CONTENTS

ORIGINAL RESEARCH

KARLA KLEIN, LISA ARMISTEAD, DANIELLE DEVINE, BETH KOTCHICK, REX FOREHAND, EDWARD MORSE, PATRICIA SIMON, MARY STOCK, AND LESLIE CLARK.
Socioemotional Support in African American Families Coping With Maternal HIV: An Examination of Mothers' and Children's Psychosocial Adjustment

CAROL W. METZLER, ANTHONY BIGLAN, JOHN NOELL, DENNIS V. ARY, AND LINDA OCHS.
A Randomized Controlled Trial of a Behavioral Intervention to Reduce High-Risk Sexual Behavior Among Adolescents in STD Clinics

CAROLINE BRAET AND M. VAN WINCKEL.
Long-Term Follow-Up of a Cognitive Behavioral Treatment Program for Obese Children

DEBORAH C. BEIDEL, SAMUEL M. TURNER, KASEY HAMLIN, AND TRACY L. MORRIS.
The Social Phobia and Anxiety Inventory for Children (SPAI-C): External and Discriminative Validity

MATTHEW R. SANDERS AND MARGARET MCFARLAND.
Treatment of Depressed Mothers With Disruptive Children: A Controlled Evaluation of Cognitive Behavioral Family Intervention

JAN MOHLMAN AND RICHARD E. ZINBARG.
What Kind of Attention Is Necessary for Fear Reduction? An Empirical Test of the Emotional Processing Model

GLENN D. WALTERS.
Behavioral Self-Control Training for Problem Drinkers: A Meta-Analysis of Randomized Control Studies

ANTONIO CEPEDA-BENITO, DAVID H. GLEAVES, TARA L. WILLIAMS, AND STEPHEN A. ERATH.
The Development and Validation of the State and Trait Food-Cravings Questionnaires

KATHERINE N. DUHAMEL, JAMIE S. OSTROFF, DANA H. BOVBJERG, MERAV PFEFFER, BENJAMIN J. MORASCO, ESPERANZA PAPADOPOULOS, AND WILLIAM H. REDD.
Trauma-Focused Intervention After Bone Marrow Transplantation: A Case Study

Socioemotional Support in African American Families Coping With Maternal HIV: An Examination of Mothers' and Children's Psychosocial Adjustment

Karla Klien, Lisa Armistead, Danielle Devine, Beth Kotchick, Rex Forehand,
Edward Morse, Patricia Simon, Mary Stock, and Leslie Clark

This longitudinal study examined the functions of socioemotional support among 205 African American mothers and children who reside in a low-income inner city environment. Approximately one-third of participating mothers were HIV-infected. Results indicated that HIV-infected women and their children endorsed receiving lower levels of socioemotional support than noninfected women and their children. More social and emotional support from neighbors and friends was associated with less psychological distress of both HIV-infected and noninfected women. More socioemotional support from the mother was associated with less depressive mood and disruptive behavior among all children. Some evidence indicated that higher levels of emotional support received by mothers from children was associated with greater psychological distress in mothers. With few exceptions, the HIV status of the mother did not qualify the relationship between socioemotional support and psychosocial adjustment. Thus, socioemotional support appeared to serve as a resource factor, rather than a protective factor, among these families. The current results tentatively indicate that families facing these stressors may benefit from clinical services enhancing mothers' access to socioemotional support from other adults.



A Randomized Controlled Trial of a Behavioral Intervention to Reduce High-Risk Sexual Behavior Among Adolescents in STD Clinics

Carol W. Metzler, Anthony Biglan, John Noell, Dennis V. Ary, and Linda Ochs, Oregon Research Institute

A five-session behavioral intervention to reduce risky sexual behavior was evaluated in a randomized controlled trial, in which 339 adolescents, ages 15 to 19 years, were recruited in public sexually transmitted disease clinics and randomly assigned to receive the intervention or usual care. The intervention targeted (a) decision-making about safer sex goals, (b) social skills for achieving safer sex, and (c) acceptance of negative thoughts and feelings. Compared to the control group at 6-months follow-up, treatment participants reported fewer sexual partners, fewer nonmonogamous partners, and fewer sexual contacts with strangers in the past 3 months, and less use of marijuana before or during sex. Treated adolescents also performed better on a taped situations test of skill in handling difficult sexual situations. Strongest intervention effects were for male and nonminority youth. Further research is needed to develop interventions with strong, durable effects across gender and ethnic groups that can be delivered cost-effectively within existing service systems.



Long-Term Follow-up of a Cognitive Behavioral Treatment Program for Obese Children

C. Braet and M. Van Winckel, University of Gent

This study presents a 4.6-year follow-up of children treated for obesity. The primary goal of the treatment program was to prevent further weight gain. In setting this modest goal, we wanted to avoid the type of dietary restraint that has been linked to the development of eating disorders. A cognitive-behavior modification (CBM) program was designed to help the child change his or her lifestyle, to enhance self-regulation skills and specific problem-solving skills in different eating situa-tions. Three active CBM treatment interventions were compared (group therapy, individual therapy, and summer camp) to an "advice in one session." At pretest, the mean age was 11 years (SD = 2.5). Mean percentage overweight was 55% (SD = 21); all subjects were at least 20% overweight. Data from 109 children were available at the 4.6 year follow-up, representing 80.1% of the original sample. At follow-up, 72 subjects (71.6%) showed no further increase in percentage overweight. This does not mean that these obese youngsters had become thin. In this study 18% of the obese children were no longer obese (<20% overweight) and 29% of the subjects had become moderately obese (20% to 40% overweight). The obese youngsters showed a mean reduction of their overweight of -11%; the mean overweight was still 42%. Eating behavior was evaluated in a subgroup of the obese children (N = 53) and a stabilization of abnormal eating behavior was noted within the subscales of the Dutch Eating Behavior Questionnaire. Using the Eating Disorder Inventory, 5 adolescents (9%) had an at-risk score on the bulimia subscale. Taking into account the pessimistic prognosis for obese adults, the trends found here are more optimistic, at least for half of the obese children.



The Social Phobia and Anxiety Inventory for Children: External and Discriminative Validity

Deborah C. Beidel, Samuel M. Turner, and Kasey Hamlin, Medical University of South Carolina
Tracy L. Morris, West Virginia University

Psychometric properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C) were determined using a sample of 254 children. External validity was examined by comparing children's SPAI-C scores with (a) independent observers' ratings of skill and anxiety in social interaction and social performance tasks and (b) parental report of social anxiety. Discriminative validity was determined by examining the ability of the SPAI-C to differentiate children with social phobia from those with other anxiety disorders. Finally, race and differences were examined. The results indicated that SPAI-C scores for the entire sample differed by gender but not by race. However, African American children with social phobia had significantly lower scores than Caucasian children with this disorder. Regarding external validity, SPAI-C scores correlated significantly with parental reports of children's social fears and with independent observer ratings of behavioral skill. Finally, SPAI-C scores successfully differentiated children with social phobia from children with other anxiety disorders. The results are discussed in terms of the SPAI-C's external and discriminative validity and children's performance based on race and gender.



Treatment of Depressed Mothers With Disruptive Children: A Controlled Evaluation of Cognitive Behavioral Family Intervention

Matthew R. Sanders and Margaret McFarland, The University of Queensland

This study compared the effects of two forms of behavioral family intervention in reducing mothers' depression and disruptive behavior problems in families with a clinically depressed parent and a child with significant conduct problems. Forty-seven parents were randomly assigned to either a Behavioral Family Intervention (BFI) or to Cognitive Behavioral Family Intervention (CBFI) which integrated cognitive therapy strategies to treat depression and teaching of parenting skills. Both treatments were equally effective in reducing mothers' depression and child disruptive behavior on observational and self-report measures at postintervention. However, at 6-month follow-up more families in CBFI (53%) compared to BFI (13%) experienced concurrent clinically reliable reductions in maternal depression and child disruptive behavior. These findings support the value of CBFI in reducing depression in mothers of children with disruptive behavior problems.



What Kind of Attention Is Necessary for Fear Reduction?
An Empirical Test of the Emotional Processing Model

Jan Mohlman and Richard E. Zinbarg, University of Oregon

Attention to feared stimuli is believed to facilitate the process of exposure-based fear reduction. However, researchers have disagreed about the importance of cognitive focus during exposure and empirical investigations have yielded inconsistent results. This study was an attempt to clarify the role of visual and cognitive attention to feared stimuli during exposure. Seventy-two spider-fearful participants focused visually on either a fear-relevant or irrelevant stimulus, while also focusing cognitively on either of these stimuli during a brief exposure session. Participants who processed fear-relevant information visually and cognitively showed the most efficient and greatest reduction on behavioral approach task ratings than the other three groups, whose patterns of reduction were highly similar. The group that focused on fear-relevant information in both modalities also reported a significantly greater degree of perceived fear reduction than the other three groups.



Behavioral Self-Control Training for Problem Drinkers: A Meta-Analysis of Randomized Control Studies

Glenn D. Walters, Federal Correctional Institution, Schuylkill, Pennsylvania

A review of the literature uncovered 17 studies that have employed a randomized control design to investigate the efficacy of behavioral self-control training for problem drinking. A meta-analysis of these 17 studies showed that behavioral self-control training was superior to no intervention and alternative nonabstinence-oriented interventions in reducing both alcohol consumption and problematic drinking. The results of this meta-analysis also favored behavioral self-control training over traditional abstinence-oriented treatment, but the effect size fell short of statistical significance. Additional analyses found self-control training to be equally effective for use with alcohol-dependent and problem-drinking subjects and for follow-ups spanning several months to several years. The implications of these results for interventions with alcohol-abusing clients are discussed.



The Development and Validation of the State and Trait Food-Cravings Questionnaires

Antonio Cepeda-Benito, David H. Gleaves, Tara L. Williams, and Stephen A. Erath, Texas A&M University

We describe three studies on the development and psychometric properties of state and trait versions of a multidimensional Food Cravings Questionnaire (FCQ-S and FCQ-T). In Study 1, we used confirmatory factor analysis to help refine the instruments. Results indicated good internal consistency for both questionnaires and their respective subscales, as well as excellent test-retest reliability for the FCQ-T. In Study 2, we examined the validity of the instruments by comparing the effect of food deprivation versus food satiation on both questionnaires. As hypothesized, we found a greater effect on the state measure than the trait measure. In Study 3, we used confirmatory factor analysis to cross-validate the factor structure of both questionnaires with a new sample. Results supported the factor structure of both instruments. Overall, we suggest that cravings can be conceptualized as multidimensional motivational states. Our preliminary data support the use of the FCQ-S and FCQ-T with clinical and nonclinical populations.



Trauma-Focused Intervention After Bone Marrow Transplantation: A Case Study

Katherine N. DuHamel, Mount Sinai School of Medicine
Jamie S. Ostroff, Memorial Sloan-Kettering Cancer Center
Dana H. Bovbjerg, Merav Pfeffer, and Benjamin J. Morasco, Mount Sinai School of Medicine
Esperanza Papadopoulos, Memorial Sloan-Kettering Cancer Center
William H. Redd, Mount Sinai School of Medicine

This paper describes the use of a Trauma-Focused Intervention (TFI) to reduce symptoms of posttraumatic stress disorder (PTSD) in a 40-year-old man who was 2 years and 11 months post–bone marrow transplantation (BMT) for leukemia. Prior to the TFI, the patient had flashbacks to BMT and reported physical sensations such as sweating and chills triggered by reminders of this treatment. A preintervention diagnosis of PTSD was confirmed using the Structured Clinical Interview for DSM-IV (SCID). After 10 TFI sessions including general and cancer BMT-specific information about PTSD, relaxation training, cognitive coping strategies, systematic desensitization, and relapse prevention, the patient no longer had a PTSD diagnosis. At 6-month follow-up, improvements were maintained, confirmed by the SCID. Using statistical analysis for a single case design, TFI was also found to significantly decrease distress and PTSD symptoms on self-report measures (as indicated with the Brief Symptom Inventory and Posttraumatic Stress Disorder Checklist-Civilian), and to improve quality of life (Medical Outcome Survey). Results are discussed in terms of this specific cognitive-behavioral treatment for BMT survivors with PTSD and the relevance of such interventions in the oncology treatment setting, where the possibility of retraumatization is a realistic patient concern.