Maternal Depressive Symptomatology and Child Maladjustment: A Comparison of Three Process Models

Jean E. Dumas and Wendy J. Serketich, Purdue University

This study compared three models to investigate the relation between maternal depressive symptomatology and child maladjustment in a community sample of 96 mother-child dyads. The models agree that symptomatic mothers report higher levels of child maladjustment and behave in a more aversive and controlling manner toward their children than asymptomatic mothers, but make different predictions about the manner in which children behave toward symptomatic mothers. Model 1 asserts that children generally display lower levels of compliance and higher levels of aversiveness, model 2 that they do not differ in their behavior when compared to children of asymptomatic mothers, and model 3 that they generally display higher levels of compliance and lower levels of aversiveness. Home observation data generally supported model 2, but showed that socioeconomic disadvantage played a major role in the association between maternal depressive symptyomatology and child maladjustment. The findings call for an expanded model that includes disadvantage as a correlate of both maternal depressive symptoms and, to a lesser extent, child maladjustment. Implications for intervention are briefly discussed.



Combined Cognitive-Behavioral and Time-Limited Alprazolam Treatment of Panic Disorder

Mark T. Hegel, C. Lewis Ravaris, and Tim A. Ahles, Dartmouth Medical School

A combined cognitive-behavioral and time-limited alprazolam treatment model for panic disorder was evaluated within the context of routine clinical practice. Twenty-two patients were followed for 1 year after the completion of cognitive-behavior therapy and alprazolam discontinuation. At 1-year follow-up, 76% of the original sample were medication-free and 85% remained panic free. These results are comparable to previous reports of cognitive-behavioral therapy alone (e.g., Craske, Brown, & Barlow, 1991) and are far superior to medication-only studies (e.g., Fyer et al., 1987). These results suggest that both rapid and long-lasting treatment effects may be obtained through such a combination, and that the combined treatment approach does not necessarily interfere with the efficacy of cognitive-behavioral therapy. This study represents a first step in evaluating this combined treatment approach and supports the utility of conducting controlled randomized studies to evaluate these issues systematically.



Role of Fear of Fear and Safety Information in Moderating the Effects of Voluntary Hyperventilation

Norman B. Schmidt and Michael J. Telch, University of Texas at Austin

The present study investigated the singular and joint effects of fear of somatic sensations and perceived safety of hypocapnia-induced bodily cues on nonclinical subjects' subjective and psychophysiological response to a hyperventilation challenge. Fear of fear was assessed with the Body Sensations Questionnaire (BSQ; High versus Low), and subjects were randomly assigned to one of two informational conditions (Safety Information versus No Safety Information). When anticipating hyperventilation, High BSQ-Safety Information subjects reported higher subjective anxiety compared to Low BSQ-Safety Information subjects. Similarly, High BSQ-Safety Information subjects reported significantly more symptoms during the anticipatory phase compared to subjects in each of the other three conditions. During hyperventilation, fear of somatic cues and safety information exerted independent effects on subjective responding. High BSQ subjects reported higher levels of subjective fear and physical symptoms compared to Low BSQ subjects; subjects who received safety information reported lower levels of anxiety and physical symptoms compared to those who did not receive safety information. High BSQ subjects' heightened subjective fear response persisted through the hyperventilation recovery period. There were no group differences on the psychophysiological variables across any of the experimental phases. These findings provide further support both that fear of fear contributes to heightened emotional responding to biological challenges and that emotional responding is also affected by conditions that alter the perceived threat of the challenge-induced cues.



Mode-Specific Impact of Relaxation Training for Hypertensive Men with Type A Behavior Pattern

David A. F. Haaga, American University, Gerald C. Davison, Marian E. Williams, Sharon L. Dolezal, Jerayr Haleblian, Joel Rosenbaum, James H. Dwyer, Sherryl Baker, Elahe Nezami and Vincent DeQuattro, University of Southern California

Multimodal therapy calls for selection of interventions on the basis of the specific modes of functioning that they are expected to affect. Mode-specificity assumptions were tested in a study of progressive muscle relaxation (PMR) training for type A men with borderline hypertension. It was expected that PMR would be especially effective in reducing psychophysiological reactivity and not effective for hostile cognition or behavioral anger expression. Forty-three subjects were randomly assigned to a control group receiving medical information or to information + PMR. PMR subjects reduced blood pressure reactivity to an anger-instigating role-play more than did controls. Although trait questionnaire measures of hostility and outward anger expression showed no group differences, a think-aloud measure of hostility and an observational measure of anger expression favored PMR. Discussion focuses on alternative explanations for these results, including the possibility that measures failing to show treatment effects were those confounded with negative affectivity.



Weight Loss, Cognitive-Behavioral, and Desipramine Treatments in Binge Eating Disorder: An Additive Design

W. Stewart Agras, Christy F. Telch, Bruce Arnow, Kathleen Eldredge, Denise E. Wilfley, Susan D. Raeburn, Judith Henderson, and Margaret Marnell, Stanford University School of Medicine

The aim of this study was to compare the effects of weight loss treatment, cognitive-behavioral treatment, and desipramine on binge eating and weight in a three group additive design involving 108 overweight participants with binge eating disorder. Subjects were allocated at random to either 9-months weight-loss-only treatment; 3-months of cognitive-behavioral treatment followed by weight loss treatment for 6-months; or the combination treatment with desipramine added for the last 6-months. After 3-months of treatment, those receiving cognitive-behavioral therapy had reduced binge eating significantly more than participants receiving weight loss therapy only, and the weight loss only group had lost significantly more weight than those in the cognitive-behavioral therapy or desipramine added to the effectiveness of weight loss therapy. However, those receiving medication lost significantly more weight than the comparable group without medication at follow-up. Abstinence from binge eating was associated with significantly greater weight losses. Overall, however, the achieved weight losses were small and the abstinence rates low. Moreover, there were no differences between the three groups either at the end of treatment or at follow-up. Suggestions for further research aimed at improving the therapeutic results for this difficult clinical problem are discussed.



Body Image and Weight Changes in a Multisite Comprehensive Very-Low-Calorie Diet Program

Thomas F. Cash, Old Dominion University

Substantial evidence points to the negative body-image experiences of obese persons. Limited evidence suggests that after successful weight loss a "vestigial" negative body image may be retained. This prospective investigation repeatedly assessed obese participants' weight and body images over the course of a comprehensive VLCD program. Of an initial sample of 88 female subjects, 36 were available for post-reduction assessments and 20 for maintenance assessments. VLCD completers reduced their weight by 24% and displayed marked improvements in most aspects of body image. A modest weight increase during maintenance partially, albeit significantly, diminished some body-image gains. Systematic analyses of attrition implicated several body-image variables as predictors of attrition independent of the extent of weight loss, including poor fitness-related attitudes and less prominent gains in body image. A revised perspective on the phenomenon of vestigial body image is offered. The potential value of cognitive-behavioral body-image therapy for obese persons is discussed.



Self-Scenarios as a Repeated Measures Outcome Measurement of Self-Schemas in Short-Term Cognitive Therapy

J. Christopher Muran, Beth Israel Medical Center and Mount Sinai School of Medicine, Zindel V. Segal, Clarke Institute of Psychiatry and University of Toronto, and Lisa Wallner Samstag, Beth Israel Medical Center

As the role of self-representation has begun to figure more prominently in clinical theories of emotional disorder, a number of assessment methodologies have been developed to measure this construct. This report describes the construction and use of self-scenarios, an idiographic interview-based measure of self-schemas. Self-scenarios depict highly distressing events that consist of four components, which reflect schematic structure: a stimulus situation and cognitive, affective, and motoric responses. They are scaled in a 9-point Likert-type format on multiple parameters and can be rated following each therapy session, thus providing for longitudinal tracking of self-schemas over the course of treatment. This study of a repeated single-subject design analyzed data of eight cases with variable outcome from short-term cognitive therapy. The results indicated high intraclass correlation coefficients calculated from rating on clinical relevance of the components by the patient, therapist, and third-party observer who constructed the scenarios, thus supporting the interrater reliability and concurrent validity of the measurement methodology. They also provided some evidence of discriminant validity, based on differences between patient initial parametric ratings of clinically relevant and nonrelevant scenarios, and predictive validity, demonstrated by comparing change on patient parametric ratings of relevant scenarios across treatment with change on a composite measure of therapy outcome.



Children's Homework Problems: A Comparison of Goal Setting and Parent Training

Alice L. Kahle and Mary Lou Kelley, Louisiana State University

Most reviews of empirical research conclude that homework is beneficial to academic achievement and learning. However, poor homework production and homework-related behavior problems are common among school-aged children. Unfortunately, research aimed at evaluating effective homework interventions has been limited. The current study compared two practical behavioral interventions for homework problems in elementary-aged children: parent training and goal setting with contingency contracting. Homework Problem Checklist scores were significantly improved in both active treatment groups. However, only goal setting resulted in significant increases in number of homework answers correct per minute.



Psychological Management of Insomnia: A Clinical Replication Series With 100 Patients

Charles M. Morin, Jackie Stone, Kathy McDonald, and Susan Jones, Medical College of Virginia/Virginia Commonwealth University

This study reports on a clinical replications series of 100 patients who presented for insomnia treatment to a university hospital sleep disorders clinic. Treatment consisted of a short-term, structured, and multifaceted intervention combining behavioral, cognitive, educational, and sleep medication withdrawal components. The results from daily sleep diaries showed that patients were sleeping more efficiently after treatment, as evidenced by significant reductions of sleep onset latency, wake after sleep onset, and early morning awakening. The magnitude of improvement obtained on these measures (range = 42% to 50%) was comparable to those previously obtained in controlled studies of patients with insomnia solicited from the community. Significant reductions in usage of sleep aids were also noted. Despite initial differences in symptom severity, treatment response was comparable across the three most common insomnia subtypes: psychophysiological, drug-dependent, and insomnia associated with psychopathology. These findings suggest that cognitive-behavior therapy is effective in the clinical management of sleep disturbances in a heterogeneous group of insomnia sufferers presenting to a sleep clinic.



An Investigation of Eye Movement Desensitization and Reprocessing (EMD/R) as a Treatment for Posttraumatic Stress Disorder Symptoms of Vietnam Combat Veterans

James A. Jensen, Ethan Allen School for Boys, Wales, Wisconsin

Eye movement desensitization and reprocessing (EMD/R) was investigated with 25 Vietnam combat veterans with posttraumatic stress disorder (PTSD), randomly assigned to EMD/R or a control condition. First, PTSD was assessed and subjects were assisted in developing a PTSD-related treatment goal. Subjective anxiety and a belief in a positive cognition related to war trauma were also assessed. Second, EMD/R subjects were then seen for one history-taking session and two treatment sessions. Approximately 17 days after the initial assessment, repeat assessments of PTSD symptomatology, goal attainment, subjective anxiety, and belief in desired positive cognitions were conducted. Overall, EMD/R showed little effectiveness in this study. Although effective in reducing in-session subjective anxiety, EMD/R was not effective in improving other PTSD symptoms, in contributing to goal attainment, or in increasing subjects? beliefs in their desired positive cognition. The results imply that EMD/R may not be successful in treating Vietnam combat veterans with PTSD.



Denial of Deviant Sexual Arousal and Psychopathology in Child Molesters

Thomas W. Haywood, St. Luke?s Medical Center, and Linda S. Grossman, University of Illinois College of Medicine

To provide information about whether alleged sex offenders honestly report their patterns of sexual interest and whether this varies with self-report of symptoms of psychopathology, the present study assessed 75 alleged child molesters and 41 normal subjects using a subjective index of self-reported sexual interest known as the Pictorial Sexual Interest Card Sort (PSICS) and the MMPI. Results indicated that child molesters who denied allegations reported significantly less sexual interest in children than did admitters or normal subjects. Self-report of low deviant sexual interest was associated with minimization of psychopathology for child molesters. Individuals who molested boys reported significantly more sexual interest in boys and men than did normal subjects or individuals who molested girls. Individuals who molested girls reported less interest in adult women than did normal subjects. Incestuous child molesters admitted to less sexual interest in children than did nonincestuous child molesters. The latter results further support the use of the PSICS as a subjective self-report measure of sexual interest. However, clinicians should be especially cautious about accepting self-reports of deviant sexual interest by child molesters who deny deviant sexual behavior and minimize psychopathology.