Evaluating Fidelity: Predictive Validity for a Measure of Competent Adherence to the Oregon Model of Parent Management Training
Marion S. Forgatch, Gerald R. Patterson, and David S. DeGarmo, Oregon Social Learning Center

When efficacious interventions are implemented in real-world conditions, it is important to evaluate whether or not the programs are practiced as intended. This article presents the Fidelity of Implementation Rating System (FIMP), an observation-based measure assessing competent adherence to the Oregon model of Parent Management Training (PMTO). FIMP evaluates 5 dimensions of competent adherence to PMTO (i.e., knowledge, structure, teaching skill, clinical skill, and overall effectiveness) specified in the intervention model. Predictive validity for FIMP was evaluated with a subsample of stepfamilies participating in a preventive PMTO intervention. As hypothesized, high FIMP ratings predicted change in observed parenting practices from baseline to 12 months. The rigor and scope of adherence measures are discussed.

Dismantling Anger Control Training for Children: A Randomized Pilot Study of Social Problem-Solving Versus Social Skills Training Components
Denis G. Sukhodolsky, Yale University School of Medicine, Arthur Golub, Hofstra University, Erin C. Stone, Hofstra University and St. John’s University, Lisa Orban, New York University School of Medicine

Two components of multimodal anger control training were compared in a randomized study. The first component, social problem-solving training, utilized the techniques of cognitive restructuring, attribution retraining, and solution generation that targeted social-cognitive deficits implicated in anger and aggression. The second component, social skills training, was based on the techniques of modeling, behavioral rehearsal, and corrective feedback that targeted social competencies for resolution of interpersonal conflicts and coping skills for appropriate expression of anger. Twenty-six participants (boys with a mean age of 9.6 years), referred for excessive anger, aggression, and disruptive behavior, completed the treatment. The 2 treatments were similar in significantly reducing aggression, conduct problems, and the frequency of anger expression. Similar rates of improvement were also reported for the relationships with parents and on the measure of competent responses to peer provocation. However, the 2 treatment modalities were specific for the targeted constructs of hostile attribution bias and anger control. Parent ratings indicated that 53% and 57% of treatment completers were either recovered or much improved on the measures of aggression and conduct problems, respectively. Treatment gains were maintained after 3 months in 17 participants who were available for the follow-up evaluation.

Mothers’ Perceptions of Neighborhood Violence and Mother-Reported Monitoring of African American Children: An Examination of the Moderating Role of Perceived Support
Deborah J. Jones, West Virginia University, Rex Forehand, University of Vermont, Cara O’Connell, West Virginia University, Lisa Armistead, Georgia State University, and Gene Brody, University of Georgia

This prospective study examined the association between perceived neighborhood violence and maternal monitoring and the moderating role of 2 sources of social support (coparents and friends/neighbors) among low-income African American single mothers. Mothers’ ratings of neighborhood violence were associated with monitoring both concurrently and longitudinally; however, this association was qualified by each source of social support. When neighborhood violence is perceived as being high by mothers, high levels of social support from coparents and from friends and neighbors are associated with more maternal monitoring. The findings point to the importance of understanding the social context in which African American single mothers live when developing and implementing parenting prevention and intervention programs targeting high-risk families.

An Evaluation of the Social Support Component of Simplified Habit Reversal
Christopher A. Flessner, Raymond G. Miltenberger, Kristin Egemo, Pam Kelso, Candice Jostad, Brigitte Johnson, Brian J. Gatheridge, and Clayton Neighbors, North Dakota State University

This study examined the role that the social support component of simplified habit reversal (SHR) plays in the treatment of body-focused repetitive behavior disorders (nail biting) in college-aged individuals. This study compared 2 versions of the SHR procedure, the first consisting of awareness training, competing response training, and social support, and the second consisting only of awareness and competing response training. Forty participants were recruited and randomly assigned to one of the two treatment conditions. Participants were assessed at baseline, posttreatment, and at 1-month follow-up. Results indicated that both conditions produced significant decreases in nail biting and increases in nail length from baseline to posttreatment and from posttreatment to follow-up, but no significant differences were found between the conditions. Limitations and areas for future research are discussed.

Cognitive Behavioral Therapy for Nocturnal Panic
Michelle G. Craske, University of California–Los Angeles, Ariel J. Lang, University of California–San Diego and VA San Diego Healthcare System, Deane Aikins, Yale University and National Center for Posttraumatic Stress Disorder, and Jayson L. Mystkowski, University of California–Los Angeles

Nocturnal panic (NP), or waking abruptly from sleep in a state of panic, is a common phenomenon among patients with panic disorder. The purpose of this study was to test the efficacy of an adaptation of cognitive-behavioral treatment for NP. Forty-three participants were randomly assigned to immediate CBT or to a wait-list control condition. The results showed that CBT was more effective than the passage of time alone. The effects of CBT were repeated in the previously wait-listed condition. Treatment-related gains were maintained over a 9-month follow-up period. In addition, symptom improvement was accompanied by lessened subjective and heart rate reactivity to laboratory stressors, as well as lowered arousal and increased cardiac variability during sleep. This is the first controlled treatment outcome trial demonstrating the efficacy of a treatment program for panic disorder patients with NP.

The Effectiveness of Treatment for Pediatric Obsessive-Compulsive Disorder: A Meta-Analysis
Jonathan S. Abramowitz, Stephen P. Whiteside, and Brett J. Deacon, Mayo Clinic

The last decade has seen a noticeable increase in the number of treatment outcome studies for pediatric obsessive-compulsive disorder (OCD). The present article describes a meta-analysis of this literature with the aim of quantifying treatment effects and examining the extent to which various patient or treatment variables are related to outcome. Results showed that pharmacotherapy with serotonergic antidepressants and cognitive-behavioral therapy involving exposure and response prevention are each effective in reducing OCD symptoms. Cognitive-behavioral therapy produced larger effect sizes and greater rates of clinically significant improvement compared to medication, although there were methodological differences between medication and psychotherapy studies.

Social Comparison Processes in Social Phobia
Martin M. Antony, Karen Rowa, Andrea Liss, St. Joseph’s Healthcare and McMaster University, Stephen R. Swallow, Private Practice, Oakville, Ontario, and Richard P. Swinson, St. Joseph’s Healthcare and McMaster University

This study used diaries to investigate social comparison processes in 59 individuals with social phobia (SP) and 58 nonclinical controls. Although groups did not differ on the total number of comparisons made during the 2-week study period, those with SP made significantly more upward comparisons (i.e., comparisons where the individual assesses him- or herself as not measuring up to others) and significantly fewer downward comparisons (i.e., comparisons where the individual assesses him- or herself as superior to others) relative to controls. SP was also associated with comparisons on a greater number of dimensions or attributes and more comparisons on particular dimensions. Those in the SP group tended to experience greater changes in affect following social comparisons than those in the comparison group. For example, upward comparisons tended to lead to increased anxiety and depression, particularly for the socially anxious participants. Implications for these findings are discussed.

Predictive Role of Daily Coping and Affective Reactivity in Cognitive Therapy Outcome: Application of a Daily Process Design to Psychotherapy Research
Kathleen C. Gunthert, American University, Lawrence H. Cohen, University of Delaware, Andrew C. Butler, Judith S. Beck, Beck Institute for Cognitive Therapy and Research

We hypothesized that patients’ initial ability to cope with daily stress would predict their rates of improvement in cognitive therapy (CT). For 1 week at the beginning of CT, 43 adult outpatients with depression and/or anxiety diagnoses completed daily assessments of stressors and associated appraisals, negative cognitions, coping strategies, and negative mood. Depression was assessed at intake and at every treatment session. Even after the statistical control of intake depression level, treatment length, and concurrent medication status, many of the stress and coping variables were associated with rates of depression-reduction in the expected direction. We discuss the findings' implications for CT theory and practice as well as the heuristic value of a daily process design to evaluate the predictive role of patient factors in psychotherapy outcome.

Short-Term Cognitive Behavioral Treatment Does Not Improve Outcome of a Comprehensive Very-Low-Calorie Diet Program in Obese Women With Binge Eating Disorder
Martina de Zwaan, University of Erlangen–Nuremberg, James E. Mitchell and Ross D. Crosby, Neuropsychiatric Research Institute, Fargo, and University of North Dakota, Fargo, Melissa P. Mussell, University of St. Thomas, Nancy C. Raymond, Sheila M. Specker, and Harold C. Seim, University of Minnesota

The purpose of this study was to determine if the addition of cognitive behavior therapy (CBT) targeting binge eating behavior to a comprehensive very-low-calorie diet (VLCD) program would improve short- and long-term outcome in obese women with binge eating disorder (BED). Seventy-one subjects with BED participated in the 6-month program. They represent a subgroup of a larger sample of 154 women (83 without BED) who participated in the program. During the last 10 weeks of treatment half of the women with BED were randomly assigned to an additional CBT component targeting the eating disorder. The mean total weight loss at the end of the VLCD program was 35.2 lb (SD = 18.4) or 16.1% (SD = 8.2) of the original weight. At one year participants had maintained a mean weight loss of 5.5% (SD = 10.1) of initial body weight. Forty-seven participants (66.2% of 71) were binge free at the end of the program and 51.8% at the 1-month follow-up. At the 1-year follow-up 56.3% no longer met criteria for BED and 33% were abstinent (no binge eating) during the 6 months prior to the follow-up assessment. There were no significant differences between participants who received and who did not receive the additional CBT component. An additional CBT component added to a comprehensive VLCD program did not improve the results for obese participants with BED with regard to weight and binge eating and with regard to most of the eating-related and general psychopathological measures. However, the reduction of binge eating at the end of treatment and at follow-up is comparable with improvements achieved with drug therapy or psychotherapy specifically designed for the treatment of BED.

Evaluation and Treatment of Swimming Pool Avoidance Exhibited by an Adolescent Girl With Autism
John T. Rapp, Timothy R. Vollmer, and Alyson N. Hovanetz, University of Florida

We evaluated and treated swimming pool avoidance that was exhibited by a 14-year-old girl diagnosed with autism. In part, treatment involved blocking for flopping (dropping to the ground) and elopement (running away from the pool) and access to food for movements toward a swimming pool. Treatment also involved reinforcement for exposure to various depths of water. Generalization of treatment outcome was demonstrated by showing sustained effects with her mother without food reinforcement and, subsequently, by replicating these effects with her mother in an untrained setting.