bt33.3

Coercion: The Link Between Treatment Mechanisms in Behavioral Parent Training and Risk Reduction in Child Antisocial Behavior
Lynn Schrepferman and James Snyder, Wichita State University

Coercive parent-child interaction, child oppositional behavior, and parental reinforcement contingencies for child misbehavior were observed before and after treatment in the families of 46 boys referred for serious conduct problems. Reliable pre- to posttreatment reductions in coercive interaction and child noncompliance, and reliable increases in parental reinforcement of constructive child behavior, were found. Posttreatment parental contingencies for coercive child behavior predicted child arrests over the susequent 2 years. Children from families whose observed posttreatment coercive interaction, parental contingencies, and child compliance failed to reach levels observed in nonreferred, normative families were more likely to evidence arrests and out-of-home placement during the 2 years after treatment. The implications of using observational data to identify critical mechanisms that mediate change in child antisocial behavior as a result of behavioral parent training are described in terms of developmental theory, the dosage of intervention, and the development of more powerful intervention for child conduct problems.

Parenting and Child Psychosocial Adjustment in Single-Parent African American Families: Is Community Context Important?

Lisa Armistead, Georgia State University, Rex Forehand and Gene Brody, University of Georgia, and Shira Maguen, Georgia State University
This study addressed two questions about single-parent African American families: Are parenting strategies associated with perceived risks in the environmental context? and Does the association between parenting and child adjustment depend on the context in which parenting occurs? Families (N = 277) resided in 2 communities that differed in violence-related risk: one rural (low risk) and one urban (high risk). Mother-reported monitoring and warm, supportive mother-child relationships and child-reported internalizing problems, externalizing problems, and social competence were examined. Mothers monitored their children more in the urban than the rural community. The warmth and supportive nature of the mother-child relationship did not differ across contexts. A warm, supportive mother-child relationship was associated with fewer internalizing and externalizing child behaviors in both contexts. Monitoring was associated with fewer problem behaviors only in the urban community.

Effectiveness of Community Positive Behavioral Intervention for Persons With Developmental Disabilities and Severe Behavior Disorders
Maurice A. Feldman, Queens University and Ongwanada Centre, Kingston, Ontario, Rosemary A. Condillac, University of Toronto, Susan Tough, York Central Hospital, Richmond Hill, Ontario, Sherril Hunt, Private Practice, Renfrew, Ontario, and Dorothy Griffiths, Brock University

We evaluated the field-effectiveness of positive behavioral intervention for persons with developmental disabilities who displayed severe self-injurious, aggressive, and disruptive behaviors. The multicomponent model included a comprehensive assessment of biomedical and environmental factors, stimulus control, and behavioral function. The intervention package was derived from the assessment findings and included antecedent- and reinforcement-based strategies and mediator training. Using a multiple baseline design across participants and pre-post measures of social validity and quality of life, we found significant decreases in problem behavior and increases in replacement skills in the 20 participants (17 children and 3 adults). Gains were sustained in the 14 participants who received follow-up observations up to 3 years after treatment. Caregivers reported noticeable improvements in the participants' behavior and quality of life. Caregivers were very satisfied with the interventions and rated them as highly acceptable, effective, and nonintrusive. The findings provided support for the field-effectiveness of functional assessment–driven, mediator-implemented, community positive behavioral intervention for persons with developmental disabilities.

Treatment Context and Return of Fear in Spider Phobia
Jayson L. Mystkowski, Michelle G. Craske, and Aileen M. Echiverri, University of California, Los Angeles

Recent research indicates that return of fear occurs when spider-fearful individuals are confronted with the phobic stimulus in a context different than the one used during exposure therapy (Mineka, Mystkowski, Hladek, & Rodriguez, 1999; Rodriguez, Craske, Mineka, & Hladek, 1999). However, limitations regarding fear measurement, lack of real-world context manipulations and statistical power suggest that further investigation is warranted. With these concerns in mind, 46 spider-fearful individuals received a 1-session exposure-based therapy in one of two contexts, and were followed-up 1 week later for fear assessment in the treatment context, as well as in a new context, in a counterbalanced order. Self-report data confirmed the hypothesis that return of fear will appear when individuals are tested for fear in a context different than the treatment context. In addition, changes in perceptions of safety, danger, control, and predictability did not mediate and/or moderate a contextually based return of fear. Limitations of the current study and directions for future study are discussed.

Treatment-Related Changes in Cardiovascular Reactivity to Trauma Cues in Motor Vehicle Accident–Related PTSD
Edward B. Blanchard, Edward J. Hickling, Connie H. Veazey, Todd C. Buckley, Brian Freidenberg, Janine D. Walsh, and Laurie Keefer, Center for Stress and Anxiety Disorders, University at Albany

We have conducted a randomized, controlled trial comparing a combination of cognitive and behavioral treatments (CBT), supportive psychotherapy (SUPPORT), or an assessment-only wait-list (WAITLIST) control. To study psychophysiological reactivity in PTSD we measured heart rate (HR) reactivity to idiosyncratic audiotaped descriptions of the motor vehicle accident (MVA) that the participants had survived, both before and after each of the treatments. Results showed significantly greater reduction in HR reactivity for those receiving CBT (n = 25) than for either those in SUPPORT (n = 26) or WAITLIST (n = 22). The latter two conditions did not differ. There were significant but low-level correlations between changes in CAPS scores and changes in HR reactivity collapsing across all groups.

Is Social Anxiety Associated With Impairment in Close Relationships? A Preliminary Investigation
Joanne Davila and J. Gayle Beck, SUNY Buffalo

We examined the association between social anxiety and interpersonal functioning. Unlike prior research, we focused specifically on close relationships, given the growing evidence of dysfunction in these relationships among people with psychopathology. We proposed that social anxiety would be associated with specific interpersonal styles. One hundred sixty-eight young adults with a range of social anxiety symptoms were interviewed regarding symptom severity, interpersonal styles, and chronic interpersonal stress. Results indicated that higher levels of social anxiety were associated with interpersonal styles reflecting less assertion, more conflict avoidance, more avoidance of expressing emotion, and greater interpersonal dependency. Moreover, lack of assertion and overreliance on others mediated the association between social anxiety and interpersonal stress. Associations held controlling for depressive symptoms. Implications of these findings for interpersonally oriented conceptualizations of social anxiety disorder are discussed.

The Effects of Alcohol Outcome Expectancy on a Carbon-Dioxide Challenge in Patients With Panic Disorder
Cassandra L. Lehman, Timothy A. Brown, Tibor Palfai, and David H. Barlow, Center for Anxiety and Related Disorders, Boston University

This study examined the effects of alcohol outcome expectancy on panic symptoms, subjective anxiety, and heart rate after a 35% carbon dioxide panic challenge in patients with panic disorder after consuming either an alcoholic or placebo beverage. Competing predictors of challenge response included beverage group and anxiety sensitivity. We found that alcohol outcome expectancies predicted severity of self-reported panic symptoms after the challenge, while controlling for alcohol and anxiety sensitivity; participants with greater positive expectancies reported fewer panic symptoms. In addition, participants who drank alcohol reported less subjective anxiety after the challenge, and self-reported anxiety prior to the challenge mediated this relationship; individuals with greater anticipatory anxiety reported greater anxiety after the challenge. Anxiety sensitivity did not predict challenge response. The results suggest that individual differences in alcohol outcome expectancies, as well as pharmacological effects of alcohol use, influence the experience of panic in patients with panic disorder.

Self-Monitoring and the Assessment of Binge Eating
Janet D. Latner and G. Terence Wilson, Rutgers University

Thirty women diagnosed with either bulimia nervosa (BN) or binge eating disorder (BED) kept continuous prospective records of their food intake without receiving additional simultaneous treatment. Compared with the frequency of binge eating assessed during initial structured interviews, participants showed a substantial decrease in their frequency of binge eating during self-monitoring. Average binge-eating frequency fell from 0.91 to 0.40 binge episodes per day. Participants with both disorders reduced their binge eating at similar rates. Half of all participants with BED and 16.6% of those with BN ceased to meet DSM-IV binge-eating frequency criteria for their disorder during the self-monitoring phase. Of participants with BED, 27.8% were abstinent from binge eating during self-monitoring. These findings suggest that self-monitoring of food intake may substantially reduce binge eating in women with bulimia nervosa or binge eating disorder.