bt34.2

A Brief Cognitive-Behavioral Intervention for Patients With Noncardiac Chest Pain
Jeanne L. Esler, David H. Barlow, Robert H. Woolard, Robert A. Nicholson, Justin M. Nash, and Mert H. Erogul, Brown University

This study assessed whether the addition of a brief (60-minute) CBT intervention delivered in an emergency department improved outcomes for patients seeking services there for noncardiac chest pain. Patients (N = 59) were recruited after their medical evaluation and randomized to CBT intervention (involving psychoeducation, diaphragmatic breathing exercises, and cognitive restructuring about physical symptoms) or treatment-as-usual control. The principal hypothesis that the CBT group would show greater improvement relative to controls was partially supported. The CBT group demonstrated a greater decrease in frequency of chest pain episodes, anxiety sensitivity, and fear of cardiac symptoms at 1- and 3-month follow-up assessments, although there were no differences on chest pain severity, cardiac-related avoidance or attention, quality of life, or general psychological distress.

Anxiety and Depression Change Together During Treatment
Jacqueline B. Persons, San Francisco Bay Area Center for Cognitive Therapy and University of California, Berkeley, and Nicole A. Roberts and Christine A. Zalecki, University of California, Berkeley

Anxiety and depression frequently co-occur and are viewed by many theorists as aspects of a unitary disorder. In contrast, the diagnostic nomenclature views anxiety and depression as discrete disorders, and current protocols for anxiety and depression treat the disorders separately. To test the hypothesis (based on the unitary view) that anxiety and depression are tightly related and change together over the course of treatment, we monitored week-by-week changes in symptoms of anxiety and depression in 58 outpatients treated naturalistically in private practice with cognitive-behavior therapy. Results were more supportive of a unitary than a discrete view, and showed that anxiety and depression were highly predictive of one another over the course of treatment. These findings lend support to a view of anxiety and depression as more unitary than discrete, and suggest the need to consider changes in the diagnostic nomenclature and in treatment strategies for anxious depressed patients.

The Effect of Trainee Experience in Psychotherapy on Client Treatment Outcome
Kimberly A. Driscoll, Kelly C. Cukrowicz, Lorraine R. Reitzel, Annya Hernandez, Scharles C. Petty, and Thomas E. Joiner, Jr., Florida State University

Some psychotherapy research demonstrates that client outcome is unrelated to therapist experience. Experience is generally defined by either the degree that the therapist holds, or the total number of months the therapist has been conducting therapy. Few studies address the amount of trainee experience in relation to client outcome, and few use fine-grained indices of experience (e.g., hours of therapy). To address these points, the current study evaluated the relation between trainee experience and client outcome in a training clinic in which empirically validated treatments were used. Results demonstrated that client outcome was significantly related to total number of client contact hours. The importance of training therapists to be experts in the implementation of well-defined therapeutic techniques is discussed.

Are Waiting-List Control Groups Needed in Future Marital Therapy Outcome Research?
Donald H. Baucom, University of North Carolina–Chapel Hill, and Kurt Hahlweg and Annett Kuschel, Technische Universitaet of Braunsweig

Behavioral couple therapy (BCT) is an efficacious treatment for maritally distressed couples. The current article includes a meta-analysis of BCT and waiting-list control groups from BCT outcome investigations. The findings indicate that, on average, distressed couples who are placed on waiting lists make no improvement during the waiting period. These results are consistent across 17 controlled investigations conducted in different countries. Given the consistency of these findings, the current investigators propose that marital therapy outcome investigators consider employing these effect-size estimates rather than using scarce resources to place distressed couples in waiting-list control conditions. Such a strategy circumvents the ethical dilemma of withholding efficacious treatment from clients and encourages effectiveness studies in real-world conditions.

Evaluating Single-Case Research Data: A Comparison of Seven Statistical Methods
Richard I. Parker and Daniel F. Brossart, Texas A & M University

This study examined and compared the performance of seven popular or promising techniques for analyzing between-phase differences in single-case research designs. The techniques are: (a) Owen White's binomial test on extended Phase A baseline (White & Haring, 1980), (b) D. M. White, Rusch, Kazdin, and Hartmann's Last Treatment Day technique (1989), (c) Gorsuch's "trend analysis effect size" (Faith, Allison, & Gorman, 1996; Gorsuch, 1983), (d) Center's mean-only and mean-plus-trend models (Center, Skiba, & Casey, 1985–1986), and (e) Allison's mean-only and mean-plus-trend models (Allison & Gorman, 1993; Faith et al., 1996). The techniques were assayed by applying them to a set of 50 single-case AB design (baseline and intervention) data sets, constructed to represent a range of type and degree of intervention effects. From analysis of these 50 data sets, four questions were answered about the analytic techniques: (a) how much statistical power is possessed by the more promising techniques? (b) what typical R2 effect sizes are evidenced for graphed data sets which, according to visual analysis, show a positive intervention effect? (c) how do the five analytic techniques covary with one another? and (d) to what extent does each technique tend to produce autocorrelated residuals?

Using Foods as CSs and Body Shapes as UCSs: A Putative Role for Associative Learning in the Development of Eating Disorders
Kristy R. R. Lascelles, Andy P. Field, and Graham C. L. Davey, University of Sussex

The present paper reports the results of two experiments exploring possible changes in the affective ratings of foodstuffs as a result of their pairing with pictures of differing types of female body shapes. Experiment 1 reports the results of a visual evaluative conditioning (EC) experiment in which pictures of foodstuffs (CSs) were paired with pictures of either obese, normal, or thin female body shapes (UCSs). The results suggested that selective EC effects could be obtained when pictures of foods were used as CSs and pictures of different body shapes as UCSs. Specifically, pairing obese body shape UCSs with food CSs resulted in a significant postconditioning negative evaluative shift in those foods. Experiment 2 suggested that the selective conditioning effects found in Experiment 1 could be explained in part by an a priori CS-UCS expectancy bias in which participants exhibited a significantly greater bias towards expecting food CSs to be paired with obese rather than thin body shape UCSs. These findings have implications for our understanding of eating disorders, and, in particular, how conditioned shifts in the affective valences of foodstuffs can occur through their pairing with particular types of negatively valenced body images.

Contribution of Behavior Therapy to Dietary Treatment in Cystic Fibrosis: A Randomized Controlled Study With 2-Year Follow-up
Lori J. Stark, Children's Hospital Medical Center/University of Cincinnati College of Medicine, Lisa C. Opipari, University of Michigan School of Medicine, Leslie E. Spieth, Children's Hospital, Boston/Harvard Medical School, Elissa Jelalian, Rhode Island Hospital/Brown University School of Medicine, Alexandra L. Quittner, University of Florida, Laurie Higgins, Children's Hospital, Boston, Laura Mackner and Kelly Byars, Children's Hospital Medical Center/University of Cincinnati College of Medicine, Allan Lapey, Massachusetts General Hospital/Harvard Medical School, Virginia A. Stallings, Children's Hospital of Philadelphia/University of Pennsylvania School of Medicine, and Christopher Duggan, Children's Hospital, Boston/Harvard Medical School

Behavioral intervention was compared to nutrition education to better understand the contribution of behavior therapy to nutrition management in children with cystic fibrosis (CF). Participants were 7 children between 6 and 12 years of age with weight for age percentiles ranging from the 3rd to the 27th. Families in each condition were seen for 7 sessions and provided the same nutrition information and calorie goals. The BI received training on child behavior management. Caloric intake across meals was evaluated via multiple baseline design. Results indicated that the BI had a greater increase in daily caloric intake (1,036 cal/day) and weight gain (1.42 kg) than the (408 cal/day, 0.78 kg). Improved caloric intake was maintained 2 years following treatment.

Coparent Conflict in Single Mother–Headed African American Families: Do Parenting Skills Serve as a Mediator or Moderator of Child Psychosocial Adjustment?
Deborah J. Jones, West Virginia University, Anne Shaffer, Rex Forehand, and Gene Brody, University of Georgia, and Lisa P. Armistead, Georgia State University

In an effort to expand the parental conflict literature beyond 2-parent and divorced families, this study examined the following questions: Is coparental conflict between single mothers and the individuals who assist them in raising their children associated with child adjustment, and do parenting skills mediate or moderate this association? The sample consisted of 238 African American mothers and their 7- to 11-year-old children. Data were collected at 2 time points separated by approximately 15 months. Results indicated that coparental conflict was associated with child adjustment both concurrently and longitudinally, and that this association was partially mediated, but not moderated, by parenting skills.