bt34.3

Evaluation of an Intervention Targeting Both Depressive and Bulimic Pathology: A Randomized Prevention Trial

Sarah Kate Bearman, Eric Stice, and Allison Chase, University of Texas at Austin

Because depressive and bulimic pathologies often co-occur among adolescent girls, a preventive program focusing on both disturbances would have clinical utility. Thus, we developed a cognitive-behavioral intervention targeting body dissatisfaction, an established risk factor for both conditions. A randomized prevention trial with late adolescent girls suggested that the intervention reduced body dissatisfaction, negative affect, depressive symptoms, and bulimic symptoms, but not dieting. Effects persisted through 3-month follow-up, but most faded by 6-month follow-up. Intervention effects on negative affect, depressive symptoms, and bulimic symptoms appeared to be mediated by change in body dissatisfaction. Participant age, ethnicity, and body mass did not moderate intervention effects. Results suggest that an intervention that improves body satisfaction might reduce depressive and bulimic symptoms but imply that greater emphasis on preventing future symptoms might be necessary for persistent effects.

Adolescent Problem Solving, Parent Problem Solving, and Externalizing Behavior in Adolescents
William B. Jaffee and Thomas J. D'Zurilla, State University of New York at Stony Brook

This study focused on the relations between the social problem-solving abilities of adolescents and their parents and aggression and delinquency in an adolescent sample. One hundred and seventeen high school students, 83 of their mothers, and 73 of their fathers completed the Social Problem-Solving Inventory–Revised, which measures five different problem-solving dimensions and several different measures of adolescent externalizing behaviors. Adolescents’ problem-solving ability was found to be significantly lower than that of their parents and significantly correlated with their mothers’ but not their fathers’ problem-solving ability. Three adolescent problem-solving dimensions were found to be related to aggression and/or delinquency. Other results suggested that the same dimensions might also be linked to substance use and high-risk automobile driving. Parents’ problem solving was minimally related to adolescent externalizing problems. Adolescents’ problem-solving ability accounted for a significant amount of variance in most externalizing measures even after controlling for mothers’ problem-solving ability. Implications for treatment and prevention of adolescent behavioral problems are discussed.

Promoting Social Skills Generalization With ADHD-Diagnosed Children in a Sports Setting
Patrick M. O’Callaghan, Louisiana State University, David Reitman, Nova Southeastern University, John Northup, Louisiana State University, Stephen D. A. Hupp, Southern Illinois University Edwardsville, Molly A. Murphy, Louisiana State University

Efforts to promote social skills generalization among ADHD-diagnosed children have had limited success. Despite evidence that attentiveness and social skills can be enhanced, the general absence of gains beyond the original treatment setting or extended through time suggests a need for systematic generalization planning. In the present study, a combination of techniques described by Stokes and Baer (1977) were implemented to foster the transfer of target behaviors across settings. A multiple-baseline design across 4 participants was used to evaluate efforts to promote the generalization of social skills in a sports context. Results suggested that a combination of generalization procedures, including training sufficient exemplars, training loosely, indiscriminable contingencies, programming common stimuli, and training to generalize, was effective in producing generalization of social skills from individual training sessions to a group kickball game. No arbitrary contingencies for appropriate social behavior were in effect during the kickball game and very little evidence of generalization was observed in the absence of explicit programming efforts. Researchers should continue to refine techniques for programming generalization and more actively involving paraprofessionals in the treatment of ADHD-diagnosed children.

Anger Experience and Expression in Social Anxiety Disorder: Pretreatment Profile and Predictors of Attrition and Response to Cognitive-Behavioral Treatment
Brigette A. Erwin and Richard G. Heimberg, Adult Anxiety Clinic, Temple University, and Franklin R. Schneier and Michael R. Liebowitz, Anxiety Disorders Clinic, New York State Psychiatric Institute and Columbia University

The present study examined social anxiety, anger, and depression among 234 persons with social anxiety disorder and 36 nonanxious controls. In addition to greater social anxiety, persons with social anxiety disorder exhibited more severe depression, greater anger, and poorer anger expression skills than did nonanxious control participants. Analyses investigating attrition and response to cognitive-behavioral group treatment (CBGT) among a subset of 68 persons treated for social anxiety disorder indicated that patients who experienced anger frequently, perceived unfair treatment, and were quick-tempered were less likely to complete a 12-session course of CBGT. Among treatment completers, significant reductions in the frequent experience of anger to perceived negative evaluation and in anger suppression were noted. However, those who suppressed anger responded less favorably to CBGT. Future directions and clinical implications are discussed.

Prediction of Response to Psychological Treatment Among Motor Vehicle Accident Survivors With PTSD
Edward B. Blanchard, Edward J. Hickling, Loretta S. Malta, James Jaccard, Trishul Devineni, Connie H. Veazey, and Tara E. Galovski, Center for Stress and Anxiety Disorders, University at Albany

We sought to predict posttreatment PTSD symptom scores (Clinician-Administered PTSD Scale scores) among motor vehicle accident (MVA) survivors with PTSD who had received either cognitive behavioral treatment (CBT; n = 30) or supportive psychotherapy (SUPPORT; n = 27) using pretreatment variables. We could account for from 43% (CBT) to 70% (SUPPORT) of variance in the measure of PTSD symptoms. The most consistent predictors were pretreatment PTSD symptom scores. Comorbid conditions, especially depression, and degree of initial impairment were also significant predictors.

Anxiety, Stress, and Health in Northern Plains Native Americans
Tami J. De Coteau and Debra A. Hope, University of Nebraska–Lincoln, and Jessiline Anderson, University of Nebraska–Omaha

In the present study the Beck Anxiety Inventory (Beck, Epstein, Brown, & Steer, 1988), Anxiety Sensitivity Inventory (Peterson & Reiss, 1992), the Holmes-Rahe Social Readjustment Rating Scale (Holmes & Rahe, 1967), Northern Plains Bicultural Inventory (Allen & French, 1994), and a health questionnaire were administered to investigate the relationship between anxiety, stressful events, health, and cultural participation among 147 Native American adults from a Midwestern reservation community. The results of these self-report measures indicated that, as has been found in the majority culture, stressful life events predicted physical health problems and self-reported anxiety. The hypothesis that participation in and identification with tribal culture would be associated with fewer life stressors, better health, and lower anxiety was not supported. Surprisingly, cultural identification did not buffer the relationship between stressful life events and anxiety. Implications for understanding anxiety and stress among Native Americans are discussed.

The Coping With Depression Course: Short-Term Outcomes and Mediating Effects of a Randomized Controlled Trial in the Treatment of Subclinical Depression
Esther Allart-van Dam, Clemens M. H. Hosman, and Cees A. L. Hoogduin, University of Nijmegen, and Cas P. D. R. Schaap, University of Groningen

This article reports on a randomized controlled trial investigating the short-term effectiveness of the Coping With Depression course in a sample of adults seriously at risk of developing major depression. In addition, possible mediating properties of several proximal outcome variables were assessed. Participants (N = 110) were adults with subclinical depressive symptoms. They were randomly assigned to either a group course condition, the Coping With Depression course, or an assessment-and-advice-only control group condition. Short-term results measured 1 month after completion of the course reveal that the course is effective in reducing depressive symptoms. The group course condition showed beneficial effects on depressive symptoms, pleasant activities, self-esteem, social skills, social support, and depressive thoughts. Changes in depressive cognition and self-esteem proved to be significant mediators of depressive symptoms. Possible implications for depression prevention are discussed.

Obsessive-Compulsive Disorder in a Multi-Ethnic Urban Outpatient Clinic: Initial Presentation and Treatment Outcome With Exposure and Ritual Prevention
Steven Friedman, Lisa C. Smith, Beth Halpern, and Carin Levine, State University of New York Downstate Medical Center, Cheryl Paradis, State University of New York Downstate Medical Center and Marymount Manhattan College, and Ramaswamy Viswanathan, Brian Trappler, and Robert Ackerman, State University of New York Downstate Medical Center

There are no naturalistic treatment outcome studies in the literature investigating the effectiveness of exposure and ritual prevention across diverse ethnic groups for OCD. We present data on the naturalistic treatment of 62 outpatients with OCD who presented at an anxiety disorders clinic in an inner-city area. More of our African American and Caribbean American patients, compared to Caucasians with OCD, were female and were more likely to be initially diagnosed with panic disorder only. On initial assessment both groups were similar on psychometric measures as well as reporting similar types of obsessive-compulsive symptoms. Both groups showed moderate improvement with treatment, although significant residual symptoms remained. Our results are discussed within the need for further cross-cultural clinical research and outreach.