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Therapeutic Alliance, Group Cohesion, and Homework Compliance During Cognitive-Behavioral Group Treatment of Social Phobia
Sheila R. Woody and Rhonda S. Adessky, Yale University

Previous research on the role of therapeutic alliance in cognitive behavioral interventions has shown mixed results. Building on the suggestion that the trajectory of the therapeutic relationship may be more predictive of outcome than simple level of alliance, we examined therapeutic alliance, group cohesion, and homework compliance over the course of treatment for 53 socially phobic clients involved in cognitive-behavioral group therapy. Working alliance increased in a linear fashion over the course of treatment, particularly for clients with social fears limited to public speaking. Homework compliance declined linearly, while group cohesion remained static. Curvilinear models did not explain additional variance beyond the linear terms. Notably, treatment outcome was not significantly related to the development of alliance or decline in homework compliance.

Testing for Group Membership Effects During and After Treatment: The Example of Group Therapy for Smoking Cessation
Thaddeus A. Herzog, Amy B. Lazev, Jennifer E. Irvin, and Laura M. Juliano, University of South Florida and H. Lee Moffitt Cancer Center & Research Institute, Paul E. Greenbaum, University of South Florida, and Thomas H. Brandon, University of South Florida and H. Lee Moffitt Cancer Center & Research Institute

Behavioral interventions often are administered in groups, yet the effects of group membership rarely have been evaluated. The current research examined 33 groups of clients (M = 5.5 clients per group, SD = 2.5) volunteering for a group smoking cessation intervention. The intervention consisted of 6 group therapy sessions over an 11-day period. Attendance at the sessions and smoking behavior during the 11-day period were the dependent variables. Hierarchical linear modeling (HLM) revealed a statistically significant (p < .05) degree of interdependence among group members (intraclass correlation = .44 and .32 for attendance and smoking, respectively). Groups were characterized disproportionately by high attendance and infrequent smoking or low attendance and relatively frequent smoking, with fewer moderate groups than would be expected by chance. Group membership effects dissipated within a month following treatment. These findings suggest the need for assessing such effects and for future research examining their causes.

Temporal Information Reduces Children's Pain Reports During a Multiple-Trial Cold Pressor Procedure
Susan E. Coldwell, University of Washington, Seattle, Tarja Kaakko, University of Washington, Seattle, and University of Helsinki, and Anita B. Gärtner-Makihara, Troy Williams, Peter Milgrom, Philip Weinstein, and Douglas S. Ramsay, University of Washington, Seattle

An experiment was conducted to determine whether providing children with information about the time remaining in each of 9 cold pressor trials would modify their pain reports. The study design included an experimental group and 2 control groups. The experimental group was given visual information about time remaining in each cold pressor trial using cartoon images presented on a computer screen. Control groups viewed either no images or randomly presented images. Temporal information reduced children's self-reported pain during short (10 to 15 s) duration cold pressor trials, but did not increase the number of trials completed. This study suggests that providing time-remaining information during brief clinical procedures may decrease children's discomfort.

The Development and Application of Individualized Levels Systems for the Treatment of Severe Problem Behavior
Louis P. Hagopian, Karena S. Rush, David M. Richman, Patricia F. Kurtz, Stephanie A. Contrucci, and Kimberly Crosland, The Kennedy Krieger Institute and The Johns Hopkins University School of Medicine

Behavioral levels systems are commonly used in a variety of settings and are usually applied at the group level to promote socially desirable behavior and compliance with institutional rules. Despite their widespread use, however, there is surprisingly little empirical data supporting the effectiveness of these interventions. In addition, some researchers have suggested that such group-based interventions may not be consistent with laws mandating individualized educational programming. The current investigation examined the effectiveness of individualized levels systems for decreasing severe problem behaviors exhibited by 4 individuals with developmental disabilities. An individualized multilevel system was developed for each participant based on functional analysis and preference assessment results. These interventions were highly effective in decreasing problem behaviors for each participant. For 2 participants, a component analysis was conducted to identify the necessary components of the levels system. Generalization and care provider training were conducted for all participants. The results suggest that levels systems based on functional analysis and preference assessment results can be effectively generalized and implemented by care providers with good treatment integrity. This approach is presented as a potential alternative to the group-based levels systems that are described in the literature and commonly applied in the community.

Testing the Cognitive Model of Eating Disorders: The Role of Dysfunctional Beliefs About Appearance
Diane L. Spangler, Brigham Young University

The cognitive theory of eating disorders posits that dysfunctional attitudes about physical appearance give rise to eating disorder risk factors such as dietary restriction, body dissatisfaction, and valuing of thinness. To test this hypothesis, the relationships between appearance beliefs and dietary restriction, body dissatisfaction, self-esteem, and thin-ideal internalization were examined using structural equation modeling. Beliefs about appearance were concurrently associated with dietary restriction, body dissatisfaction, self-esteem, and thin-ideal internalization, and predicted these variables within each time point and across time points. In contrast, none of the eating disorder risk factors predicted beliefs about appearance either within or across time points. Implications of these results for cognitive theory of eating disorders and eating disorder prevention are discussed.

Physical and Psychological Effects of Written Disclosure Among Sexual Abuse Survivors
Sonja V. Batten, National Center for PTSD, Boston VA Healthcare System, and University of Nevada, Reno, and Victoria M. Follette, Mandra L. Rasmussen Hall, and Kathleen M. Palm, University of Nevada, Reno

Although numerous studies demonstrate the efficacy of writing about stressful events on measures of participants' health, most studies have included psychologically and physically healthy participants. The purpose of the current study was to determine whether writing about stressful or traumatic events would have the same effect with participants who had experienced a significant trauma. The physical and psychological impact of writing about child sexual abuse (CSA) experiences or time management was examined in 61 women (mean age 35.0) who reported a CSA history. Participants completed biweekly telephone interviews for 12 weeks after writing, as well as 12-week follow-up questionnaires. The results indicate that writing about CSA history alone is not sufficient to provide psychological or physical health benefits. As these results diverge from the extant literature, possible reasons for these findings are discussed, along with implications for writing interventions with survivors of significant traumas.

Behavioral Couples Therapy With Alcoholic Men and Their Intimate Partners: The Comparative Effectiveness of Bachelor's- and Master's-Level Counselors
William Fals-Stewart, University at Buffalo, The State University of New York, Gary R. Birchler, Veterans Affairs Medical Center, San Diego, and University of California, San Diego, School of Medicine

The purpose of this study was to examine whether bachelor's-level counselors (N = 4) as compared to master's-level counselors (N = 4) could deliver manualized behavioral couples therapy (BCT) to alcoholic men and their intimate partners (N = 48) with equal compliance and achieve comparable patient outcomes. Male alcoholic patients, being treated in an outpatient program, and their intimate partners were randomly assigned to receive BCT from either a bachelor's-level or a master's-level counselor. Equivalency testing revealed that, in comparison to master's-level counselors, bachelor's-level counselors were equivalent in terms of adherence ratings to a BCT treatment manual, but were rated lower in terms of competence of treatment delivery. However, partners who received BCT from the bachelor's- and master's-level counselors reported equivalent levels of (a) satisfaction with treatment, (b) marital happiness during treatment, and (c) dyadic adjustment and percentage of days abstinent at posttreatment, 3-, 6-, 9-, and 12-month follow-up.

Imaginal Provocation of Panic in Patients With Panic Disorder
Norman B. Schmidt, The Ohio State University, Julie Miller, National Naval Medical Center, Darin Lerew, United States Air Force Academy, and Kelly Woolaway-Bickel and Kathleen Fitzpatrick, The Ohio State University

An imaginal challenge was designed to determine the degree to which cognitive manipulations, in isolation from specific biological challenge agents, might be sufficient for the production of panic in patients with panic disorder. Patients with panic disorder (n = 20) and nonclinical controls (n = 18) were exposed to four audiotaped vignettes (physical threat, social threat, loss of control threat, control). In relation to a composite measure of panic, the experimental vignettes produced panic in 30% of the patient sample compared to 0% of the control sample. There was also evidence for increased subjective reactivity to personally relevant panicogenic stimuli.

Treating a Heterogeneous Set of Anxiety Disorders in Youth With Group Cognitive Behavioral Therapy: A Partially Nonconcurrent Multiple-Baseline Evaluation
Peyton White Lumpkin, Wendy K. Silverman, Carl F. Weems, Michael R. Markham, and William M. Kurtines, Florida International University, Miami

This study Ininvestigated the efficacy of Group Cognitive Behavioral Therapy (GCBT) in the treatment of a heterogeneous set of anxiety disorders in children and adolescents using a partially nonconcurrent multiple-baseline across groups design with 12 clinically referred youth between 6 and 16 years of age who met DSM-IV criteria for an anxiety disorder. Targeted diagnoses included specific phobia, separation anxiety disorder, social phobia, generalized anxiety disorder, and obsessive-compulsive disorder, with 3 of the children also presenting with school-refusal behavior. Duration of baseline for each of the 3 groups varied and ran for 1, 2, or 3 weeks. Dependent measures included diagnostic status, daily child and parent ratings of child anxiety severity, and child- and parent-completed questionnaires. Results indicated that GCBT was generally efficacious in reducing anxious symptoms in youth treated in diagnostically heterogeneous groups, and that gains were generally maintained at 6 and 12 month follow-ups. Findings are discussed in terms of their theoretical and practical implications for the efficient treatment of children and adolescents with anxiety disorders.