c&bp7.1

Prescribing Therapeutic Interventions Through Strategic Treatment Selection
Larry E. Beutler and Benny R. Martin

A Self-Control Skills Group for Persistent Auditory Hallucinations
Lawrence M. Perlman and Bruce A. Hubbard

Introductory Cognitive Therapy Training Issues
Francis R. Kush

A Comprehensive and Individualized Treatment Approach for Children and Adolescents With Conduct Disorders
Paul J. Frick

Cognitive Behavioral Therapy With Ethnic Minority Adolescents: Therapist Perspectives
Gary W. Harper and Gayle Y. Iwamasa

Cognitive Behavior Therapy for Ethnic Minority Adolescents: Broadening Our Perspectives
David J. Hansen, Byron L. Zamboanga, and Georganna Sedlar

Introduction
Kim Fromme and Sandra A. Brown

A Cigarette Smoking Intervention for Substance-Abusing Adolescents
Mark G. Myers, Sandra A. Brown, and John F. Kelly

Computer-Enhanced Primary Care Practitioner Advice for High-Risk College Drinkers in a Student Primary Health-Care Setting
Linda A. Dimeff and Marguerite McNeely

Implementation of the Risk Skills Training Program: A Brief Intervention Targeting Adolescent Participation in Risk Behaviors
Elizabeth J. D'Amico and Kim Fromme

The Case of Howard
Matthew O. Kimble

Constructing a Model of Change: Clinical Commentary on a Complex Case
Michael W. Otto

Depression-Focused Treatment in the Context of PTSD and Other Comorbid Disorders
Lynn F. Bufka

Treatment of Concurrent PTSD and OCD: A Commentary on the Case of Howard
David S. Riggs

Treating PTSD in the Presence of Multiple Comorbid Disorders: The Case of Howard
Matthew O. Kimble

Continuing Education Quizzes

Prescribing Therapeutic Interventions Through Strategic Treatment Selection

Larry E. Beutler & Benny R. Martin, University of California, Santa Barbara

This article describes the rational and current research on Systematic Treatment Selection, a method for matching and fitting interventions to patients and patient problems. An efficient method of treatment planning must not only use effective and empirically tested procedures, but should take into account the fit of these procedures with important nondiagnostic information about the patient, and aspects of the patient's environment. The effort to transfer research-based treatment manuals to clinical practice has often failed because it requires therapists to give up procedures and theories that have been accepted on the basis of clinical experience and fails to consider ways in which patient qualities affect the fit of the treatment. Systematic Treatment Selection and its derivative, Prescriptive Therapy, seeks to overcome these difficulties by empirically defining general principles of treatment intervention and selection that cut across therapist theoretical orientation and capitalize on the selection and use of methods that are favored by the clinician.

A Self-Control Skills Group for Persistent Auditory Hallucinations

Lawrence Perlman, Maimonides Medical Center and Bruce A. Hubbard, Cognitive Health Group

A self-control skills group was developed to help schizophrenic clients cope with persistent auditory hallucinations. Nine clients were provided with a variety of coping strategies for shifting attention away from hallucinations. Seven reported improved symptom control. Matching skill complexity to functional level may yield optimal treatment benefit.

Introductory Cognitive Therapy Training Issues

Francis R. Kush, Sewickley Valley Hospital, Sewickley, PA, and Allegheny University of the Health Sciences

Introductory cognitive therapy (CT) training can be complex and challenging for the graduate student in clinical placements regarding theoretical positions, technical skills, and practical application. The CT approach presents with implications for the general practice of psychotherapy as well as the developing academic/professional identity of the clinician. This paper reviews eight basic prerequisite CT conceptual training issues that, if addressed during introductory CT training, may increase the likelihood of optimum student understanding and professional integration of the cognitive therapy model.

A Comprehensive and Individualized Treatment Approach for Children and Adolescents With Conduct Disorders

Paul J. Frick, University of Alabama

The more effective treatments that have emerged from research evaluating various treatments for children and adolescents with conduct disorders are cognitive or behavioral in orientation. Unfortunately, there are substantial limitations in the effectiveness of these treatment approaches when used in isolation. In this paper, research on the nature and causes of conduct disorders is reviewed and used as a guide to alternative approaches to treatment that integrate these individual components into a more comprehensive and individualized treatment strategy. Examples and guidelines are provided for clinicians in various settings.

Cognitive-Behavioral Therapy With Ethnic Minority Adolescents: Therapist Perspectives

Gary W. Harper, DePaul University and Gayle Y. Iwamasa, Oklahoma State University

Examination of the mental health needs and services for ethnic minority adolescents has been woefully neglected. The present article summarizes the current literature on the mental health status of ethnic minority adolescents, discusses the applicability of cognitive-behavioral treatment interventions with ethnic minority adolescents, and presents data from a survey of cognitive-behavior therapists who provided services to adolescents. Results from the survey indicated that although most therapists consider adolescent client ethnicity during the various phases of the therapy process, they typically do not directly address ethnicity or ethnic differences in therapy sessions unless it is clearly part of the presenting problem. Education on techniques for incorporating cultural factors into therapy is suggested for new therapists as well as for more seasoned clinicians. Specific recommendations are offered for conducting culturally sensitive cognitive-behavioral therapy with ethnic minority adolescents.

Cognitive-Behavior Therapy for Ethnic Minority Adolescents: Broadening Our Perspectives

David J. Hansen, Byron Zamboanga, & Georganna Sedlar, University of Nebraska-Lincoln

Adolescents are a burgeoning, and sometimes challenging, section of the population. In addition, a reality for cognitive behavior therapists is the rapidly increasing culturally diverse client base. While cognitive behavioral procedures have been shown to be effective for a variety of problems experienced by adolescents, these treatments often lack consideration of the role of ethnicity in adolescent development and mental health problems. Thus, the increasing number of both ethnic minority and adolescent populations in combination with the challenges involved in providing treatment to these populations emphasize the need for efforts to improve the relevance and effectiveness of cognitive behavior therapy with ethnic minority adolescents. This article discusses the complexity of the developmental and cultural context of treating ethnic minority adolescents and the utility of cognitive behavioral procedures for providing a strong basis for advancing our treatment efforts.

Introduction

Kim Fromme, University of Texas at Austin
Sandra A. Brown, University of California at San Diego and VA San Diego Health Care System

This is the lead article in a special series of papers on the prevention and treatment of adolescent and young-adult substance use. We introduce three studies that provide preliminary evidence for successful approaches to (a) smoking cessation or reduction among adolescent substance abusers (Myers, Brown, & Kelly, 2000), (b) reducing alcohol use among high-risk college students (Dimeff & McNeely, 2000), and (c) reducing or preventing drug use, drinking, and driving after drinking among high school students (D'Amico & Fromme, 2000). All three approaches are brief (one to six sessions), share a cognitive-behavioral theoretical basis, and have been examined in controlled trials. This article addresses commonalties among the three programs and describes future directions for prevention efforts among these age groups.

A Cigarette Smoking Intervention for Substance-Abusing Adolescents

Mark G. Myers & Sandra A. Brown, U.C. San Diego and Veterans Affairs San Diego Healthcare System and John F. Kelly, U.C. San Diego/San Diego State University

Tobacco use is prevalent among youth with alcohol and other drug problems, yet this issue has been afforded limited research or clinical attention. To this end we developed a behavioral cigarette smoking intervention designed specifically for substance-abusing youth. The present article outlines the empirical and theoretical basis for the intervention, followed by a detailed description of assessment procedures and treatment content. In addition, preliminary data are described that provide initial support for the feasibility and utility of tobacco intervention in the context of adolescent substance abuse treatment.

Computer-Enhanced Primary Care Practitioner Advice for High-Risk College Drinkers in a Student Primary Health-Care Setting

Linda A. Dimeff & Marguerite McNeely, University of Washington

Heavy drinking among college students remains a significant public health concern. Studies of a brief intervention for high-risk college drinkers developed by Alan Marlatt and colleagues have produced promising results. This current study sought to extend this earlier work by developing a streamlined version for use at a student health center. Undergraduate students seeking services at a student health center were asked to complete the Multi-Media Assessment of Student Health (MMASH), an interactive computer program developed for purposes of this study. Students meeting high-risk criteria for heavy or hazardous drinking were invited to participate in the research program. Forty-one students volunteered to participate and were randomly assigned by MMASH to either the brief intervention experimental condition or a treatment-as-usual control condition. Immediately following completion of MMASH, experimental participants and their primary care practitioner received and reviewed a personalized graphic feedback from an attached printer that summarized their drinking habits, risks, and encouraged moderate drinking. Moderate to large treatment effect sizes favoring the brief intervention were observed on self-report measures of binge drinking episodes and alcohol problems at the 30-day follow-up. Statistically significant gains were observed among those participants receiving the most exposure to the intervention in comparison to those who received less exposure.

Implementation of the Risk Skills Training Program: A Brief Intervention Targeting Adolescent Participation in Risk Behaviors

Elizabeth J. D'Amico and Kim Fromme, The University of Texas at Austin

Adolescence is a crucial developmental time period in which youth experience increased freedom and begin to individuate from their parents. During this time of exploration, participation in risk behaviors, such as heavy drinking, driving after drinking, and drug use tends to become more frequent. Traditional prevention efforts that typically focus on education have had little success in reducing youth participation in risk behaviors. In contrast, contemporary efforts that incorporate skills training and motivational techniques in addition to education have begun to show promise. The Risk Skills Training Program (RSTP) was developed as a brief, nonconfrontational, 50-minute program that targets high school–age students' alcohol and drug use. Results from a recent study suggest that the RSTP has a positive impact on this age group and is effective in reducing their subsequent participation in risk behaviors.

The Case of Howard

Matthew O. Kimble, VA Boston Healthcare System and Boston University School of Medicine

This paper presents the case of Howard, a 51-year-old self-referred Vietnam veteran who was seeking a posttraumatic stress disorder (PTSD) compensation evaluation and treatment recommendations at his local VA hospital. At the time of the assessment, Howard was divorced, had not worked regularly for 7 years, and was living in the suburbs with his 9-year-old son. The evaluation revealed the presence of multiple Axis I disorders, including PTSD, major depression, obsessive-compulsive disorder, and somatization disorder. His primary concerns at initial presentation were intrusive memories of Vietnam, an inability to work, and ongoing health complaints. Further evaluation revealed additional concerns with paranoia, difficulties concentrating, and significant social isolation. This case study emphasizes Howard's psychosocial history, symptom presentation, and psychometric test results. Case summary and treatment recommendations are deferred until the final case conceptualization (Kimble, 2000).

Response Paper: Constructing a Model of Change: Clinical Commentary on a Complex Case

Michael W. Otto, Massachusetts General Hospital and Harvard Medical School

In this clinical case commentary, attention was placed on the selection of the optimal targets and order of interventions for a 51-year-old male who meets criteria for four Axis I disorders: post-traumatic stress disorder (PTSD), major depression, somatization disorder, and obsessive-compulsive disorder (OCD). A theoretical model of what was learned in the context of trauma was developed to aid conceptualization of the interrelationship among the patient's symptoms. A model of change was presented, emphasizing cognitive-behavior therapy delivered in the context of a well-being therapy approach.

Response Paper
Depression-Focused Treatment in the Context of PTSD and Other Comorbid Disorders

Lynn F. Bufka, Boston University

This response paper describes cognitive-behavioral approaches to treating a patient, Howard, who is a combat veteran diagnosed with posttraumatic stress disorder, somatization disorder, major depressive disorder, and obsessive-compulsive disorder. This paper focuses on strategies for addressing the depression symptoms within the context of the broader clinical picture. Treatment strategies include increasing involvement in positive activities, self-monitoring of mood and behaviors, and cognitive restructuring. Collaboration with other providers is discussed. Potential problems are addressed, and expected treatment outcomes conclude the paper.

Response Paper: Treatment of Concurrent PTSD and OCD: A Commentary on the Case of Howard

David S. Riggs, VA Boston Healthcare System and Boston University School of Medicine

The complexity inherent in treating patients diagnosed with multiple disorders often leaves clinicians feeling unsure of how best to encourage change, or even where to begin. The present commentary discusses the interplay between the symptoms of posttraumatic stress disorder and obsessive-compulsive disorder (Kimble, 2000). Focusing on the need to assess the interplay of the two symptom clusters, the paper presents a model for understanding the etiological and functional relations that could link the symptoms of posttraumatic stress disorder and obsessive compulsive disorder. Further, the paper discusses ways in which a clinician might approach such complex cases in order to address all of the client's needs in an effective and efficient manner.

Response Paper: Treating PTSD in the Presence of Multiple Comorbid Disorders: The Case of Howard

Matthew O. Kimble, VA Boston Healthcare System and Boston University School of Medicine

This paper integrates the comments of Otto (2000), Bufka (2000), and Riggs (2000) on the case of Howard (Kimble, 2000), a 51-year-old Vietnam veteran who presented with multiple comorbid psychiatric concerns. This summary conceptualization outlines themes that were common among all three case commentaries and emphasizes issues related to comorbidity. Common themes include the importance of patient preparation for treatment, the necessity for initial and ongoing functional assessments, the value of utilizing patient strengths, the significance of acknowledging the interplay among symptoms, and the advantages of multi-disciplinary treatment. All three case commentaries were cautiously optimistic that change could be implemented even in this complicated and chronic case.