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CONTENTS
PRESIDENTIAL ADDRESS
ORIGINAL RESEARCH
SPECIAL SERIES: APPLYING PERSONALITY SCIENCE TO COGNITIVE-BEHAVIORAL THERAPY AND RESEARCH Guest Editor: William G. Shadel
ABSTRACTS
Over three decades ago, D’Zurilla and Goldfried (1971) published a seminal article delineating a model of problem-solving training geared to enhance social competence and decrease psychological distress. Since that time, a substantial amount of research has been conducted to test various hypotheses that this model has engendered. Much of this research can be categorized into three lines of inquiry: (a) whether a relationship between problem solving and distress exists; (b) whether effective problem solving serves to attenuate the deleterious effects of stressful life events that in general increase the likelihood of experiencing psychological distress; and (c) whether training individuals experiencing a variety of psychological problems and disorders is an effective means by which to decrease their pathology and enhance their overall quality of life. This article provides an overview of this literature and especially highlights the flexible nature of problem-solving therapy with regard to targeted problems and populations, clinical treatment goals, and modes of implementation. Recommendations regarding future research directions are offered.
Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and Functional Analytic Psychotherapy have recently come under fire for “getting ahead of their data” (Corrigan, 2001). The current article presents a descriptive review of some of the actual evidence available. Dialectical Behavior Therapy and Acceptance and Commitment Therapy have a small but growing body of outcome research supporting these procedures and the theoretical mechanisms thought to be responsible for them. Functional Analytic Psychotherapy has a limited research base, but its central claim is well substantiated. The claims made in the published literature about these technologies, at least by their originators, seem proportionate to the strength of the current evidence. There is no indication that those interested in the new wave of behavior therapy innovations are less committed to empirical evaluation than has always been the case in behavior therapy.
This study examined the effects of supplementing sildenafil (Viagra) with use of a cognitive-behavioral treatment manual plus minimal therapist contact. Participants were 6 heterosexual couples in which the man met criteria for erectile dysfunction and was using sildenafil. Erectile dysfunction resulted from psychological factors or psychological and organic factors combined. In a multiple baseline design, participants completed a period of 4, 6, or 8 weeks during which they used sildenafil alone and monitored several psychosocial and behavioral variables. The experimental treatment, which lasted 6 weeks, comprised the cognitive-behavioral treatment manual and brief weekly phone contact with a therapist. Results suggest that manualized treatment was associated with increases in sexual satisfaction among men, some improvement in sexual satisfaction among partners, and an increase in the frequency of sexual intercourse. There was some evidence of improvement in sexual functioning among both men and women. Treatment gains were largely maintained at a 4-to-8-week follow-up and a 4-to-10-month follow-up. Results suggest that this cognitive-behavioral intervention may enhance the benefits of sildenafil. Additional research is needed to further test the potential benefits of this treatment approach.
The psychometric properties of the Anxiety Control Questionnaire (ACQ) were evaluated in 1,550 outpatients with DSM-IV anxiety and mood disorders and 360 nonclinical participants. Counter to prior findings, exploratory factor analyses produced a 3-factor solution (Emotion Control, Threat Control, Stress Control) based on 15 of the ACQ’s original 30 items. Factor analyses in two independent clinical samples (e.g., confirmatory factor analysis, CFA) replicated the 3-factor solution. Multiple-groups CFAs indicated that the measurement properties of the ACQ were invariant in male and female patients, and that the ACQ was largely form and parameter equivalent in a clinical versus nonclinical sample. Hierarchical analysis supported the existence of a higher-order dimension of perceived control. Structural regression analyses indicated that each of the ACQ factors accounted for significant unique variance in one or both latent factors representing the dimensions of autonomic anxiety and depression. The results are discussed in regard to their conceptual and psychometric implications to the construct of perceived emotional control.
Personality, as a construct, has been largely ignored or misapplied in the clinical and/or cognitive-behavioral literature. This article discusses the history of the concept of personality in clinical psychology and in cognitive-behavioral approaches and provides the main rationale for this special series. The articles that comprise the series present perspectives on personality and personality science from a decidedly social-cognitive viewpoint. These articles share the overall goal of advancing understanding of how personality as a construct may be conceptualized within cognitive-behavioral paradigms. The article highlights dominant themes within the special series and suggests that work at the intersection of personality and cognitive-behavioral science has the potential to advance theory and research in both disciplines.
This article conceptualizes goals and strategies of personality assessment, and the relevance of personality assessment to the behavior therapist, in light of recent advances in personality science. Two assessment principles are presented: that personality assessment procedures should include in their purview those psychological systems that are unique to persons, and that assessments should tap psychological systems that are possessed by the individuals being assessed and that causally contribute to their overt experiences and actions. The limitations of traditional assessment strategies based on between-person factor-analytic constructs are discussed in light of these principles. The paper then outlines an alternative strategy in which social-cognitive personality systems are tapped in a manner that is sensitive to the potentially idiosyncratic qualities of the individual. Illustrative research is summarized and implications for the practice of behavior therapy are considered.
Trait-based theories of personality explain behavior across situations based on a set of broad personality attributes or dimensions. In contrast, recent social-cognitive theories of personality emphasize the importance of context and take a combined nomothetic/idiographic approach to personality. The social-cognitive perspective on personality resembles cognitive-behavioral therapies, which explain behavior in particular situations based on interactions of specific cognitions, mood states, and stimulus conditions. This article considers how contemporary personality theory and research might be integrated into the study of the outcomes and processes associated with cognitive-behavioral therapies. We propose that applying the social-cognitive perspective on personality to the study of how cognitive-behavioral therapies work provides both validation of current theories and promising directions for additional research. We review the research literatures on cognitive theories of psychopathology and cognitive-behavioral treatments to examine how the topic of personality has been addressed in those literatures to date. We then explore some commonalities between cognitive theories of psychopathology and psychotherapy and recent social-cognitive approaches to personality, suggesting that an integration of the two areas is overdue.
This article outlines a conceptualization of personality as a cognitive-affective processing system (CAPS) and explores its implications for understanding disorders and pursuing therapeutic change. The CAPS conception of personality was proposed in 1995 in order to resolve a long-standing paradox in personality and social psychology, namely, the apparent contradiction of, on the one hand, a core assumption about personality as stable and invariant across situations and, on the other hand, the empirical findings of behavioral variability. It was prompted by the demonstration that stable and characteristic patterns can be discerned in behavior variation, or "behavioral signatures," and by a common theme from cognitive sciences that views the human mind as consisting of a stable and distinctive network of specific cognitions and affects. CAPS characterizes personality not simply by a set of thoughts and feelings highly accessible to an individual, but by the dynamic network of functional relations among the cognitions and affects, which guide and constrain their activation. After outlining the CAPS view of personality, this article will discuss how it relates to diverse existing models of anxiety and depression, approaches for measurement and case conceptualization as well as treatment methods, with the goal of clarifying the relationships among them by translating them into a common language provided by the CAPS framework.
This article applies a dynamic model of self-structure to self-change during psychological treatment. At the outset of treatment, many individuals may have a negative compartmentalized self-structure. That is, a wide range of perceived negative attributes are closely linked to each other within their important self-aspect categories. During treatment, these individuals may develop an evaluatively integrative structure for self-beliefs in which negative beliefs are more closely associated with positive ones to mitigate their impact. When individuals leave treatment, they may either retain their integrative self-structures (and, possibly, a more realistic view of self) or they may revert to positive compartmentalization (an easy and efficient self-structure that minimizes access to any negative self-beliefs). This model illustrates the inherent flexibility in strategies of self-organization and their implications for clinical research.
Dramatic changes in our science in recent years have profound implications for how psychologists conceptualize, assess, and treat people. I comment on these developments and the contributions to this special series, focusing on how they speak to new directions and challenges for the future of CBT. Discoveries about mind, brain, and behavior that have vitalized psychological science in the last few decades are providing insights into such directly CBT-relevant processes as memory and the construction of personal narratives, attention control, and executive functions, including planning and conflict-monitoring, emotion and self-regulation, meta-cognition, and unconscious, automatic processing, as well as the nature, organization, and expressions of important individual differences. As the understanding of the subsystems and part-processes that collectively constitute the person’s cognitive and emotional architecture escalates, it is an opportune moment to consider the implications for clinical psychology and the behavior therapies, especially CBT. I do so, drawing on work at the vanguard of the science and pointing to some of the implications for therapies committed to growing as the cognitive and behavioral sciences on which they are based evolve. |
ARTHUR M. NEZU. Problem Solving and Behavior Therapy Revisited