ABSTRACTS

Violence in Youth: Where Do We Go From Here? Behavior Therapy's Response

Thomas H. Ollendick, Virginia Polytechnic Institute and State University

Violence in America is widespread and affects many aspects of our daily lives. This paper reviews one form of violence in America, youth violence, and examines the extent and scope of the problem and its associated challenges. In addition to alarming rates of mortality, especially for minority youths, considerable morbidity is associated with youth violence. Many youths who experience or witness violence develop posttraumatic stress disorder or related cognitive, affective, and behavioral problems. Following a review of these sequelae to violence, attention is directed toward the multiple interacting and transacting causes of violence, including biological, physiological, chemical, behavioral, psychological, sociological, economical, and political determinants. In response to these multiple influences, cognitive and behavior therapists have developed a range of intervention and prevention programs that have proven useful and effective, at least in the short run. Yet we must do more. The development of new programs that are developmentally sensitive, ecologically valid, and that build on a solid functional analysis of violent behavior in society is proposed.



Validation of the Minor Injury Severity Scale: Expert and Novice Quantification of Minor Injury

Lizette Peterson, Naamith Heiblum, and Lisa Saldana, University of Missouri-Columbia

This article investigates the validity of the Minor Injury Severity Scale (MISS) as a behavioral, objective measure of injury-induced tissue damage. The MISS is a scale that allows a coder to quantify the physical signs of an injury (e.g., bleeding, swelling) for 22 different kinds of minor injury. Intercoder reliability of the MISS, as well as experts' and novices' ratings of ease of use, accuracy, and applicability were examined. Severity rankings made by school nurses with extensive experience assessing and treating injuries served as the criterion. Nurses' severity rankings on an open-ended Visual Analogue Scale (VAS) and the MISS were compared with the VAS and MISS rankings of laypersons having no previous medical training. These data suggest that the MISS has adequate construct validity and is more reliable than the VAS for layperson use. In addition, the majority of coders found the MISS to be easier to use, to be more accurate, and to have more practical applicability than the VAS, irrespective of medical expertise. Limitations of this study and future potential applications of the MISS are also discussed.



The Dual Pathway Model Differentiates Bulimics, Subclinical Bulimics, and Controls: Testing the Continuity Hypothesis

Eric Stice, Stanford University, Chris Ziemba, Joy Margolis, and Penny Flick, Arizona State University

Although research suggests that the dual pathway model of bulimia predicts bulimic symptoms, it has not been applied to diagnostic levels of this disorder. This study first tested whether bulimics differed from controls on the variables composing this etiologic model. Second, because there is some debate as to whether the predictors of subclinical and clinical levels of eating pathology differ, this study also tested whether the variables composing the dual pathway model were able to differentiate subclinical bulimics from both controls and bulimics. Female bulimics, subclinical bulimics, and controls were compared on body mass, ideal-body internalization, body dissatisfaction, dietary restraint, perceived pressure to be thin, and negative affect. Bulimics reported elevated scores on all but one of the variables composing the dual pathway model, and subclinical bulimics differed from both controls and bulimics on most constructs. A discriminant function analysis indicated that the three groups lay along a single continuum. Results suggest that the dual pathway model applies to diagnostic levels of bulimia and support the continuity perspective of eating pathology.



Effect of Social Feedback on Learning Rate and Cognitive Distortions Among Women With Bulimia

Linda Wilcoxon Craighead, University of Colorado at Boulder, Heather N. Allen, University of North Carolina at Chapel Hill, W. Edward Craighead, University of Colorado at Boulder, and Ruth DeRosa, Duke University

A group of college women diagnosed with bulimia nervosa and past depression (n=15) were compared to women with no bulimia and past depression (n=46) and women with no bulimia and no past depression (n=88) on their rate of learning and cognitive distortions on a computerized mental maze task. Half of the participants in each group were randomly assigned to receive positive social feedback for correct responses during the learning task and half to receive negative social feedback for errors. Participants with bulimia (and past depression) receiving negative feedback learned the task at a significantly faster rate (p<.03) than those receiving positive feedback, who learned at the same rate as all no-bulimia control groups. It was suggested that participants with bulimia nervosa learned the task unusually quickly in order to minimize the particularly salient negative social feedback they were receiving.



Treatment of Generalized Anxiety in Older Adults: A Preliminary Comparison of Cognitive-Behavioral and Supportive Approaches

Melinda Stanley, University of Texas Health Sciences Center at Houston, J. Gayle Beck, State University of New York at Buffalo, and Jill DeWitt Glassco, University of Houston

Generalized Anxiety Disorder (GAD) in older adults has received little attention from researchers, despite evidence that anxiety disorders are a significant mental health problem in this population. This study compared the efficacy of cognitive behavior therapy (CBT) and nondirective, supportive psychotherapy (SP) for 48 older adults, ages 55 and up, with well-diagnosed GAD. Treatments were administered in small groups that met for 14 weekly 1 ½ hour sessions. Treatment effects were assessed at posttreatment and over a 6-month follow-up period. Primary outcome variables targeted anxiety and worry, and transfer effects were assessed with measures of depression and associated fears. Two composite indexes of treatment response were derived to identify treatment responder status and high endstate functioning. Two participants declined participation prior to randomization; 15 others were classified as drop-outs. Results for the remaining 31 participants (CBT: n=18; SP: n=13) demonstrated significant improvements on primary outcome and transfer effect variables in both treatment conditions. Effect sizes generally were large, and treatment gains were maintained or improved over the 6-month follow-up phase. Examination of treatment responder status and endstate functioning revealed no significant differences between groups. The data support the potential efficacy of psychosocial group treatment for GAD in older adults, although limitations of the work and suggestions for future research are discussed.



Variants of Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: A Meta-Analysis

Jonathan S. Abramowitz, The University of Memphis

Consistent findings suggest that exposure and response prevention (ERP) procedures are highly effective in treating obsessive-compulsive disorder (OCD). However, the studies that have reported success with this intervention have employed numerous variations in treatment procedures. Four general variations have been (1) whether the exposure sessions were supervised by the therapist or conducted by the patient on his or her own, (2) whether in vivo or imaginal exposure was used, (3) whether exposure stimuli were presented, beginning with the least or the most anxiety-evoking, and (4) whether response prevention involved the complete or partial abstinence from ritualizing. Whereas a few authors have addressed the relative efficacy of these procedural variations within single studies, results have been largely equivocal. We employed meta-analytic methods to quantitatively examine the degree of symptom improvement associated with the aforementioned variations of ERP. A total of 38 trials from 34 controlled and uncontrolled studies were included in the meta-analysis. Effect sizes were calculated as the standardized within-group change from pre- to posttreatment, a procedure that varies from traditional meta-analytic methods and likely yielded inflated estimates of treatment efficacy. Our results suggested that therapist-supervised exposure was more effective than self-controlled exposure. Further, the addition of complete response prevention to exposure was associated with better outcome than partial or no response prevention. In reducing symptoms of anxiety, the combination of in vivo and imaginal exposure was superior to in-vivo exposure alone. Findings are discussed in terms of advancing the effectiveness of ERP in the treatment of OCD.



Functional Assessment of Behaviors Related to Attention-Deficit/Hyperactivity Disorder: Linking Assessment to Intervention Design

George J. DuPaul, Lehigh University, and Ruth A. Ervin, Western Michigan University

A variety of behavioral interventions are effective in ameliorating the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in children. Unfortunately, the diagnosis of ADHD does not provide clinicians with sufficient information to determine specific interventions to use with an individual child. Functional assessment procedures have been successfully used to design effective treatment plans for individuals exhibiting symptoms of a variety of behavior disorders. An overview of functional assessment procedures is provided and evidence that such procedures can lead to effective treatment decisions for children with ADHD is reviewed. Finally, the advantages and limitations of presently available functional assessment methods for clinical use in the treatment of ADHD are discussed.



A Radical Behavioral Understanding of the Therapeutic Relationship in Effecting Change

William C. Follette, Amy E. Naugle, and Glenn M. Callaghan, University of Nevada, Reno

This paper presents a behavior analytic understanding of the functional components of the therapeutic relationship. Whereas other models of understanding therapy have offered interpretations of the importance of the client-therapist alliance, few have specified mechanisms responsible for mediating change that have a foundation in experimental psychology. Consistent with the radical behaviorally based Functional Analytic Psychotherapy (FAP), we describe, using a contemporary understanding of verbal behavior, how the therapist establishes him or herself as a provider of social reinforcement in order to shape change using contingent and noncontingent responding. We propose a reason why a limited amount of client-therapist contact can produce large changes in behavior. The paper closes with a description of a research strategy for evaluating the proposed model of effecting client change as a function of the therapeutic relationship.