stable when it followed baseline, but was substantially lower for one participant and slightly lower for a second participant when it followed the full integrity condition. In Experiment 2, we evaluated errors of commission. For three participants, we compared treatment at full integrity to a condition in which errors of commission were made on every trial (i.e., 0% integrity). For one of these three participants, we also compared treatment at full integrity to baseline and to a condition in which errors of commission were made on 50% of trials. Results of all four evaluations again indicate that compliance varied according to the level of integrity in place: compliance was low in both the 0 and 50% integrity conditions, regardless of the preceding condition. These results suggest that during alternative reinforcement of compliance, the effect of occasional errors of omission may depend on the immediately preceding context but that errors of commission are more detrimental. Keywords Alternative reinforcement * Compliance * Noncompliance * Preschoolers * Treatment integrity, Noncompliance, the failure to follow a specific caregiver-delivered instruction, is among the most common behavior problems exhibited by young children (Bernal et al. 1980) and, according to teachers, compliance is [...]

Twenty-nine peer-reviewed journal articles that analyzed intervention implementation in schools using single-case experimental designs were meta-analyzed. These studies reported 171 separate data paths and provided 3,991 data points. The meta-analysis was accomplished by fitting data extracted from graphs in mixed linear growth models. This analytic approach was adopted to provide a model whose assumptions were met and could model both level and trend. The extent to which interventions were implemented as planned in baseline was low with a downward trend. Performance feedback, performance feedback augmented with additional procedures, and self-monitoring with environmental supports were found to be highly effective for improving intervention implementation. Follow-up meetings without review of implementation data were ineffective. Maintenance data were positive across studies. Implications of the results for future research and practice are discussed. Keywords Meta-analysis * Single-case * Treatment integrity * Consultation, Introduction Over the past two decades, the education literature has seen an increased emphasis on consultation, prevention, intervention, tiered intervention models, positive behavior supports, and progress monitoring (e.g., Fuchs et [...]

Background: The 'biological susceptibility' model posits that some individuals, by genetic predisposition, are highly sensitive to environmental stimuli. Exposure to adverse stimuli leads to negative outcomes, and better outcomes follow favourable stimuli. Recent studies indicate that individuals carrying the low-activity (short; s) variant of the serotonin transporter (5-HTT)-linked polymorphic region (5-HTTLPR) show an enhanced vulnerability to posttraumatic stress disorder (PTSD). Simultaneously, they respond poorly to exposure therapy, the first-line treatment to enhance fear extinction in individuals with PTSD. Given that s-allele carriers also show improved adaptive responding when exposed to positive stimuli, we hypothesized that this trait could be used to offset impaired fear extinction. Methods: We explored this hypothesis preclinically using wild-type and 5-HTT knockout (5-[HTT.sup.-/-]) male rats (n = 36) that share behavioural similarities with 5-HTTLPR s-allele carriers. Subsequent to cued fear conditioning, animals were tested for short- (1 and 2 days postconditioning) and long-term (6 days postconditioning) fear extinction in the absence or presence of a secondary 'distracting' stimulus predicting the delivery of sucrose pellets. Results: Introducing a secondary stimulus predicting sucrose pellets that distracts attention away from the fear-predicting stimulus led to a long-lasting improvement of impaired fear extinction in 5-[HTT.sup.-/-] male rats. Limitations: The context-dependency of the efficacy of the 'distraction therapy' was not tested. In addition, it remains to be clarified whether the positive valence of the distracting stimulus is critical for the distraction of attention or whether a neutral and/or novel stimulus can induce similar effects. Finally, although of lesser importance from a therapeutic perspective, underlying mechanisms remain to be elucidated. Conclusion: These data indicate that positive environmental stimuli can be used to offset heightened responses to negative stimuli, particularly in individuals characterized by inherited 5-HTT downregulation and high sensitivity to environmental stimuli., Introduction Posttraumatic stress disorder (PTSD), like many other neuropsychiatric disorders, is shaped by gene x environment interactions. According to the classic 'diathesis-stress' model, individuals characterized by high stress sensitivity who [...]

From the beginning of time, there has been a pervasive interest in getting some members of the human race to conform to the wishes of other members of the human race. The use of positive as well as not so positive methods have been utilized, researched and espoused upon. The current paper presents a review of the vast literature on the history of aversive intervention. Aversive intervention is defined and deeply explored. This paper examines the course of such treatment through human history and ends with a provocative reflection that delves into some of the mysteries surrounding this topic., Introduction Anyone who has watched the police drama NCIS: Navel Criminal Investigative Service on the CBS network has witnessed aversive intervention (Bellisario, 2010). Mark Harmon's character, Jethro Gibbs, as a [...]

Since the mid-1980s and 1990s, behavioral treatment of alcohol abuse and dependence (i.e., alcohol use disorders [AUDs]) has advanced steadily. This article introduces different types of behavioral treatment, summarizes the [...]

The current article describes the phenomenology and empirically supported treatments for Tourette's disorder (TD) and presents data on treatment utilization from two separate national surveys of adults with TD (N = 672) and parents of children with TD (N = 740). Despite a wealth of empirical evidence demonstrating its effectiveness, results suggest that most people with TD do not receive behavior therapy for the condition. Reasons for this include a lack of information about the disorder among consumers and providers, a shortage of providers trained in the treatment, and concern about possible negative effects of behavioral treatment. The article concludes with a discussion about dissemination efforts aimed at making behavior therapy more widely available to children and adults with chronic tics and a review of beliefs about the negative effects of behavior therapy. Keywords: Tourette's disorder, habit reversal, behavior therapy, emerging practice, tic disorder DOI: 10.1037/a0021709

Bedtime problems and frequent night wakings are common sleep problems in infants and toddlers, affecting 20 to 30% of young children. Such problems, categorized as behavioral insomnia of childhood (BIC), lead to insufficient sleep, which contributes to multiple domains of child dysfunction. Behavioral treatments of BIC, such as extinction and positive routines are introduced, and supporting evidence is reviewed. Critical factors in developing a successful treatment plan include conducting a detailed assessment, collaboratively developing a plan that starts where the family is, and providing support between sessions. A case of a 3-year-old girl with BIC illustrates how treatment helped her to develop healthy sleep habits and taught her to sleep independently via graduated and standard extinction. [c] 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1195-1204, 2010. Keywords: infants; toddler; sleep; sleep disorders; extinction; behavioral treatment DOI: 10.1002/jclp.20731

This study compares the effectiveness of Parent--Child Interaction Therapy (PCIT) in reducing behavior problems (e.g., aggression, defiance, anxiety) of 62 clinic-referred, 2to 7-year-old, maltreated children exposed to interparental violence (IPV) with a group of similar children with no exposure to IPV (N = 67). Preliminary analyses showed that IPV-exposed dyads were no more likely to terminate treatment prematurely than non IPV-exposed dyads. Results of repeated-measures MANCOVAs showed significant decreases in child behavior problems and caregivers' psychological distress from pre-to posttreatment for IPV-exposed and IPV nonexposed groups, and no significant variation by exposure to IPV. Stress in the parent role related to children's difficult behaviors and the parent--child relationship decreased from pre-to posttreatment, but parental distress did not decrease significantly over the course of PCIT. Results of an analysis testing the benefits of a full course of treatment over the first phase of treatment showed that dyads completing the full course of treatment reported significantly greater improvements in children's behavior problems than those receiving only the first phase of treatment. Keywords: interparental violence: parent--child interaction therapy; treatment outcomes DOI: 10.1891/0886-6708.25.4.486

Skills training is a crucial mode of treatment in dialectical behavioral therapy (DBT; Linehan, 1993b), yet a psychometrically sound measure of DBT skills use does not exist. We adapted the Revised Ways of Coping Checklist (RWCCL; Vitaliano, Russo, Carr, Maiuro, & Becker, 1985) to create the DBT Ways of Coping Checklist (DBT-WCCL). Using factor analysis procedures, two subscales emerged: one assessing coping via DBT skills, the DBT Skills Subscale (DSS), and one assessing coping via dysfunctional means, the Dysfunctional Coping Subscale (DCS). Principal component, internal consistency, test-retest reliability, and content validity analyses suggested that the scale has good to excellent psychometric properties. In addition, the DSS successfully discriminated patients who received skills training during 4 months of treatment from patients who did not. Moderators of skills use are also discussed. The DBT-WCCL appears to be a promising new measure of DBT skills use. [c] 2010 Wiley Periodicals, Inc. J Clin Psychol: 66:563-582, 2010. Keywords: dialectical behavior therapy; borderline personality disorder; skills training; measurement; psychometrics DOI: 10.1002/jclp.20685

Objective: To follow distressed married couples for 5 years after their participation in a randomized clinical trial. Method: A total of 134 chronically and seriously distressed married couples were randomly assigned to approximately 8 months of either traditional behavioral couple therapy (TBCT; Jacobson & Margolin, 1979) or integrative behavioral couple therapy (IBCT; Jacobson & Christensen, 1998). Marital status and satisfaction were assessed approximately every 3 months during treatment and every 6 months for 5 years after treatment. Results: Pre- to posttreatment effect sizes on marital satisfaction were d = 0.90 for IBCT and d = 0.71 for TBCT, which were not significantly different. However, data through 2-year follow-ups revealed statistically significant superiority of IBCT over TBCT in relationship satisfaction, but subsequent data showed increasing similarity and nonsignificant differences in outcome. At 5-year follow-up for marital satisfaction relative to pretreatment, effect sizes were d = 1.03 for IBCT and d = 0.92 for TBCT; 50.0% of IBCT couples and 45.9% of TBCT couples showed clinically significant improvement. Relationship status, obtained on all 134 couples, revealed that 25.7% of IBCT couples and 27.9% of TBCT couples were separated or divorced. These follow-up data compared favorably to other, long-term results of couple therapy. Conclusion: TBCT and IBCT both produced substantial effect sizes in even seriously and chronically distressed couples. IBCT produced significantly but not dramatically superior outcomes through the first 2 years after treatment termination but without further intervention; outcomes for the 2 treatments converged over longer follow-up periods. Keywords: behavioral couple therapy, posttherapy adjustment DOI: 10.1037/a0018132

Maladaptive behaviors, such as aggressive and disruptive behaviors, are a significant risk factor for maintaining community placement by individuals with intellectual disabilities. When experienced researchers provide training to individuals with intellectual disabilities on a mindfulness-based strategy, Meditation on the Soles of the Feet, the individuals are able to effectively self-manage their maladaptive behaviors. We investigated whether similar effectiveness would be found if community-based therapists provided the training to similar individuals living in the community. Three adults with mild intellectual disabilities and mental illness living in the community were taught by a community-based therapist to use this strategy to control maladaptive behaviors that included verbal aggression, disruptive behavior and physical aggression. They were taught to shift the focus of their attention from the negative emotions that triggered their maladaptive behavior to a neutral stimulus, the soles of their feet. All three individuals were able to reduce their maladaptive behaviors to near-zero levels and maintain their community placement that they had been at risk for losing, due to their maladaptive behavior. Subjective measures of various psychological symptoms showed a reduction in two of the individuals. Our study suggests that the demonstrated effectiveness of Meditation on the Soles of the Feet can be achieved by a community-based therapist. Keywords Maladaptive behavior * Meditation on the soles of the feet * Community placement * Verbal and physical aggression * Disruptive behavior * Research to practice DOI 10.1007/s10826-009-9348-9

Objective: The health consequences of tobacco smoking disproportionately affect African Americans, but research on whether efficacious interventions can be generalized to this population is limited. This study examined the efficacy of group-based cognitive-behavioral therapy (CBT) for smoking cessation among African Americans. Method: Participants (N = 154; 65% female, M = 44 years old, mean cigarettes/ day = 13) were randomly assigned to either (a) group CBT or (b) group general health education (GHE). Participants in both conditions received 6 sessions of counseling and 8 weeks of transdermal nicotine patches. The primary outcome variable was 7-day point prevalence abstinence (ppa), assessed at the end of counseling (2 weeks) and at 3- and 6-month follow-ups. Secondary outcomes included 24-hr ppa and 28-day continuous abstinence (assessed at 3 and 6 months). Results: Intent-to-treat analyses demonstrated the hypothesized effects, such that 7-day ppa was significantly greater in the CBT than the GHE condition at the end of counseling (51% vs. 27%), at 3 months (34% vs. 20%), and at 6 months (31% vs. 14%). Results of a generalized linear mixed model demonstrated a significant effect of CBT versus GHE on 7-day ppa (odds ratio = 2.57, 95% CI [1.40, 4.71] and also an effect of time (p < .002). The Condition x Time interaction was not significant. Similar patterns of results emerged for 24-hour ppa and 28-day continuous abstinence. Results from per protocol analyses (i.e., participants who completed all aspects of the study) corroborate the intent-to-treat findings. Conclusions: These results demonstrate that intensive, group CBT smoking cessation interventions are efficacious among African American smokers. Keywords: smoking, smoking cessation, African American, cognitive-behavioral therapy, randomized controlled trial DOI: 10.1037/a0017669

This article describes a brief, 12-week dialectical behavior therapy program modified for female victims of domestic abuse and provides a preliminary examination of this intervention. Dialectical behavior therapy is a comprehensive cognitive--behavioral treatment, which was originally developed to treat multiproblem clients with severe and chronic emotion dysregulation, and was adapted for this study to treat female victims of domestic abuse. From pretreatment to posttreatment, participants (N = 31) showed significant reductions in depressive symptoms, hopelessness, and general psychiatric distress as well as increased social adjustment. Additionally, participants reported high levels of consumer satisfaction with the treatment. Findings support the possible utility of dialectical behavior therapy for enhancing psychological and social well-being in female victims of domestic abuse. Keywords: domestic abuse, women victims, dialectical behavior therapy, group therapy, emotion regulation

One hundred and ninety-six youth, ages 7-16, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for various specific phobias were randomized to a one-session exposure treatment, education support treatment, or a wait list control group. After the waiting period, the wait list participants were offered treatment and, if interested, rerandomized to 1 of the 2 active treatments. The phobias were assessed with semistructured diagnostic interviews, clinician severity ratings, and behavioral avoidance tests, whereas fears, general anxiety, depression, and behavior problems were assessed with self- and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Results showed that both treatment conditions were superior to the wait list control condition and that 1-session exposure treatment was superior to education support treatment on clinician ratings of phobic severity, percentage of participants who were diagnosis tree, child ratings of anxiety during the behavioral avoidance test, and treatment satisfaction as reported by the youth and their parents. There were no differences on self-report measures. Treatment effects were maintained at follow-up. Implications of these findings are discussed. Keywords: specific phobias, children and adolescents, randomized control trial, cognitive behavior therapy, treatment outcome

Trichotillomania is an impairing condition that involves repetitive hair pulling. Habit reversal therapy is helpful for many persons with this disorder. Unfortunately, habit reversal therapy is not helpful for everyone and maintenance of gains is often problematic. Successful habit reversal therapy requires the individual to be aware of hair pulling and handling. Unfortunately, most people with trichotillomania report that much of their plucking occurs outside of awareness. Monitoring of trichotillomania behaviors is also problematic. The present project involved a pilot study of a prototype awareness enhancing and monitoring device aimed at increasing the effectiveness of habit reversal therapy. The device included a watch, bracelet, magnetic necklace, and a pager that was hard-wired for remote activation of a vibrating alert when hair pulling behaviors occurred. Following structured diagnostic assessment, three female participants were randomly assigned to be initially observed for varied lengths of time without the device followed by observation with the device in place. The results indicated a marked reduction in trichotillomania behaviors when the device was in place. Semi-structured interviews revealed that the device was very effective in enhancing awareness and monitoring of trichotillomania related behaviors and enthusiastic acceptance of the device was provided by all participants. Keywords: Trichotillomania Measurement Awareness Habit reversal Behavior therapy Device Multiple baseline

This bridge study evaluated the effects of contingency-specifying instructions (CSIs) and incomplete instructions (IIs) in terms of establishing instructional control of appropriate behavior. Results suggested that instructional control and maintenance were achieved with CSIs but not with IIs. Results are discussed in terms of the potential use of instructional control in the maintenance of appropriate behavior for children with attention deficit hyperactivity disorder. DESCRIPTORS: attention deficit hyperactivity disorder, delay to reinforcement, instructional control, maintenance, rule-governed behavior

Exposure-based therapies are efficacious treatments for social anxiety disorder (i.e., Gould et al., 1997). Much of the theory behind these treatments is derived from Foa and colleagues' (Foa, Huppert, & Cahill, 2005; Foa & Kozak, 1986) work on emotional processing. However, there has been little research examining individual differences in emotional processing patterns within and between treatment sessions among clients with social anxiety disorder. This study utilized longitudinal data analytic methods to examine changes in subjective anxiety during the first 3 exposure sessions in group and individual cognitive-behavioral therapy for social anxiety disorder. The results of this study provide preliminary evidence that, although anxiety generally decreases across exposures, some individuals experience considerable fluctuations in anxiety during a single exposure. Although anxiety during the first exposure was not significantly related to outcome, the relationship between anxiety during exposure and outcome became stronger during subsequent exposures. Overall, this study highlights the need to conduct more fine-grained analyses to better understand the mechanisms underlying exposure-based therapies for social anxiety disorder.

One-Session Treatment (OST) is a form of massed exposure therapy for the treatment of specific phobias. OST combines exposure, participant modeling, cognitive challenges, and reinforcement in a single session, maximized to three hours. Clients are gradually exposed to steps of their fear hierarchy using therapist-directed behavioral experiments. Although there are several studies in the literature examining the efficacy of OST, little has been done to summarize this research. In the following review, research on and empirical support for OST are reviewed with an emphasis on the types of stimuli, samples, and methodologies utilized. Research generally supports OST's efficacy, although replication by independent examiners using adult and child samples is needed using more rigorous comparisons (e.g., psychological placebo or other treatments). Overall, OST continues to be a promising treatment for specific phobias; however, a great deal more investigation is needed to identify mechanisms of change, mediators, and moderators.

During the last two decades a number of therapies, under the name of the third wave of cognitive behavior therapy (CBT), have been developed: acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), cognitive behavioral analysis system of psychotherapy (CBASP), functional analytic psychotherapy (FAP), and integrative behavioral couple therapy (IBCT). The purposes of this review article of third wave treatment RCTs were: (1) to describe and review them methodologically, (2) to meta-analytically assess their efficacy, and (3) to evaluate if they currently fulfil the criteria for empirically supported treatments. There are 13 RCTs both in ACT and DBT, 1 in CBASP, 2 in IBCT, and none in FAP. The conclusions that can be drawn are that the third wave treatment RCTs used a research methodology that was significantly less stringent than CBT studies; that the mean effect size was moderate for both ACT and DBT, and that none of the third wave therapies fulfilled the criteria for empirically supported treatments. The article ends with suggestions on how to improve future RCTs to increase the possibility of them becoming empirically supported treatments. Keywords: Third wave of CBT; ACT; DBT; CBASP: IBCT; Systematic review; Meta-analysis