CONTENTS
SPECIAL SERIES: A FUTURISTIC LOOK AT BEHAVIOR THERAPY
FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
Introduction: CHRISTOPHER A. KEARNEY
ORIGINAL RESEARCH
 CARA ANN GARDENSWARTZ AND MICHELLE G. CRASKE. Prevention of Panic Disorder
GER P. J. KEIJSERS, MIRJAM KAMPMAN, AND CEES A. L. HOOGDUIN. Dropout Prediction in Cognitive Behavior Therapy for Panic Disorder
PER CARLBRING, BENGT E. WESTLING, PETER LJUNGSTRAND, LISA EKSELIUS, AND GERHARD ANDERSSON. Treatment of Panic Disorder Via the Internet: A Randomized Trial of a Self-Help Program
PETER J. NORTON AND DEBRA A. HOPE. Kernels of Truth or Distorted Perceptions: Self and Observer Ratings of Social Anxiety and Performance
WILLIAM FALS-STEWART, TIMOTHY J. O'FARRELL, AND JILL M. HOOLEY. Relapse Among Married or Cohabiting Substance-Abusing Patients: The Role of Perceived Criticism
MICHAEL S. GRUNES, FUGEN NEZIROGLU, AND DEAN MCKAY. Family Involvement in the Behavioral Treatment of Obsessive-Compulsive Disorder: A Preliminary Investigation
J. GAYLE BECK. Postscript—Closing Editorial Comments
ABSTRACTS
SPECIAL SERIES: A Futuristic Look at Behavior Therapy for Persons With Developmental Disabilities
Christopher A. Kearney, University of Nevada, Las Vegas
This special series is designed to take a futuristic look at behavior therapy for persons, mostly youth, with various types of developmental disabilities. One goal of the special series is to reintroduce readers to areas that they may have overlooked in recent years or relegated to the roles of school psychologists and special education teachers. In addition, the series is meant to help provide a glimpse of how behavior therapy for developmental disabilities will have to evolve in the next few years to retain its utility while simultaneously synthesizing with advances in neurobiology and genetics. Each author provides some "crystal-ball" analysis of what the field of behavior therapy may look like regarding these populations over the next several years. In addition, the challenges that face the field and the questions that must be answered are laid out in detail
Focus on Integration: The Future of the Behavioral Treatment of Autism
Laura Schreibman & Aimee Anderson, University of California, San Diego
The question was posed: What is the future of the behavioral treatment of autism? This paper answers that question by suggesting that integration will be pivotal to the successful treatment of autism in the future. Five main levels of integration are proposed: (a) integration of disciplines (e.g., applied behavior analysis with education, developmental psychology, neuroscience); (b) integration of treatment types (e.g., structured and naturalistic behavior therapy, speech therapy, medicine); (c) integration of the domains of behavior (e.g., language, play, attention); (d) integration of treatment programs (e.g., behavior therapy with school programming, occupational therapy); and, (e) integration of treatment providers (e.g., therapists, teachers and professionals with parents, siblings and peers). Integration is important because it (a) involves the sharing of information, which allows researchers and treatment providers with varying expertise to benefit from one another; (b) helps maximize treatment success by facilitating individualized treatment based on each child's specific characteristics and needs; (c) facilitates effective and efficient teaching; and (d) encourages consistency across treatment programs, settings, and providers.
Future Directions for Children and Adolescents With Mental Retardation
V. Mark Durand, University at Albany
There have been fundamental changes in the way children and adolescents with mental retardation are viewed and treated. And, in the years to come, we will see significant advances in treatment and prevention efforts that will be unprecedented in the history of this field. Leading the way will be the biomedical discoveries about the nature of the differing forms of mental retardation and our ability to intervene. This paper discusses some of these trends, including the impact of the mapping of the human genome and advances in functional genomics and functional proteomics on interventions for genetic disorders. Additionally, the potential roles for behavior therapists in both biomedical as well as behavioral treatments are outlined. It is argued that behavior therapists must play a central role in each of these areas in order to ensure successful implementation and dissemination.
Learning Disability and Behavior Therapy: A Review of Practice and a View to the Future
Elizabeth A. Bredberg & Linda S. Siegel, University of British Columbia
The authors report on their review of the literature published on the use of behavior therapy to assist students with learning disabilities. Three main areas of application are noted: the use of behavior modification techniques to develop fundamental reading skills such as phonological decoding and word identification: the use of cognitive behavior modification to enhance students' productivity and comprehension, and a variety of approaches to deal with the social and emotional problems associated with a learning disability. Conclusions that might have been drawn regarding the utility and applicability of behavior therapy are weakened by the diversity of the practices used to identify students with learning disabilities. The skill-oriented approach that is characteristic of behavior therapy is recognized as particularly well suited for application to a diagnostic approach that focuses on performance rather than on the usual discrepancy between IQ scores and achievement. Future directions should include more focus on appropriate definitions of learning disabilities; training a wide range of specific reading, arithmetic, and spelling skills; developing dynamic, as opposed to the traditional static, assessment techniques; and working more closely with educational personnel directly in the schools.
Serious Emotional Disturbance in Children and Adolescents: Current Status and Future Directions
Linda A. Reddy, Fairleigh Dickinson University
Research indicates low rates of identification, poor school performance and completion, and high rates of restrictive placements, despite federal mandates requiring appropriate educational and mental health–related services for children with serious emotional disturbance (SED). The present paper examines the current status of assessment and treatment needs of children with SED. A synthesis of child characteristics, diagnostic criteria, placement rates, and outcomes is presented. Challenges to appropriate and effective care for children with SED are outlined. Five empirically validated behavioral prevention and intervention models are described as examples of "programs that work" with this population. New frameworks are provided to stimulate future thinking on behavioral assessment and therapy for children with SED. Finally, priorities for professional development and research are described.
The Future of Cognitive and Behavioral Therapies in the Prevention and Early Management of Psychosis: Opportunities and Risks
David J. Kavanagh, University of Queensland, & Kim T. Mueser, Dartmouth Medical School
Behavioral and cognitive interventions for people with psychosis have a long and distinguished history, although the evidence for their application to young people remains limited. We anticipate that the next decades will show substantial research into psychological intervention for this population. Important targets will include the management of environmental stressors, reduction of substance misuse, and promotion of early treatment. Psychological management of positive symptoms, depression, and suicidal behavior will continue to be critical objectives. Important secondary prevention goals will be the retention of cognitive functioning, vocational options, social skills, and social network support, including appropriate family support. We expect primary prevention to include both universal programs and interventions for adolescents at particularly high risk. Technical innovations will include increasing use of Internet-based intervention and behavior cueing devices. Pressures for intervention brevity will continue, as will problems with the systematic delivery of effective procedures.
ORIGINAL RESEARCH
Prevention of Panic Disorder
Cara Ann Gardenswartz & Michelle G. Craske, University of California, Los Angeles
The goal of this study was to empirically test a prevention program for panic disorder. Participants who had experienced at least 1 panic attack in the last 12 months and at least moderate anxiety sensitivity, but did not meet criteria for panic disorder, were randomly assigned to either a 1-day prevention workshop group or a wait-list control group. Participants were followed for 6 months. Relative to the wait-list control, workshop participants were less likely to develop panic disorder and reported significantly more improvement in panic attacks and avoidance of social situations. Satisfaction with the workshop predicted outcome 6 months later. These findings suggests that prevention may be a viable option for panic disorder, and one that warrants further development.
Dropout Prediction in Cognitive Behavior Therapy for Panic Disorder
Ger P. J. Keijsers, Mirjam Kampman, & Cees A. L. Hoogduin, University of Nijmegen
The aim of this study was to attempt to identify reliable factors associated with dropout risk in a sample of 161 panic disorder patients treated with manualized cognitive behavior therapy. Four possible predictors of dropout were selected from the literature: level of education, treatment motivation, personality psychopathology, and initial symptom severity. Thirty-two patients (19.9%) were dropouts. Level of education and motivation were significantly associated with dropout, but the associations were small. Personality psychopathology and initial symptom severity were not associated with dropout. It is concluded that, at present, we are unable to make precise dropout risk predictions, even in a homogeneous group of patients treated using standardized treatment.
Treatment of Panic Disorder Via the Internet: A Randomized Trial of a Self-Help Program
Per Carlbring & Bengt E. Westling, Uppsala University, Peter Ljungstrand, Interactive Institute, University of Gothenburg, Lisa Ekselius, Uppsala University Hospital, & Gerhard Andersson, Uppsala University and Uppsala University Hospital
This controlled study evaluated an Internet-delivered self-help program plus minimal therapist contact via e-mail for people suffering from panic disorder. Out of the 500 individuals screened using the self-administered diagnostic instrument Composite International Diagnostic Interview in shortened form (World Health Organization, 1999), 41 fulfilled the inclusion criteria. These participants were randomized to either treatment via the Internet or to a waiting-list control. The main components of the treatment were psychoeducation, breathing retraining, cognitive restructuring, interoceptive exposure, in vivo exposure, and relapse prevention. From pre- to posttest self-help, participants improved significantly more on almost all dimensions. The results from this experiment generally provide evidence for the continued use and development of self-help programs for panic disorder distributed via the Internet.
Kernels of Truth or Distorted Perceptions: Self and Observer Ratings of Social Anxiety and Performance
Peter J. Norton & Debra A. Hope, University of Nebraska–Lincoln
This study compared self and observer ratings of social performance and anxiety among individuals with social anxiety disorder, nonclinical controls, and participants with dysthymia serving as clinical controls. The purpose was to elucidate whether self-perceptions of individuals with social anxiety disorder reflect observable performance and anxiety differences, negative self-perceptions, or an interaction of the two. Participants engaged in three role-played interactions, and self and observer ratings of performance and anxiety were obtained. In general, self-ratings of anxiety and performance were more negative (greater anxiety and poorer performance) than were observer ratings. Interactions of rating source and diagnosis indicated the discrepancy between self and observer ratings of both anxiety and performance was significantly greater among participants with social anxiety disorder. Observers, however, generally noted differences across the groups in both anxiety and performance. The discrepancy between self and observer ratings of anxiety were related to negative evaluation fears and negative thoughts patterns, while performance discrepancies were related to negative thought patterns. Treatment implications are discussed.
Relapse Among Married or Cohabiting Substance-Abusing Patients: The Role of Perceived Criticism
William Fals-Stewart, University at Buffalo, The State University of New York, Timothy J. O'Farrell, Harvard Medical School and VA Boston Healthcare System, & Jill M. Hooley, Harvard University
The purpose of the present investigation was to examine the contribution of perceived criticism (PC) to the prediction of relapse among married or cohabiting heterosexual male substance-abusing patients (N = 106) entering outpatient treatment. After controlling for sociodemographic variables and substance abuse problem severity, higher levels of patients' PC by their spouses were significantly associated with greater likelihood of relapse, fewer days abstinent, and shorter time to relapse. PC continued to make a significant unique contribution to relapse variables even when level of relationship satisfaction was also controlled.
Family Involvement in the Behavioral Treatment of Obsessive-Compulsive Disorder: A Preliminary Investigation
Michael S. Grunes & Fugen Neziroglu, Bio-Behavioral Institute and Hofstra University, & Dean McKay, Fordham University
The purpose of this study was to examine the effect of family involvement in the behavioral treatment of obsessive-compulsive disorder (OCD). Two groups of OCD patients (14 in each group) received exposure and response prevention (ERP alone) individually from a trained behavior therapist. One group was in a family involvement group (FI), where 1 family member participated in an 8-week family-intervention group for each of the 14 FI patients. In the ERP-alone group, only individual behavior therapy was conducted. Results indicated that patients whose family member was involved in the FI group had a greater reduction in OCD symptoms than patients whose family member was not involved. Patients in the FI group also experienced a greater reduction in depressive symptoms. Furthermore, expressed emotion in treated family members diminished significantly more than those in the ERP-alone group. In addition, anxiety and depression were significantly lower in the family members of the FI group at the end of treatment. These gains were maintained at 1-month follow-up. The study suggests that there is an advantage to inclusion of family members during the behavior therapy of OCD patients.
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