bt33.4

Self-Criticism in Generalized Social Phobia and Response to Cognitive-Behavioral Treatment
Brian J. Cox, John R. Walker, Murray W. Enns, and Dianne C. Karpinski, University of Manitoba

Excessive self-criticism is a putative psychological vulnerability for depression, and recent findings suggest it may be important in social phobia as well. The present study investigated the role of self-criticism in predicting outcome to cognitive-behavior therapy for generalized social phobia. Eighty-four patients were assessed before and after treatment using a latent social phobia factor based on six different symptom measures. A hierarchical regression analysis was used to sequentially enter baseline severity of social phobia symptoms, interpersonal dependency (another depressogenic vulnerability), depressed mood state, and changes in the latter two variables in response to treatment. In the final model, change in level of self-criticism over the course of treatment was significantly associated with social phobia outcome. Implications of these findings for understanding psychological processes in social phobia are briefly discussed. Further research is needed to determine whether some social phobia patients with excessive self-criticism might benefit from treatment augmentation to more intensively target their core beliefs about self-worth.

Effects of Cognitive-Behavioral Therapy for Panic Disorder on Comorbid Conditions: Replication and Extension
Jennie C. I. Tsao, University of Florida, Jayson L. Mystkowski, University of California, Los Angeles, Bonnie G. Zucker, Michelle G. Craske, University of California, Los Angeles

Replicating and extending our prior work (Tsao, Lewin, & Craske, 1998), the present study examined the impact of cognitive-behavioral treatment (CBT) for principal panic disorder/agoraphobia (PDA) on the frequency and severity of comorbid conditions in 51 principal PDA patients diagnosed using the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV; Brown, Di Nardo, & Barlow, 1994). Patients with at least 1 additional diagnosis of clinical severity declined from 60.8% (n = 31) at pretreatment to 37.3% (n = 19) at posttreatment, and 35.3% (n = 18) at follow-up. ADIS-IV severity ratings for comorbid generalized anxiety disorder (GAD), depression, and specific phobia also declined significantly following treatment. Reductions in comorbidity were maintained at 6-month follow-up. Baseline comorbidity was not associated with increased severity of PDA at pretreatment and did not adversely impact outcome for PDA immediately posttreatment or at follow-up. Possible mechanisms, as well as implications for clinical practice and policy decisions, are discussed.

Predictors of Response to Problem-Solving Treatment of Depression in Primary Care
Mark T. Hegel and James E. Barrett, Dartmouth Medical School, John E. Cornell, South Texas Veterans Affairs Health Care System, University of Texas Health Science Center, San Antonio, and Thomas E. Oxman, Dartmouth Medical School

Problem-solving treatment of depression is a brief intervention specifically designed for primary care (PST-PC). To date, predictors of an optimal response to PST-PC have not been studied. In primary care, knowing such factors is essential for proper triage decisions. Patient, therapist, and process variables were evaluated for their ability to predict remission of minor depression or dysthymia in patients treated with PST-PC. The most salient predictors of remission were the ability to understand the PST-PC rationale and to apply the PST-PC procedure in early treatment sessions, having a cognitive-behavioral therapist, and, for dysthymia, having a lower depression severity level at baseline. These results provide preliminary evidence of some factors associated with an optimal response to PST-PC and also present challenges for the ability to broadly disseminate the intervention. Modifications to the existing PST-PC training program and directions for future research are discussed.

Clinical Significance Methods: Which One to Use and How Useful Are They?
Joseph B. McGlinchey, David C. Atkins, and Neil S. Jacobson, University of Washington

Clinical significance refers to changes that are clinically meaningful for individuals as they progress through a course of treatment. Since the first method of assessing clinical significance was proposed, a number of alternatives have been suggested, each purporting to increase sensitivity for detecting meaningful change. However, few comparisons have been conducted on these methods, and there is little evidence for any method's predictive validity. This study compares classification rates of five clinical significance methods with participants treated for major depressive disorder (N = 128). It also compares the methods' accuracy in predicting relapse of depression 2 years posttreatment. Although all methods successfully predicted relapse from chance discrimination, no significant differences emerged between methods. Implications for future research are discussed.

Different Types of Experimentally Induced Sad Mood?
Willem Van der Does, Leiden University

Mood-induction procedures have been useful to investigate the role of dysfunctional cognitions in depression. In general, studies have shown that individuals with a history of depression endorse more dysfunctional attitudes following the induction of sad mood than never-depressed individuals. However, a recent study failed to find the expected differences between previously depressed and never-depressed participants. In the present study, two widely used mood-induction procedures were compared to investigate the possibility that different mood inductions lead to different outcomes. Forty-eight participants underwent two types of sad mood induction: focusing on a sad memory while listening to music and watching a movie fragment. Consistent with modern cognitive theory, mood-state dependency of dysfunctional cognitions (cognitive reactivity) was much higher in vulnerable individuals. This effect occurred during both mood inductions. However, the effects of the music induction were somewhat larger, and the correlation between change of mood and cognitive reactivity was significant in this condition only. Some other subtle differences between both procedures were found. In conclusion, although the effects of both inductions were largely similar, the musical induction is more sensitive, and is preferable for research into cognitive dysfunction in depression.

The Role of Emotion in the Psychological Functioning of Adult Survivors of Childhood Sexual Abuse
Brian P. Marx and Denise M. Sloan, Temple University

This study examined the role of two aspects of emotion in the psychological distress of individuals with and without a history of childhood sexual abuse (CSA). It was hypothesized that experiential avoidance and expressivity would mediate the relationship between CSA status and psychological distress. Ninety-nine participants completed measures that assessed for a CSA history, experiential avoidance, emotional expressivity, and psychological functioning. The results indicated that CSA status, experiential avoidance, and emotional expressivity were significantly related to psychological distress. However, only experiential avoidance mediated the relationship between CSA status and distress. These results contribute to the growing body of literature indicating that experiential avoidance has an influential role in the development of psychological symptoms.

Noninfected Children of HIV-Infected Mothers: A 4-Year Longitudinal Study of Child Psychosocial Adjustment and Parenting
Rex Forehand, University of Georgia, Deborah J. Jones, University of Pittsburgh, Beth A. Kotchick, University of Georgia, Lisa Armistead, Georgia State University, Edward Morse, Tulane University, Patricia Simon Morse and Mary Stock, Louisiana State University Medical School

The purposes of this study were to compare, across 4 years, the psychosocial adjustment of noninfected children (ages 6 to 11 at first assessment) whose mothers are and are not HIV-infected, examine differential changes of the two groups of children across the 4 years, and examine the role of parenting on the child's adjustment. Children of HIV-infected mothers reported more depressive symptoms across the four assessments than children whose mothers were not infected. Evidence for differential change of child psychosocial adjustment across assessments for the two groups did not emerge. Parenting variables, particularly the mother-child relationship, were related to child adjustment in both groups. Many of the findings suggest that mothers and children often provide unique perspectives. Prevention and intervention implications are considered.

Evaluating Supervisors in the UCLA Treatment Model for Children With Autism: Validation of an Assessment Procedure
Billie Jo Davis, Washington State University, Tristram Smith, University of Rochester Medical Center, and Patricia Donahoe, Lovaas Institute of New Jersey

We examined the validity of competency measures for supervisors of early, intensive behavioral intervention (EIBI) for children with autism by comparing 26 supervisors and 22 aides on a behavior observation of participants' therapy and written examinations on instructional programming, ability to critique others' therapy, and knowledge of EIBI and autism. A discriminant analysis based on these measures correctly classified 97% of participants into their respective groups. The correct classification rate for the programming examination (95%) exceeded that for the behavior observation (78%), critique (73%), and written examination (88%). The results indicated that the measures had validity and that the program examination was especially useful.