ABSTRACTS

Confessions of a Behavior Therapist in Primary Care: The Odyssey and the Ecstasy

Kirk Strosahl, Group Health Cooperative of Puget Sound, Seattle, WA

As the pressures surrounding health care reform continue to mount, there has been a corresponding emphasis on reintegrating health and behavioral health services. This trend promises to provide behaviorally trained clinicians with numerous opportunities to practice in medical settings. The de facto mental health system in the United States is the primary care system; yet, there are few behavioral health practitioners practicing "on site" in primary care practice groups. This is unfortunate, because research studies and clinical experience suggest that physicians have very favorable attitudes toward behavioral procedures and use them regularly in medical practice. This article attempts to summarize key learning experiences from a 5-year primary care integration project at Group Health Cooperative, organized by three behaviorally trained psychologists. The major principles underpinning effective health and behavioral health integration will be examined. Main sources of organizational and disciplinary resistance, along with some "tried and true" strategies for countering that resistance, are highlighted. The concept of primary mental health care is introduced, as a distinctive form of behavioral health service that shares many of the philosophies of primary medical care. Changes in the structure of clinical practice are inevitable in primary care and, accordingly, moving to a consultation model is a more viable method for delivering services. The defining characteristics of the consultant, versus therapist, model will be highlighted, as will the core clinical services that are most valued in primary care settings. Finally, key practice style adjustments will be discussed to highlight how much the practice of behavior therapy must change to accommodate the demands of the primary care setting.



Cognitive Therapy for Clients With Bipolar Disorder

Jan Scott, University of Newcastle Upon Tyne

Biological models and treatments have dominated the research agenda in bipolar disorder (BD) for many decades. However, there is increasing evidence that individuals with BD and their significant others would welcome the introduction of more systematic psychological interventions aimed at helping the process of adjustment to the disorder, overcoming barriers to compliance with the recommended pharmacological treatments, and enhancing coping repertoires to reduce vulnerability to future episodes. Cognitive therapy appears to be an approach that not only helps clients with BD to understand the disorder, and achieve these goals, but may also improve their self-esteem and sense of self-efficacy. Adaptations to cognitive therapy that may facilitate its use in BD are outlined.



Ambulatory Psychophysiological Monitoring: A Potentially Useful Tool When Treating Panic Relapse

Stefan G. Hofmann and David H. Barlow, Boston University

Following Relapse after 11 sessions of cognitive behavioral treatment of panic disorder, a client wore an ambulatory physiological monitoring device for 1 day. The physiological data were used to test the client's hypothesis that panic attacks always occur from "out of the blue." Results showed that hyperventilation and fearful thoughts preceded panic attacks, refuting the client's initial hypothesis. A comparison of the client's self-report data before and after wearing the device indicated that this therapeutic strategy had a beneficial treatment effect. The results are discussed in the context of the scientist-practitioner approach to treatment failure.



Building a Reasonable Bridge in Childhood Anxiety Assessment: A Practitioner's Resource Guide

Kevin R. Ronan, Massey University

This article presents a resource guide for the practice-based assessment of childhood anxiety. Transporting empirically based methods and measures from research to clinical settings can be difficult, and often these methods do not underlie current practice as carried out by assessment-active professionals (Watkins et al., 1995). Consequently, the focus in this paper is on building a reasonable bridge between research-based methods and current assessment practice. Information is provided that can be useful when issues of childhood anxiety are present during assessment (and ongoing treatment). Suggestions are provided regarding brief and focused functional assessment. Methods and measures are described that can be used with school-aged children in the practice setting. Consideration is given to practice implementation of these methods, including recommendations concerning both comprehensive and goal-oriented assessment. Clinical vignettes are provided to illustrate salient issues.



Behavioral Assessment of Substance Abuse With Co-Occurring Psychiatric Disorder

Paul R. Stasiewicz, Hutchings Psychiatric Center, Kate B. Carey, Syracuse University, Clara M. Bradizza, Hutchings Psychiatric Center, and Stephen A. Maisto, Syracuse University

Substance-related disorders are common in individuals with severe and persistent mental illness. The effects of substance use in patients with comorbid mental illness are varied and include both increases and decreases in psychiatric symptoms. Behavioral assessment of substance use provides a useful framework for identifying the interdependence of substance use and psychiatric symptoms. One important component of behavioral assessment is the analysis of antecedents and consequences. This paper describes the use of this approach in the assessment and treatment of a man with a multiple substance-related disorder and major depressive disorder with psychotic features. Eighteen-month outcome date are reported, and the utility of conducting a behavioral assessment for treatment planning and ongoing treatment evaluation is discussed.



A National Survey of Assessment and Therapy Techniques Used by Behavior Therapists

Amy J. Elliott, Raymond G. Miltenberger, Jessica Kaster-Bundgaard, and Vicki Lumley, North Dakota State University

The present mail survey investigated behavior therapy as it is currently practiced by members of the Association for Advancement of Behavior Therapy (AABT). Information regarding professional attitudes, assessment techniques used, problems treated, and treatment procedures utilized was obtained. the questionnaire was mailed to 964 full members of the AABT, and 334 members responded for a 34.6% rate of return. The respondents were divided into two categories based on their primary professional activities (practitioner or academic), and comparisons between these groups were made. The results were also compared to the findings of previous surveys of AABT members (Swan & MacDonald, 1978; Wade, Baker, & Hartman, 1979). The survey results suggested a movement in recent years toward a cognitive behavioral orientation, and identified striking similarities and some differences between practitioners and academics.



A Basic Internet Primer for Behavior Therapists: Part I

Michele Funk, Lisa Saldana, and Lizette Peterson, University of Missouri-Columbia

The Internet holds a wealth of resources for the practicing behavior therapist, and these resources are more easily obtained than might be expected. this article describes the basic processes of the Internet, including equipment and software needed to become a user and contributor, and specific functions offered by the Internet. The use of electronic mail, the World Wide Web, newsgroups and listservs, and talking in real time over the Internet are described as examples. Finally, the interactive contributions that the behavior therapist can make and receive from the Internet are considered.



The Internet II: Future Effects on Cognitive Behavioral Practice

Michael G. Dow, William Kearns, and David H. Thornton, University of South Florida

The Internet is a vast international network of computers linked to each other. Users can send electronic mail quickly and easily to each other—free or at low cost. Users can also access pages of information stored as computer files on publicly available locations called Web sites. The development and widespread use of electronic mail and the World Wide Web (WWW) has many implications for clinical practice, prevention, education, and research related to cognitive behavior therapy. this article presents an overview of current usage on the Internet, provides examples of how mental health professionals can use the Web to enhance practice, presents speculation about possible future applications of the Internet, and discusses major changes that may take place that would affect clinicians, researchers, and consumers of cognitive behavior therapy.



Habit Reversal Training for Trichotillomania: A Group Approach

Suzanne G. Mouton and Melinda Stanley, University of Texas Health Science Center, Houston

The efficacy of Habit Reversal Training (HRT) in a group format for the treatment of trichotillomania was investigated. Original HRT procedures described by Azrin and Nunn (1973) were modified for use in a group context. five patients were treated over a 6-week period. Treatment included self-monitoring, awareness training, competing response training, and homework assignments. Posttreatment data indicated decreases in measures of global severity of symptoms, severity of thoughts about hair-pulling, and severity of hair-pulling behavior, relative to pretreatment measures. Three of the 5 patients maintained improvement at 1-month follow-up, and 2 patients maintained treatment gains at 6 months. Follow up scores for all patients continued to be lower than pretreatment scores. These case illustrations replicate and extend prior data, lending support to the viability of HRT in a group format as a meaningful approach to treating trichotillomania.



Single Session Treatment of a Borderline Personality Disorder

Arthur Freeman and James Jackson, Philadelphia College of Osteopathic Medicine

The transcript of a single session is presented to demonstrate how a short-term cognitive behavioral therapy model can be used with a borderline patient. Annotations to the session are interspersed throughout the therapy transcript in order to highlight the therapist?s development of hypotheses and treatment conceptualizations.