ABSTRACTS

Assessing a Smoking Cessation Intervention Involving Groups, Incentives, and Self-Help Manuals

Leonard A. Jason, Susan D. McMahon, DePaul University, Doreen Salina, Northwestern University, Donald Hedeker, University of Illinois at Chicago, Mary Stockton, Katharine Dunson, DePaul University, and Peter Kimball, American College of Health Care Executives, Chicago, Illinois

A media-based worksite smoking cessation program was evaluated. Participants in each worksite received a television program and one of three conditions: 1) self-help manuals alone, 2) self-help manuals and incentives, or 3) maintenance manuals, incentives, support groups, and cognitive behavioral strategies for quitting smoking. During the 6 months following the initial media and group meeting intervention phase, 14 booster meetings were held for participants who had received support groups. The quit-rate among participants who received manuals, incentives, and groups was significantly higher than the quit rate among participants who received the manuals and incentives, or just the manuals. The results indicate that the combination of cognitive behavioral techniques and social support may represent an effective worksite smoking cessation intervention. The significant effect of the group condition 12 months following initial quit efforts is particularly promising.



Conceptual and Methodological Issues in Social Problem-Solving Assessment
Thomas J. D'Zurilla, State University of New York at Stony Brook, and Albert Maydeu-Olibares, University of Illinois at Urbana-Champaign

Several promising instruments are currently available to researchers and clinicians who require a reliable and valid measure of social problem-solving abilities. However, all of these measures have shortcomings and none has definitive, unequivocal support for its construct validity at the present time. The conceptual and methodological issues that are most directly related to the validity of social problem-solving measures were discussed. The strengths and weaknesses of the major current instruments were examined with respect to these issues. Empirical evidence related to convergent and discriminant validity was also reviewed. Recommendations were made for the improvement of these measures as well as the future development of new and better measures of social problem-solving processes and outcomes.



Social Skills Training With Chronic Schizophrenic Patients: Effects on Negative Symptoms and Community Functioning

Robyn L. Hayes, W. Kim Halford, and Francis T. Varghese, University of Queensland

Sixty-three patients with schizophrenia who showed social skills deficits and poor community functioning were assigned randomly to either social skills training (SST) or a discussion group condition. In both treatments, patients met in small groups for 36 sessions of therapy over 4 months, followed by booster sessions of decreasing frequency during the following six months. Social skills, community functioning, quality of life, and positive and negative psychiatric symptoms were assessed at pre- and post-treatment, and at 6-month follow up. Relapse was assessed during the treatment and follow-up phases. Those subjects who completed SST showed greater increases in social skill than subjects who completed the discussion condition, but there were no other significant differences between the conditions. Patients who completed either treatment showed improvements on quality of life and reduced psychopathology. SST alone had limited effect on community functioning.



Special Series: Mechanisms, Populations, and Treatment Innovations in Anxiety Disorders

Lizette Peterson, University of Missouri-Columbia

Seven papers serve as examples of three major research directions in the field of anxiety disorder. Three papers describe mechanisms that underlie anxiety disorders and their treatment, two papers extend past treatment successes to new populations, with important information about different needs in the treatment of minority adults and of adolescents, and two papers describe innovations in the application of treatment, including self-help tools and virtual reality as-in-vivo techniques. The variety of measures, populations, research designs, and treatment techniques characterizes the methodological richness of this field and forecasts an exciting future for cognitive behavioral research on anxiety disorders.



Vagal Tone in Generalized Anxiety Disorder and the Effects of Aversive Imagery and Worrisome Thinking

James D. Lyonfields, T. D. Borkovec, and Julian F. Thayer, The Pennsylvania State University

Vagal tone was assessed in 15 generalized anxiety disorder (GAD) and 15 nonanxious control participants during initial baseline, aversive imagery related to worry topics, worrisome thinking, and final baseline. The GAD group showed significantly lower vagal tone at initial baseline and little change over experimental tasks, suggesting the possibility of chronic reduction in parasympathetic tone. Nonanxious participants, on the other hand, displayed significant decreases in vagal tone from baseline to imagery and further reductions from imagery to worrisome thinking. Participants reported greater anxiety during worry than during aversive images but also greater ease of generation and maintenance of the worrisome thoughts. The results support prior theorizing that GAD is characterized by autonomic inflexibility, that this phenomenon is partly due to deficient parasympathetic tone, and that worrisome thinking in particular causes phasic reductions in vagal tone.



Social Phobia Subtype and Avoidant Personality Disorder: Effect on Severity of Social Phobia, Impairment, and Outcome of Cognitive Behavioral Treatment

Elissa J. Brown, Richard G. Heimberg, and Harlan R. Juster, University at Albany, State University of New York

The relationship between subtypes of social phobia and avoidant personality disorder (APD) and their effects on severity of impairment and outcome of cognitive behavioral treatment were examined. Before treatment, most assessment measures differentiated only between generalized and nongeneralized subtypes of social phobia. Individuals with generalized social phobia were younger when they developed social phobia and achieved higher scores on measures of depression, social anxiety and avoidance, and fear of negative evaluation. During treatment, subjects with generalized social phobia and nongeneralized social phobia improved similarly, but subjects with generalized social phobia remained more impaired after treatment. APD was not predictive of treatment outcome, but several subjects who received a diagnosis of APD before treatment no longer met criteria for APD after treatment.



The Impact of Fear Activation and Anger on the Efficacy of Exposure Treatment for Posttraumatic Stress Disorder

Edna B. Foa, Medical College of Pennsylvania/EPPI, David S. Riggs, National Center for PTSD, The Boston VA Medical Center, Elise D. Massie, and Matthew Yarczower, Bryn Mawr College

This paper explores the hypothesis that fear activation during exposure treatment promotes improvement. Twelve female assault victims diagnosed with posttraumatic stress disorder (PTSD) received treatment that included prolonged repeated reliving of the assault in imagination. Two measures of fear activation were used: facial fear expression coded from videotapes of the first reliving session and the client's highest reported distress score during the same session. The results indicated that clients who evidenced more severe PTSD prior to treatment displayed more intense facial fear expressions during the first reliving of the assault and benefitted more from treatment than did clients who had less severe PTSD and displayed less fear. In contrast, clients who reported more anger prior to treatment tended to display less fear expression during reliving of the trauma and benefitted less from treatment than less angry clients. The relationship of pretreatment PTSD and anger severity to improvement seems to be mediated by fear facial expression and were not simply a product of regression toward the mean of extreme pretreatment scores. The results are discussed within an emotional processing theory of fear.



A Preliminary Study of African Americans With Agoraphobia: Symptom Severity and Outcome of Treatment With in Vivo Exposure

Dianne L. Chambless and K. Elaine Williams, The American University

Eighteen African American and 57 White agoraphobic outpatients were compared on symptom severity. The groups did not differ on severity of depression or fear of fear, or on frequency of panic attacks. However, Black clients were more severely phobic than White clients on self-report, assessor, and behavioral measures. Forty-three White and 15 Black clients provided posttest data after treatment with in vivo exposure. Both Black and White clients improved, but Black clients remained more severe at treatment's end on measures of phobia and changed somewhat less with treatment on these variables. Differences were generally less evident at follow-up, but African Americans did show less change on frequency of panic attacks and on one measure of avoidance.



Cognitive Behavioral Treatment of Panic Disorder With Agoraphobia in Adolescents: A Multiple Baseline Design Analysis

Thomas H. Ollendick, Virginia Polytechnic Institute and State University

In this study, four adolescents with Panic Disorder with Agoraphobia (PDAG) were treated using cognitive behavior therapy. A multiple baseline design across subjects was used to illustrate the controlling effects of treatment. Panic attacks were eliminated, agoraphobic aviodance was reduced, and self-efficacy for coping with future attacks was enhanced as a function of treatment. In addition, heightened levels of anxiety sensitivity, trait anxiety, fear, and depression were reduced to normative levels. Issues related to use of these procedures, and their extension to children, are addressed.



Self-Help Plus Minimal Therapist Contact in the Treatment of Panic Disorder: A Replication and Extension

Robert A. Gould, Massachusetts General Hospital/Harvard Medical School, and George A. Clum, Virginia Polytechnic Institute and State University

A self-help (SH) treatment for panic disorder was compared to a wait-list (WL) control. The SH treatment consisted of reading the book Coping With Panic, watching a 15-minute videotape providing information regarding panic attacks and instruction in diaphragmatic breathing, and being provided with a relaxation tape that taught progressive muscle relaxation. Evidence strongly supported the effectiveness of SH relative to WL both at posttreatment and at 2-month follow-up. The results provide support for the possible treatment of panic disorder with SH methods.



Virtual Reality Graded Exposure in the Treatment of Acrophobia: A Case Report

Barbara Olasov Rothbaum, Emory University School of Medicine, Larry F. Hodges, Rob Kooper, Georgia Institute of Technology, Dan Opdyke, Georgia State University, and James S. Williford, 101st Airborn Division (Air Assault), Fort Campbell, Max North

This is the first case report to test the efficacy of computer-generated virtual reality (VR) for the treatment of acrophobia (fear of heights). The subject was a 19 year-old undergraduate student with at fear of heights, particularly of elevators. Twice weekly, sessions were conducted for 3 weeks, for a total of 5 sessions. Outcome was assessed on measures of anxiety, avoidance, attitude, distress, and included a behavioral avoidance test. VR graded exposure was successful in reducing fears of heights. VR graded exposure is proposed as a new medium for exposure therapy.