ABSTRACTS

Cost-Benefit and Cost-Effectiveness Analyses of Behavioral Marital Therapy With and Without Relapse Prevention Sessions for Alcoholics and Their Spouses

Timothy O'Farrell, Keith A. Choquette, Henry S. G. Cutter, Elizabeth Brown, Rogelio Bayog, William McCourt, Judith Lowe, Alfredo Chan, and Paul Deneault, Harvard Families and Addiction Program, Harvard Medical School Department of Psychiatry, Veterans Affairs Medical Center

Fifty-nine couples with a newly abstinent alcoholic husband, after participating in weekly behavioral marital therapy (BMT) couples sessions for 5 to 6 months, were randomly assigned to receive or not to receive 15 additional conjoint couples relapse prevention sessions over the next 12 months. Costs of treatment delivery and health and legal service utilization were measured for the 12 months before and 12 months after BMT. Cost-benefit analysis results for both standard BMT and for the longer and more costly form of BMT with the additional RP sessions showed (a) decreases in health care and legal costs after, as compared to before, treatment, (b) positive cost offsets, and (c) benefit to cost ratios greater than 1, indicating that health and legal system cost savings (i.e., benefits) exceeded the costs of delivering the BMT treatments. In fact, cost savings from reduced utilization were more than 5 times greater than the cost of delivering the standard 5- to 6-month BMT program. Although adding RP to BMT led to less drinking and better marital adjustment, it did not lead to greater cost savings in health and legal service utilization. A trend for subjects with higher baseline costs to incur lower costs at follow-up if they received BMT plus RP suggested additional cost savings from RP may come only for more severe problem patients who have a history of high utilization of services. Cost-effectiveness analyses indicated that BMT only was more cost-effective than BMT plus RP in producing abstinence from drinking, but the 2 treatments were equally cost-effective when marital adjustment outcomes were considered. Since BMT only was actually less effective than BMT plus RP in producing abstinent days, it was the lower cost of BMT only that produced its greater cost-effectiveness in relation to abstinence. Study limitations are discussed.



Children's Perceptions of Peer Influence on Eating Concerns

Krista K. Oliver and Mark H. Thelen, University of Missouri at Columbia

This study explored how children's perceptions of peer influence were associated with their eating and body image concerns and how children's eating concerns and perceptions of peer influence differed by grade and gender. Children's perceptions of peer messages (e.g., being teased about one's weight), peer interactions (e.g., talking about food or dieting), and peer likability (i.e., the belief that being thin will increase how much peers like them) were measured with the Inventory of Peer Influence on Eating Concerns. This inventory, along with the Body Image and Eating Questionnaire, and 3 scales of the Eating Disorder Inventory for Children, were administered to third- and fifth-grade children (n=264). Results indicated that likability was the major contributor in predicting eating and body concerns; messages and likability related significantly with the eating and body image concern measures; and girls reported more eating-related concerns than boys. Results are discussed in terms of the potential role that peers play in children's eating-related disorders.



Contingent Use of Take-Homes and Split-Dosing to Reduce Illicit Drug Use of Methadone Patients

Michael Kidorf and Maxine L. Stitzer, The Johns Hopkins University School of Medicine

This study tested a novel treatment intervention for illicit drug use that combines positive and aversive incentives. Sixteen chronic polydrug abusing methadone maintenance patients who had not responded to our usual take-home incentive program were randomly assigned to one of two treatment groups. While in the experimental care condition, patients received a take-home following each drug-negative urine (free of opiates, cocaine, and benzodiazepines as detected by EMIT) and were placed on a split-dose following each drug-positive urine. While in the control condition, patients participated in a standard care protocol in which they could not earn take-homes or be placed on split-dose. Patients receiving a split-dose were required to attend the clinic on two separate occasions (morning and evening) to receive their full daily methadone dose. After two months, patients crossed over to the alternative treatment condition for another two months. Results demonstrated that patients, while exposed to the experimental care condition, submitted significantly more drug-free urines (M=29%) than when studied in standard care (M=9%) or at baseline (M=12%). Twenty-eight percent of patients (n=5) showed marked improvements in drug-free urines during the experimental intervention as compared with control or baseline conditions. The combination of take-homes and split-dosing appears to help some polydrug abusing patients initiate and sustain abstinence.



What Does "High Risk" Mean? A PsycINFO Scan of the Literature

Steve Sussman, Thomas R. Simon, University of Southern California, Shirley M. Glynn, West Los Angeles VA Medical Center, and Alan W. Stacy, University of Southern California

Recent health research has emphasized the study of high risk variables without consensus regarding different meanings of the term high risk. We provide a categorization scheme for this concept that includes prediction of consequence variables from antecedent variables in different contexts. Different antecedent-consequence combinations (notions of high risk) across a variety of health research contexts are described based on a search of PsycINFO entries from 1985 to 1990. Investigators apparently limit their notions of high risk by specific research areas. We discuss the potential usefulness of the category scheme for providing a conceptual framework which bridges different research domains, or at least reduces the likelihood of misuse of the term.



Effect of Cognitive Behavior Therapy on Persons With Body Dysmorphic Disorder and Comorbid Axis II Diagnoses

Fugen Neziroglu, Dean McKay, John Todaro, and Jose A. Yaryura-Tobias, Institute for Bio-Behavioral Therapy and Research

A study was conducted to determine the effect of intensive cognitive behavior therapy on body dysmorphic disorder (BDD) and to investigate the presence of comorbid personality disorders in this population. Seventeen patients diagnosed with BDD participated. They all received 4 weeks of daily 90-min sessions of cognitive behavior therapy. During treatment they were exposed to their perceived physical defect and prevented from engaging in behaviors that reduce their discomfort. The majority of the patients were preoccupied with their nose and complexion, and, consequently, they frequently checked their defective body parts, looked in the mirror, and avoided social interaction. At the end of treatment there was a significant decrease in their preoccupation and time engaged in the above behaviors. As for the personality disorders, the mean number of personality disorders was 6. The most common personality disorders were avoidant, obsessive compulsive, borderline, self-defeating, and dependent.



Issues Related to Social Anxiety Among Controls in Social Phobia Research

Stefan G. Hofmann and Walton T. Roth, Stanford University School of Medicine and Veterans Affairs Medical Center, Palo Alto, California

Twenty-four social phobic individuals and 22 nonphobic controls participated in an interview and questionnaire study. By applying the same criterion that was used in a previous study, both phobics and controls were retrospectively subdivided into groups with or without generalized social fear, yielding four groups: nongeneralized phobics (n=9), generalized phobics (n=15), nongeneralized controls (n=10), and generalized controls (n=12). The four groups differed in the severity ratings of their social anxiety. Generalized controls scored as high as nongeneralized phobics. These two groups showed lower scores than generalized phobics and higher scores than nongeneralized controls. A comparison with scores reported in other studies indicated that the nongeneralized controls can be characterized as "supernormal," and generalized controls as "subclinical." The results illustrate problems related to the use of control groups in social phobia research.



Parental Involvement in the Treatment of Childhood Obsessive-Compulsive Disorder: A Multiple-Baseline Examination Incorporating Parents

Lenna S. Knox, Anne Marie Albano, and David H. Barlow, Center for Stress and Anxiety Disorders, University at Albany, State University of New York

The efficacy of exposure and response prevention and the potential contribution of parental involvement in treatment were investigated for four children with principal DSM-III-R diagnoses of obsessive compulsive disorder (OCD) referred to the Center for Stress and Anxiety Disorders, Child and Adolescent Fear and Anxiety Treatment Program. Monitoring consisted of parent and child diaries of obsessive compulsive symptoms and daily child Subjective Units of Distress (SUDS) ratings for a 10-item hierarchy. Children progressed in a multiple baseline fashion through four phases: baseline monitoring, exposure and response prevention, exposure and response prevention plus parent involvement, and maintenance. Results through 12-month follow-up suggest that exposure and response prevention with parent involvement shows promise in the treatment of childhood OCD.



Suffocation False Alarms and Efficacy of Cognitive Behavioral Therapy for Panic Disorder

Steven Taylor, Sheila Woody, William J. Koch, Peter D. McLean, and Kent W. Anderson, University of British Columbia

Cognitive behavioral therapy (CBT) is an effective treatment for many but not all patients with panic disorder. This raises the question of whether there are types of panic disorder for which CBT is effective, and other types for which it is ineffective. Klein's (1993) suffocation alarm theory suggests two types of panic disordered patient: those with intense dyspnea as a frequent panic symptom (suffocation panickers) and those with little or no dyspnea (nonsuffocation panickers). Klein's theory suggests CBT will be less effective for suffocation panickers compared to nonsuffocation panickers. To test this prediction, 22 unmedicated panic-disordered patients were classified as suffocation panickers (n=13) or nonsuffocation panickers (n=9) and received 10 sessions of CBT. Both groups had significant reductions in symptoms from pre- to posttreatment, and gains were maintained at 3-month follow-up. Groups did not differ in treatment response. At 3-month follow-up 75% of suffocation panickers, and 50% of nonsuffocation panickers were panic-free, and 75% of suffocation panickers and 63% of nonsuffocation panickers were classified as treatment responders. These results fail to support the prediction from Klein's theory and suggest that panic disorder with intense dyspnea can be successfully treated with CBT.