bt34.1

Psychometric Properties of the Sutter-Eyberg Student Behavior Inventory–Revised With Preschool Children
Jane G. Querido and Sheila M. Eyberg, University of Florida

This study evaluated the reliability and validity of a revised teacher rating scale of disruptive behavior with preschool-aged children. The Sutter-Eyberg Student Behavior Inventory–Revised (SESBI-R) was completed by teachers of 74 nonreferred preschoolers and 49 children referred for evaluation of behavior problems, age 3 to 6. Results of the study demonstrated satisfactory internal consistency, test-retest stability, and inter-teacher agreement, as well as the absence of systematic bias in scores over repeated administration. Analyses also showed no differences in SESBI-R scores by children's age, gender, or ethnicity. Evidence of convergent, discriminant, incremental, and discriminative validity was demonstrated, in addition to criterion validity for the factor scores of the SESBI-R. The results of this study suggest that the SESBI-R is a promising instrument for measuring classroom behavior problems in preschoolers.

Amending the Fear-Avoidance Model of Chronic Pain: What Is the Role of Physiological Arousal?
Peter J. Norton, University of Nebraska-Lincoln, and Gordon J. G. Asmundson, Regina Health District

This article outlines an amendment to current fear-avoidance models of chronic pain. These models propose that fear and avoidance behavior contribute significantly to the development and maintenance of chronic pain and related functional limitations. Fear is typically expressed in three response domains, including cognitive, behavioral, and physiological. To date, however, fear-avoidance models of chronic pain have focused primarily on the role of the cognitive and behavioral responses to the relative exclusion of the physiological response domain. This paper describes how states of physiological arousal resulting from autonomic nervous system activation may influence fear of pain and avoidance behavior and thereby contribute to the maintenance of chronic pain. Clinical implications and future research directions are discussed.

The Relevance of Age of Onset to the Psychopathology of Generalized Anxiety Disorder
Laura A. Campbell, Timothy A. Brown , and Jessica R. Grisham, Center for Anxiety and Related Disorders, Boston University

The present study sought to clarify the relevance of age of onset to the psychopathology of generalized anxiety disorder (GAD) using a large clinical sample of 154 patients with DSM-IV GAD. Most patients reported onset of GAD by early adulthood, although a smaller proportion of cases emerged in middle adulthood. Structural equation and regression models tested predictions that earlier onset GAD would be characterized by different levels of stress at disorder onset, disorder severity, lifetime comorbidity, and traits that predispose individuals to emotional disorders. Results showed that cases of GAD that emerged without any precipitating stressors were more likely to be of earlier onset. However, another sizable group of patients with earlier-onset GAD identified severely stressful early environments that they linked to the emergence of GAD symptoms. In contrast, cases of GAD that began in adulthood were most likely to emerge in the context of mild to moderate stress. Further analyses revealed that earlier-onset GAD was associated with higher levels of disorder severity, comorbidity, and temperamental vulnerability to emotional disorders. These results are discussed in regard to their clinical and conceptual implications for anxiety disorders.

Effects of Cognitive Behavioral Treatment on Physical Health Status in Patients With Panic Disorder
Norman B. Schmidt, The Ohio State University, Beth T. McCreary, Johns Hopkins Bloomberg School of Public Health, John. J. Trakowski and Helen T. Santiago, Uniformed Services University of the Health Sciences, Kelly Woolaway-Bickel, The Ohio State University, and Nicholas Ialongo, Johns Hopkins Bloomberg School of Public Health

The relationship between panic disorder and nonpsychiatric medical illness is complex, but some evidence suggests that panic disorder increases risk for a variety of nonpsychiatric medical conditions. Given the demonstrated efficacy of cognitive behavioral therapy (CBT) for panic disorder, we were interested in evaluating the effects of CBT for panic disorder on nonpsychiatric medical symptoms among these patients. Patients were randomized to a 12-week group administered CBT protocol (n = 22) or a delayed-treatment control (n = 24). Treated patients showed marked improvement in both anxiety symptoms and physical health symptom ratings that were evident at midtreatment and were maintained through a 6-month follow-up period. Despite comparable rates of change, changes in anxiety symptoms did not appear to mediate the relationship between treatment and improved physical health ratings. These findings indicate that CBT appears to have an immediate and long-term beneficial impact on physical health and that this effect is independent from its impact on anxiety symptoms.

Long-Term Follow-Up of Computer-Aided Vicarious Exposure Versus Live Graded Exposure in the Treatment of Spider Phobia
Lisa J. Gilroy, Kenneth C. Kirkby, and Brett A. Daniels, University of Tasmania, Ross G. Menzies, University of Sydney, and Iain M. Montgomery, University of Tasmania

This study investigated the long-term efficacy of three 45-minute sessions of live-graded exposure, computer-aided vicarious exposure, or progressive muscle relaxation placebo for the treatment of spider phobia, and is a follow-up of the results previously reported by Gilroy, Kirkby, Daniels, Menzies, and Montgomery (2000). Forty-two out of 45 participants were assessed, using both subjective and behavioral assessments, at a mean of 33 months after completing treatment. The assessor was unaware of treatment group. Results showed significant improvement from pretreatment to 33-month follow-up across a range of measures in all treatment groups, although the group by time interaction was not statistically significant. Between 3-month and 33-month follow-up, no significant change was observed in any group, indicating sustained long-term improvement. The results support previous reports of the long-term efficacy of live-graded exposure and indicate similar durable treatment outcome effects for computer-aided vicarious exposure.

Cognitive Behavioral and Supportive Group Treatments for Partner-Violent Men
Tanya M. Morrel, Jeffrey D. Elliott, Christopher M. Murphy, and Casey T. Taft, University of Maryland, Baltimore County

The study examined the relative efficacy of cognitive-behavioral group therapy (CBT) and supportive group therapy (ST) for partner-violent men at a community agency. Eighty-six men were assigned and exposed to ST or CBT. Outcome analyses, based on participant reports at pre- and posttreatment, collateral partner reports at pre, post, and 6-month follow-up, and criminal justice data gathered 2 to 3 years after treatment, revealed no significant differences between ST and CBT on the primary outcomes of partner aggression and arrests. Across conditions, clients showed significant decreases in physical assault, psychological aggression, and injuries, significant increases in self-esteem and self-efficacy for abstaining from partner aggression, and significant movement on stage-of-change scales. ST clients had significantly greater increases than CBT clients on two secondary outcome variables: negotiation tactics and self-efficacy for abstaining from verbal aggression. Neither partner reports of criminal recidivism nor criminal data revealed significant treatment condition differences. The findings failed to demonstrate an added benefit of behavioral group interventions over the effects of a supportive group treatment experience for partner-violent men.

Anxiety-Based Cognitive-Behavioral Therapy for Paranoid Beliefs
Follin Armfield Key, Michelle G. Craske, and Rochelle M. Reno, University of California, Los Angeles

Seven patients with chronic paranoid schizophrenia or schizoaffective disorder, in remission from substance dependence, received 8 sessions of cognitive-behavioral treatment (CBT) aimed at reducing their conviction in paranoid beliefs and associated anxiety (both measured on a 0% to 100% scale). Treatment was modeled on established CBT treatments for anxiety and included psychoeducation, relaxation training, and cognitive restructuring. Starting with neutral situations and gradually addressing paranoid situations, participants were taught to generate and evaluate alternative explanations for events. Participants were assigned diagnoses using the SCID-IV. They were assessed at baseline, posttreatment, and 1-month follow-up using interview, self-report, and cognitive measures. A multiple-baseline-across-subjects design was used. Results indicated clinically significant improvement by 3, mixed results for 1, and no change for 3.

Using Hypnosis to Facilitate Direct Observation of Multiple Tics and Self-Monitoring in a Typically Developing Teenager
Karola Dillenburger, The Queen's University of Belfast, and Mickey Keenan, University of Ulster at Coleraine

Hypnotic induction was used to facilitate direct observation of multiple tics in a typically developing teenager in a home setting. A comprehensive habit-reversal program then was implemented, including awareness training, competing response training, relaxation training, self-monitoring, social support, and contingency management. Duration of relaxation was then self-monitored using a changing criterion design. The procedure eliminated multiple tics and achieved long-term maintenance of treatment gains. Implications for assessing and treating tics are discussed.