ABSTRACTS

Beyond Direct Verbal Instructions In Cognitive Behavioral Supervision

Tammie Rosen and Michael Rosenbaum, Tel-Aviv University

In clinical supervision of cognitive behavior therapy (CBT), the supervisor relies primarily on verbal instruction, although in the practice of CBT the therapist employs a variety of "nontalking" methods to facilitate change. This paper suggests a range of techniques that can be used in clinical supervision that are not based on direct verbal communication, such as the use of writing, metaphors, and imagery. The goal of these techniques, like the goal of CBT supervision in general, is to empower the supervisee to independently think and act as a CBT therapist.



A Cognitive Behavioral Model of Assessment and Treatment for Intellectually Disabled Sexual Offenders

Christine Maguth Nezu, Arthur M. Nezu, and Jonathan A. Dudek, Allegheny University of the Health Sciences

Sex offending behavior continues to exist as a major public health concern. In recent years, studies of risk prediction and identification of both static and dynamic factors associated with the behavior of sexual perpetrators have added to a collective understanding of the problem. However, a limited amount of avail-able information exists concerning how to translate relevant factors into effective clinical treatments or risk management strategies for this population. This is par- ticularly true with regard to intellectually disabled offenders. This paper presents a model of sex offending that focuses on cognitive behavioral variables proposed as functional causal pathways to guide assessment and treatment of such individuals. Clinical case examples are provided to illustrate the linkage betweenassessment and treatment.



Cognitive Behavioral Group Therapy for Depressed, Low-Income Minority Clients: Retention and Treatment Enhancement

Jason M. Satterfield, University of California, San Francisco

Despite the ever-increasing clinical needs of "undeserved populations," research, practice guidelines, and clinical training programs have focused primarily on treating middle- and upper-middle class nonminority clients. This paper high-lights the mental health needs of low-income minority patients, pointing out specific risks, obstacles to service utilization, reasons for treatment failures and significant opportunities for clinical interventions and innovations. Countertherapeutic patients and therapist beliefs and attributions are discussed. A pilot cognitive-behavioral depression group specifically designed for low-income minority patients is used to demonstrate practical interventions and guidelines for working with this population. Preliminary results suggest that premature attrition and clinical outcomes can be significantly improved. Group structure, content, and special attention to group processes were thought to be responsible for positive findings.



Engaging Parents in Cognitive Behavioral Treatment for Children With Anxiety Disorders

Lynne Siqueland and Guy S. Diamond, University of Pennsylvania Medical School, Children's Hospital of Philadelphia

The involvement of parents in individual child-focused treatment is a complex issue that needs to be treated as a therapeutic target in its own right. A number of manuals and protocols articulate interventions with parents, but do not describe how to implement them or what to do when parents do not comply. This paper provides a rationale for the inclusion of parents into the treatment of childhood anxiety disorders and describes approaches to engage parents. Discussion is organized around the assessment and intervention in three domains of functioning that might impede progress in individual child cognitive behavioral treatment: parents' beliefs about parenting and their role as parents, family dynamics or interactional styles, and parental psychopathology. This article identifies some of the difficulties inherent in involving parents and offers some treatment goals and producers, illustrated through clinical vignettes, for involving parents.



Prolonged Exposure Therapy and Irritable Bowel Syndrome: A Case Study Examining the Impact of a Trauma-Focused Treatment on a Physical Condition

Terri L. Weaver, Pallavi Nishith, and Patricia A. Resick, Center for Trauma Recovery, University of Missouri-St. Louis

Previous research has shown that psychological treatments, particularly those employing cognitive techniques, are particularly effective in the treatment of irritable bowel syndrome (IBS). It is presumed that these psychological interventions are effective at ameliorating the IBS by treating an underlying psychological disorder (often an anxiety disorder), which may be contributing to the autonomic reactivity. This case study examined the change in the physical symptoms of IBS for a patient seeking treatment for rape-related PTSD with comorbid conditions of major depression and panic. At posttreatment, the patient no longer met criteria for PTSD, major depression, or panic. In addition, her primary symptoms of IBS, diarrhea frequency, was significantly improved. These findings were maintained at 3 and 9 months posttreatment. Implications for the assessment and treatment of IBS patients with PTSD are discussed.



Therapeutic Effects of Clozapine on Tarive Dyskinesia

Chand J. Nair, George Abraham, Joseph K. Stanilla, and Joseph I. Tracy, Allegheny University of the Health Sciences, Jose de Leon, University of Kentucky, George M. Simpson, University of Southern California School of Medicine, and Richard C. Josiassen, Allegheny University of the Health Sciences

Neuroleptic-induced tardive dyskinesia (TD) negatively impacts the quality of life for persons with schizophrenia. While no satisfactory treatment is available for TD, a growing body of literature suggests the efficacy of clozapine in reducing TD. This paper describes the efficacy of clozapine in reducing TD in relation to the variables of treatment duration and dosage. Eighteen schizophrenic patients were categorized as with and five as without probable TD, and a pattern of reversible decrease in severity of TD on higher doses was found. The importance of this information for behaviorally oriented psychiatrists, psychologists, social workers, and nurses who work with the serious mentally ill is emphasized. Because of their strong scientific training and their roles as treatment team leaders, behavioral clinicians need to understand these new findings and disseminate them to mental health treatment teams. Combining this information with cognitive and behavioral interventions should lead to improved outcomes, less serious side effects, and improved quality of life for schizophrenic and schizoaffectively disordered patients.