ABSTRACTS

Introduction to the State-of-the-Art Review Series: Research Contributions to Clinical Assessment

Lizette Peterson, University of Missouri-Columbia, and Linda C. Sobell, University of Toronto

This paper introduces the theme for the five State-of-the-Art Reviews (SOARs) that follow. Clinical assessment is presented as an integral part of any behavior therapy intervention. Seven components of assessment are outlined: initial diagnosis and assessment of the treatment context and the client's internal resources, assessment as part of treatment planning, assessment as a method of monitoring treatment progress, and assessment as a method of making decisions about treatment completion and checking on maintenance of treatment gains. Following this introduction, SOARs address assessment and treatment issues in the areas of substance abuse, panic, obsessive-compulsive disorder, eating disorders, and insomnia.



Behavioral Assessment and Treatment Planing for Alcohol, Tobacco, and Other Drug Problems: Current Status With an Emphasis On Clinical Applications

Linda C. Sobell, Tony Toneatto, and Mark B. Sobell, University of Toronto

Clinical assessments serve several important function: (1) they provide a clinical picture of the severity of the problem(s) which then can be used to develop treatment plans tailored to the needs of individual clients; (2) if change is not evident during treatment, ongoing assessment information can be used to make systematic changes in the treatment plan; and (3) progress during and after treatment can be assessed. This paper updates an earlier review, with a continuing emphasis on the clinical utility, cost minimization, and user friendliness of the instruments. The review also adds new sections on (a) clinical tools for assessing psychiatric comorbidity; ( b) alcohol and drug effect expectancies questionnaires; (c) readiness/commitment to change measures; and (d) measures to assess nicotine use. This review is intended to help practitioners identify methods that will be useful and expedient in their assessment and treatment of alcohol and other drug abusers.



Behavioral Assessment and Treatment of Panic Disorder: Current Status, Future Directions

J. Gayle Beck and Barbara J. Zebb, State University of New York at Buffalo

This article reviews the current status of behavioral approaches to the assessment and treatment of Panic Disorder (PD). One goal in writing this article is to facilitate exchange between the science and the practice of behavior therapy for PD. Although current behavioral and cognitive-behavioral treatment interventions for PD show favorable results, this disorder remains fairly common. Prior to reviewing the data from controlled trials of these types of intervention approaches, the presentation and diagnosis of PD is discussed. Additionally, an overview of conceptual accounts of PD is included, as these provide the rationale for current approaches to assessment and treatment. Specific recommendations regarding assessment, treatment planning, progress monitoring, and outcome evaluation are included throughout. As noted, behavioral approaches to PD represent a vital, active area of the field, where many innovations and answers have been forthcoming. This review highlights these recent developments and suggests future directions which would further enhance our knowledge about PD.


Behavioral Assessment and Treatment Planning With Obsessive Compulsive Disorder: A Review Emphasizing Clinical Application

Gail Steketee, Boston University

This paper provides an overview of the current state-of-the-art in behavioral assessment and treatment planning for obsessive compulsive disorder (OCD). New developments in assessment include the availability of the Yale-Brown Obsessive Compulsive Scale and Symptom Checklist for detailed interviewing regarding multiple types of obsessions and compulsions and the self-report Padua Inventory. Cognitive features and personality traits specific to OCD are being examined with increasing frequency. Behavioral treatment methods continue to rely on the highly successful combination of exposure to feared situations and prevention of avoidance and compulsions, with or without serotonergic medications. Several variants of these methods are discussed, including group behavioral treatment and involvement of family members. Cognitive treatments have been increasingly studied with recent positive outcomes reported using this method. It seems likely that efforts to improve treatment efficacy will include assessment that is continued throughout treatment, and focus on personality and associated cognitive features and on interventions involving family members.



Binge Eating Syndromes: A Review of Assessment and Treatment With an Emphasis on Clinical Application

Delia E. Smith, University of Alabama at Birmingham School of Medicine, Marsha D. Marcus, University of Pittsburgh School of Medicine, and Kathleen L. Eldredge, Stanford University School of Medicine

Binge eating is characterized by the ingestion of a large amount of food accompanied by a sense of loss of control and is pathognomonic of bulimia nervosa and binge eating disorder (BED). Research on syndromes of binge eating has burgeoned in the previous decade. This paper reviews the literature on bulimia nervosa and BED, with particular attention to issues of diagnosis, etiology, assessment, and treatment that are relevant to clinicians treating individuals with binge eating syndromes.



Behavioral Assessment and Treatment of Insomnia: A Review With an Emphasis on Clinical Application

Kenneth L. Lichstein and Brant W. Riedel, University of Memphis

We reviewed behavioral and related nonpharmacologic treatments for insomnia, as well as salient diagnostic and assessment issues. The paper evaluates the scientific status of the existing literature, giving greater weight to the literature of the past decade, and offers practical, clinical recommendations for assessment and treatment that derive from the literature. We found that treatments for insomnia, namely relaxation, cognitive behavior therapy, stimulus control, sleep restriction, and sleep hygiene are all effective to varying degrees, and it is both practically feasible and clinically desirable to favor a tailored package treatment approach rather than relying on unitary interventions. Overall, we underscored the importance of comprehensive, developmentally tuned assessment, and we concluded that behavioral treatment of insomnia has demonstrated strong success. Promising areas for future inquiry include comparing nonpharmacologic vs. hypnotic treatments and exploring the utility of very brief and self-help interventions.



Prognostic Factors in the Behavioral Treatment of Panic Disorder With and Without Agoraphobia

Ger P. J. Keijsers, Cees A. L. Hoogduin, and Cas P. D. R. Schaap, University of Nijmegen

Pretreatment and early treatment variables were evaluated as predictors of outcome for the behavioral treatment of panic disorder (PD) with and without agoraphobia. The following variables were examined: severity of agoraphobic complaints, catastrophic agoraphobic cognitions, level of depression, quality of the therapeutic relationship, motivation for treatment, personality psychopathology, and marital dissatisfaction. Sixty patients, diagnosed with PD, received a standardized exposure-based behavioral treatment program. Severity of agoraphobic complaints, level of depression, motivation for treatment, personality psychopathology, and catastrophic agoraphobic cognitions were related to treatment outcome, whereas the quality of the therapeutic relationship and marital dissatisfaction were not. Catastrophic agoraphobic cognitions were the strongest predictor of poorer outcome. Patients frequently distressed by maladaptive cognitions tended to improve less with an exposure-based treatment program. Based on several predictors taken together, 75% to 85% of the patients were correctly classified as treatment failures or treatment successes. A decision model based on multiple prognostic variables may lead to a reliable screening method of PD patients who are unlikely to improve. Treatment programs can then be adapted for these patients.



Restricting Environmental Stimulation (REST) to Enhance Cognitive Behavioral Treatment for Obsessive Compulsive Disorder With Schizotypal Personality Disorder

W. Rand Walker, Robert F. Freeman, and Daniel K. Christensen, Washington State University

Restricted Environmental Stimulation Therapy (REST) was used adjunctively in an imaginal exposure plus response prevention treatment for a subject with Obsessive-Compulsive Disorder (OCD) with comorbid Schizotypal Personality Disorder. An audio loop tape was used as the eliciting stimuli during exposure to REST. Psycholphysiological measures and self reports indicated a substantial reduction of arousal to fear-evoking stimuli, as well as a marked reduction in OCD symptoms. Additionally, imaginal ability and attention to the task appeared to improve in the REST versus non-REST condition in this data-based single case report. Restricted environmental stimulation may enhance the effectiveness of imaginal exposure in patients with treatment refractory OCD.



Functional Analysis and Unsuccessful Treatment of Tourette's Syndrome in a Man With Profound Mental Retardation

Joseph R. Scotti, West Virginia University, Deborah E. Schulman, Catholic Charities, Brockton, MA, and Roxanne M. Hojnacki, Broome Developmental Services, Binghamton, NY

The head and vocal tics of a man with Tourette's syndrome and profound mental retardation were successfully assessed with the Motivation Assessment Scale and an analog functional analysis procedure. The functional analysis revealed that the primary motivation of the tic behaviors was escape from demand situations. A combined intervention of social disapproval and escape extinction was implemented without success. Subsequent administration of haloperidol also failed to decrease the frequency of tic behavior. The functional analysis and intervention results are discussed within the context of the scientist-practitioner model and the need for hypothesis-driven intervention strategies.