bt32.3

Treatment Effects of Cognitive Processing Therapy on Cognitive Distortions of Female Child Sexual Abuse Survivors
Gina P. Owens, Julie L. Pike, Kathleen M. Chard, University of Kentucky

Fifty-three female adults with a history of child sexual abuse (CSA) were assessed to determine whether Cognitive Processing Therapy for Sexual Abuse (CPT-SA) affects cognitive distortions. CPT-SA is a 17-week manualized treatment designed to alleviate cognitive distortions as well as symptoms of PTSD and depression. At the initial assessment, 28 subjects were assigned to treatment, while 25 subjects entered a minimal-attention condition. Participants were assessed at pretreatment, posttreatment, 3-month follow-up, and 1-year follow-up. The authors examined the correlation between PTSD severity, subscales of the Personal Beliefs and Reactions Scale (PBRS), and higher-order scales of the World Assumptions Scale (WAS). Most PBRS subscales were significantly correlated with PTSD severity at all assessment periods. Paired samples t tests indicated significant differences between pretreatment and posttreatment severity of distortions on both the PBRS and WAS for participants completing treatment. No significant differences in distortions were found between postassessment, 3-month follow-up, and 1-year follow-up points.

The Relationship of Child Worry to Cognitive Biases: Threat Interpretation and Likelihood of Event Occurrence
Lourdes Suarez and Debora Bell-Dolan, University of Missouri-Columbia

Worry, the cognitive component of anxiety, has been related to cognitive processing biases in adults. However, the relationship of child worry to cognitive biases has been largely unexplored. The present study examined this relationship. Worry in a community sample of 277 5th- and 6th-grade children was assessed with the Penn-State Worry Questionnaire for Children (Chorpita, Tracey, Brown, Collica, & Barlow, 1997). The Children's Opinions of Everyday Life Events (COELE) was designed to measure children's threat interpretation biases. Children's responses to worry-relevant vignettes were used to assess interpretation of ambiguous and threatening situations, degree of perceived threat, degree of situation-specific worry, and perceived likelihood of future occurrence. Results suggested strong relationships between child worry and threat interpretation biases. Compared to nonworriers, worriers interpreted both ambiguous and threatening situations as more threatening, expressed more worry in response to the events, and judged the events to have a higher probability of happening to them in the future. Temporal stability was only moderate, perhaps reflecting worry and cognitive biases as more variable phenomena in a community sample. Theoretical, clinical, and research implications of the findings are discussed.

The Effects of Maternal Modeling and Negative Familial Communication on Women's Eating Attitudes and Body Image
Jessica C. Kichler and Janis H. Crowther, Kent State University

This research examined negative familial communication as a moderator of the relationship between maternal modeling and daughters' eating attitudes and body image after controlling for Body Mass Index (BMI) and family environment. Participants were 103 college-aged women and their mothers. Following informed consent, mothers and daughters completed the demographic questionnaire, the Negative Familial Communication items, the Body Shape Questionnaire (BSQ; Cooper, Taylor, Cooper, & Fairburn, 1987), and the Eating Attitudes Test (EAT; Garner & Garfinkel, 1979). Daughters also completed the Family Environment Scale (FES; Moos & Moos, 1986). Three components comprised the maternal modeling variable: past and present dieting behaviors, body image dissatisfaction, and maladaptive eating attitudes and behaviors. Results indicated that negative familial communication moderated the relationship between maternal modeling and daughters' eating attitudes and body image; the influence of maternal modeling was significant at high levels of negative familial communication but not at low levels of negative familial communication. These results may clarify the equivocal findings with respect to modeling in past research and suggest that negative familial communication should be assessed when examining the role of modeling in the development of eating- and weight-related disturbances.

Cost-Effectiveness Analysis of a Hospital-Based Cognitive-Behavioral Treatment Program for Eating Disorders
Donald A. Williamson and Jean M. Thaw, Louisiana State University and Pennington Biomedical Research Center, and Paula J. Varnado, Southeastern Louisiana University

This outcomes-management study evaluated the cost-effectiveness of a hospital-based cognitive-behavioral treatment program for eating disorders. The study found that by using a systematic, decision-tree approach to treatment, patients with severe eating disorders could be treated effectively by initiating treatment in a partial day hospital program, with less cost than when treatment was initiated at an inpatient level of care. The average cost saving of this approach was $9,645 per case. The rate of recovery for the entire sample was 63% at 12-month follow-up and did not differ as a function of initial level of care. Patients who were treated with a shorter duration of illness and at an older age of onset had the best response to treatment. A longer duration of illness was associated with higher levels of eating disorder symptoms and higher levels of depression, which suggests that the early intervention may be more effective because treatment can begin at a lower level of psychopathology.

An Interpersonal Problem Approach to the Division of Social Phobia Subtypes
Kevin E. Kachin, Michelle G. Newman, and Aaron L. Pincus, The Pennsylvania State University

In the DSM-IV, social phobia has been subdivided into a generalized and a nongeneralized subtype. Although a number of important quantitative distinctions have been identified between the subtypes, most studies have failed to find support for qualitative differences between them. The goal of the present study was to determine whether the investigation of interpersonal problems in social phobia would lead to qualitatively different subgroups, subgroups that would provide additional nonoverlapping information to the DSM-IV classification. Thirty generalized socially phobic, 30 nongeneralized socially phobic, and 30 nondisordered control participants were selected based on dual structured interviews. All participants completed the Inventory of Interpersonal Problems Circumplex Scales (IIP-C; Alden, Wiggins, & Pincus, 1990). Results showed that when social phobia subtypes were classified using the DSM-IV definition, the IIP-C reflected subgroup differences in global severity of interpersonal problems, with the generalized social phobia group evidencing the greatest difficulty. However, the subgroups could not be discriminated on core or central interpersonal problems. In contrast, when an interpersonal analysis of subtype classification was employed, two groups were formed, each with discriminating core unifying features suggesting qualitatively different problematic reactions to interpersonal situations. One group evidenced interpersonal problems related to hostile, angry behavior, whereas the other group exhibited problems related to friendly - submissive behavior. Interpersonally derived subtypes were unrelated to DSM-IV defined subtypes, depression, and Axis I or avoidant personality disorder comorbidity. The potential clinical relevance of an assessment of interpersonal dysfunction to the treatment of social phobia is discussed.

Effects of Worry and Progressive Relaxation on the Reduction of Fear in Speech Phobia: An Investigation of Situational Exposure
Holly Hazlett-Stevens and T. D. Borkovec, Pennsylvania State University

Previous research has demonstrated the facilitative effects of relaxation and inhibitory effects of worry on the emotional processing of imaginal fear exposures. The present study was designed to determine whether these same effects occur in the emotional processing of in vivo exposures to feared stimuli. Forty-two speech-anxious college students were randomly assigned to one of three experimental induction conditions. Participants engaged in either progressive muscle relaxation, a neutral control procedure, or worry immediately before each of five repeated speech presentations while heart period and self-reported fear were monitored. Relative to the relaxation condition, the worry group demonstrated greater subjective anxiety across exposures, despite the fact that all three groups displayed strong and equivalent cardiovascular response to the first speech presentation and showed equivalent heart rate decreases across the repeated presentations. The role of parasympathetic activity in fear reduction was also documented, with decreased parasympathetic activity occurring during initial fear exposure and increased activity across repeated presentations. Implications for the role of relaxation and worry during real-life exposure to feared social situations are discussed.

A Mediational Model Relating Affect Intensity, Emotion Inhibition, and Psychological Distress
Thomas R. Lynch, Clive J. Robins, Jennifer Q. Morse, and Elizabeth D. Krause, Duke University

A growing empirical literature suggests that attempts to suppress, inhibit, or avoid private experience (e.g., thoughts, feelings) can be problematic. The purpose of this study was to examine a model in which inhibition of thoughts and emotion was predicted to mediate the relationship between the trait of negative affect intensity and acute psychological distress. Two studies evaluated the model using structural equation modeling procedures: one in a clinical sample and the other in a nonclinical sample. Support for the model was found in both studies, indicating its generalizability. These results provide further evidence for the notion that avoiding or inhibiting cognitive and emotional experience may be a particularly problematic coping style, which is more likely to be engaged in by emotionally intense individuals who are vulnerable to psychological distress.

Cognitive-Behavior Therapy for Medically Unexplained Symptoms: A Critical Review of the Treatment Literature
Arthur M. Nezu, Christine Maguth Nezu, and Elizabeth R. Lombardo, MCP Hahnemann University

Research has indicated that substantial numbers of physical or medical symptoms presented by patients remain unexplained medically. For example, studies have indicated that less than 25% of physical complaints presented to physicians have known or demonstrable organic or biological causes. Cognitive-behavior therapy (CBT) provides for a potentially effective means of impacting on this significant public health problem, both medically and psychologically. This paper reviews the extant literature regarding CBT for medically unexplained symptoms, as well as three related disorders - chronic fatigue syndrome, fibromyalgia, and noncardiac chest pain. Whereas this review provides support for the efficacy of CBT for such problems (e.g., effect sizes for CBT compared to control conditions centered around .40), it also identified a variety of methodological limitations regarding the studies themselves. Based on this analysis, recommendations for future research endeavors are provided and the implications of this area for prevention and treatment are offered.

Treating Low-Income and African-American Women With Posttraumatic Stress Disorder: A Case Series
Ulrike Feske, University of Pittsburgh School of Medicine

The present uncontrolled case series was designed to examine the feasibility of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) with low-income and African-American women. Five of 10 eligible women completed PE and showed significant improvements in symptoms of PTSD, general anxiety, and depression. Clinical observations suggest that the addition of interventions aimed at improving interpersonal problems might lead to a more complete recovery in this population of women with complex trauma and psychiatric histories and that a priming intervention focused on teaching affect-regulation skills might enhance the effectiveness of PE. The removal of structural barriers (e.g., lack of transportation and child care) appears to be necessary in order to boost the benefits of traditional treatment interventions in disadvantaged women.

A Systematic Evaluation of Stimulus Preference, Response Effort, and Stimulus Control in the Treatment of Automatically Reinforced Self-Injury
Carole M. Van Camp, Louisiana State University, Timothy R. Vollmer, University of Florida, and Dency Daniel, Children's Seashore House

Environmental enrichment (EE) was evaluated as treatment for the automatically reinforced self-injurious behavior (SIB) of a 13-year-old male diagnosed with autism. First, a functional analysis determined that the participant's SIB persisted in the absence of social consequences. Next, EE was implemented as treatment and various components of the intervention were manipulated. The results suggested that three factors were correlated with increased EE efficacy: stimulus preference, response effort, and inhibitory stimulus control.