Social Phobia: Effects of External Attention on Anxiety, Negative Beliefs, and Perspective Taking

Adrian Wells and Costas Papageorgiou, University of Manchester

When entering anxiety-provoking social situations, individuals with social phobia tend to shift attention inward, toward the self. This tendency is likely to diminish the potential for exposure to correct negative beliefs and associated anxiety. The present study tested the hypothesis that by shifting to an external attention focus on disconfirmatory information, the effectiveness of brief exposure is increased. This hypothesis was tested in a single-case series of 8 socially phobic patients. Following an initial behavior test, half of the patients received one session of exposure alone followed by one session of exposure plus external attention focus, while the other half of the patients received these sessions in reversed order. Both conditions were rated as equally credible. Exposure plus external attention focus was significantly more effective than exposure alone in reducing within-situation anxiety and belief in feared catastrophes. Moreover, the attention condition produced a shift from an observer to a field perspective in patients' images of the feared social situation. A manipulation-check measure of degree of self-focused attention confirmed that the attention manipulation had influenced self-focus as intended. The role of attention manipulations in the treatment of social phobia is discussed.



The Influence of Weight-Related Variables on Smoking Cessation

J. Scott Mizes, Philadelphia College of Osteopathic Medicine, Denise M. Sloan, Kathleen Segraves, Case Western Reserve University, School of Medicine–MetroHealth Campus, Bonnie Spring, Regina Pingitore
Finch University of Health Sciences/The Chicago Medical School, and Jean Kristeller, Indiana State University

Recently, researchers have suggested the possible importance of weight-related variables, particularly among women, in relapse to smoking. The present study prospectively examined the prediction of success versus failure (both relapse and dropout) in a smoking-cessation program using several weight-related variables and gender. Weight-related variables accounted for a significant amount of variance in the prediction of dropout from a cessation program. The interaction of gender with Body Mass Index (BMI) and gender with concern about postcessation weight gain also accounted for a significant amount of variance in dropout. Particularly, women who were lower in weight and women who were concerned about postcessation weight gain were more likely to drop out of a cessation program before completion than the other participants in the study. Results also indicated that people who have chronic weight concern and gain weight during a cessation attempt were more likely to drop out of a cessation program before completion than individuals with chronic weight concern and little to no weight gain during the quit attempt. Prediction of relapse to smoking during the cessation program was not very revealing. One finding that did emerge was that, among those who completed the study and did not drop out, men were twice as likely to relapse as were women. These results indicate the importance of weight-related variables, particularly among women, in the prediction of success in a cessation program. Findings also suggest that dropout may be more revealing in predicting failure in a cessation program than relapse to smoking in terms of the influence of weight-related issues.



Analysis of Social Behavior in Individuals With Social Phobia and Nonanxious Participants Using a Psychobiological Model

Kenneth S. Walters and Debra A. Hope, University of Nebraska-Lincoln

This study sought to test hypotheses derived from Trower and Gilbert's (1989) psychobiological/ethological model of social anxiety. This model purports that social anxiety should be characterized by less social cooperation and dominance and greater submission and escape/avoidance. Individuals with social phobia and nonanxious participants completed a structured social interaction. Behavioral measures related to cooperativeness, dominance, submissiveness, and escape/avoidance were coded by independent observers. Those with social phobia exhibited fewer behaviors of social cooperativeness and dominance than did nonanxious participants. The groups did not differ with regard to submissive and escape/avoidance behaviors. Two dominance behaviors correlated with a self-report measure of social anxiety. Implications for the Trower and Gilbert model and for social anxiety theory and treatment are discussed.



The Relationship Between Maternal HIV Status and Child Depressive Symptoms: Do Maternal Depressive Symptoms Play a Role?

Heather Biggar and Rex Forehand, University of Georgia

Family Health Project Research Group

This study examined whether maternal depressive symptoms serve as a mediator, moderator, or both, between maternal HIV status (absence vs. presence of HIV) and child depressive symptoms. Participants were 224 noninfected children, ages 6 to 11, and their mothers, 38% of whom were HIV-infected. Initial analyses indicated that HIV-infected mothers and their children reported more depressive symptoms than noninfected mothers and their children. The primary analyses suggested that maternal depressive symptoms differed between HIV-infected and noninfected groups. Explanations for the findings are offered and implications for prevention and intervention programs are considered.



Effects of Cognitive-Behavioral Treatment for Panic Disorder with Agoraphobia on Concurrent Alcohol Abuse

Cassandra L. Lehman, Timothy A. Brown, and David H. Barlow, Center for Anxiety and Related Disorders, Boston University

Research has shown that panic disorder with agoraphobia (PDA) and alcohol abuse co-occur frequently. One theory suggests that alcohol consumption is motivated by the goal of tension reduction and that "self-medication" will decrease with successful treatment of the anxiety disorder as more adaptive coping skills are employed by the patient. The present study is a series of case studies (N = 3) examining the effects of a cognitive-behavioral treatment for PDA on concurrent alcohol abuse. At posttreatment, two patients reported a remission of PDA while the third patient had a decline, but not a remission in the severity of PDA. All patients had diagnoses of alcohol abuse in early full remission at posttreatment. At 6-month follow-up, one patient continued to have no clinical diagnoses, one patient had a clinical diagnosis of PDA but no alcohol abuse, and one patient had clinical diagnoses of PDA and alcohol abuse. Suggestions for future research with this population are discussed.



Statistical and Reliable Change With Eye Movement Desensitization and Reprocessing: Treating Trauma Within a Veteran Population

Grant J. Devilly, Susan H. Spence, University of Queensland, and Ronald M. Rapee, Macquarie University

Fifty-one war veterans with posttraumatic stress disorder symptomatology were randomly allocated to one of three conditions: two sessions of eye movement desensitization and reprocessing (EMDR), an equivalent procedure without EMDR, or a standard psychiatric support control condition. There was an overall significant main effect of time from pre- to posttreatment, with a reduction in symptomatology for all groups. However, no statistically significant differences were found between the groups. Participants in the two treatment conditions were more likely to display reliable improvement in trauma symptomatology than subjects in the control group. By 6-month follow-up, reductions in symptomatology had dissipated and there were no statistical or reliable differences between the two treatment groups. Overall, the results indicated that, with this war veteran population, improvement rates were less than has been reported in the past. Also, where improvements were found, eye movements were not likely to be the mechanism of change. Rather, the results imply that other nonspecific or therapeutic processes may account for any beneficial effects of EMDR.



Perceived Control as a Mediator of Family Environment in Etiological Models of Childhood Anxiety

Bruce F. Chorpita, University of Hawaii, Timothy A. Brown, and David H. Barlow, Center for Anxiety and Related Disorders at Boston University

Recent developments in cognitive and emotion theory emphasize the importance of cognitive dimensions related to control and helplessness. Drawing from evidence in the area of control and explanatory style, the present study used a cross-sectional design to evaluate structural models investigating the relation of perceived control and attribution to family environment, negative affect, and clinical disturbance. It was hypothesized that the anxiogenic and depressogenic influences of a controlling family environment on negative affect would be mediated by cognitive dimensions. A mixed clinical and nonclinical sample of 93 children and their families was assessed, and findings suggested superior fit for the model in which the dimension of perceived control mediated between family environment and negative affect. The findings are discussed with respect to models of the etiology of childhood anxiety.



Role of Parent-Mediated Pain Behavior Management Strategies in Biofeedback Treatment of Childhood Migraines

Keith D. Allen and Mark D. Shriver, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center

This study explored the use of parent-mediated pain behavior management strategies as an adjunct to the biofeedback treatment of children with migraine headaches. Twenty-seven children, ages 7 to 18, presenting with migraine headaches were randomly assigned to either a biofeedback treatment group or a biofeedback treatment group that included pain behavior management guidelines for parents. Both groups demonstrated significant reductions in headache activity. The group receiving parent-mediated pain management guidelines, however, evidenced significantly greater reductions in headache frequency, were more likely to experience clinically significant improvements, and were more likely to be headache-free. In addition, the group that received parent-mediated pain management guidelines reported children who demonstrated better adaptive functioning during treatment and at 3-month follow-up. The addition of parent-mediated pain behavior management guidelines are supported as an important adjunct to the clinical management of migraine headaches in children.



The Effects of Caloric Deprivation and Negative Affect on Binge Eating in Obese Binge–Eating Disordered Women

W. Stewart Agras, and Christy F. Telch, Stanford University

Sixty obese women meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) research criteria for binge-eating disorder were randomly allocated either to a 14-hour period of caloric deprivation or to no deprivation. These women were then randomized within each deprivation condition to an induced negative or neutral mood before being served a multi-item buffet. Negative mood, but not caloric deprivation, significantly increased loss of control over eating. For self-defined binges, negative mood, but not caloric deprivation, significantly increased the occurrence of binge eating. However, for investigator-defined binges, both deprivation and negative mood increased the occurrence of binge eating. Caloric deprivation also led participants to eat significantly more during the buffet, but not over the laboratory day. Fat intake was significantly higher in both self-defined and investigator-defined binges as compared to overeating episodes. For those in the negative mood condition, anxiety had significantly declined by the end of the buffet.



Changing Health Behavior Via Telecommunications Technology: Using Interactive Television to Treat Obesity

Jean Harvey-Berino, University of Vermont

This study compared a 12-week behavioral weight-control treatment program conducted over interactive television (N = 133) to a standard therapist-led (in-person) treatment condition (N = 33). Subjects started treatment with an average Body Mass Index (BMI) of 34.9 and lost 7.7 kg over 12 weeks with no difference between conditions noted for weight loss, calorie (-622 calories per day), or exercise changes (+ 970 calories expended per day). Ratings of the technology were positive and there was no difference in subjects' expectations for change, nor was there any difference by treatment condition in overall attrition. A cost-effectiveness analysis showed that the per-person cost of the interactive technology was higher.



A Psychoeducational Approach to the Treatment of Depression: A Meta-analysis of Lewinsohn's "Coping With Depression" Course

Pim Cuijpers, Trimbos-institute, Netherlands Institute for Mental Health and Addiction

The Coping With Depression course is a cognitive behavioral treatment for unipolar depression. The psychoeducational format allows this intervention to be used in several ways, for example, in bibliotherapy, primary prevention, relapse prevention, and treatment of specific populations. Possibly, depressed individuals who otherwise would not seek treatment can be reached with this course because of the nonstigmatizing format and active recruitment. In a literature search 20 studies on the effects of one of the several forms of the Coping With Depression course were found. An important limitation is that few of the 20 studies made direct comparisons between the effects of the course and those of other psychological and pharmacological interventions. The results of a meta-analysis indicate that this course is an effective therapy for unipolar depression, with effect sizes that are comparable to those of other treatment modalities for depression.