c&bp8.3

Cognitive-Behavioral Therapy With Lesbian, Gay, and Bisexual Youth
Steven A. Safren, Massachusetts General Hopital/Harvard Medical School and Fenway Community Health Center, Boston, Gary Hollander, University of Wisconsin Medical School, and Trevor A. Hart, and Richard G. Heimberg, Temple University

The purpose of the present paper is to sensitize cognitive-behavior therapists to issues that are faced by many lesbian, gay, and bisexual youth. Little information is available to cognitive-behavioral therapists about same-sex sexual attractions in lesbian, gay, and bisexual youth, or how to incorporate these concerns into one's functional analysis and treatment plan. However, lesbian, gay, and bisexual youth may be at risk for a variety of clinical problems amenable to cognitive-behavioral therapy. We provide necessary information for the incorporation of issues concerning same-sex sexuality into one's case formulations when working with lesbian, gay, and bisexual youth, illustrated by case examples and clinical vignettes.

Revisiting Prochaska and DiClemente's Stages of Change Theory: An Expansion and Specification to Aid in Treatment Planning and Outcome Evaluation
Arthur Freeman and Michael Dolan, Philadelphia College of Osteopathic Medicine

Why people change and why they do not change is a question that therapists have asked for many years. For almost two decades one model of change has stood as the standard bearer in conceptualizing the stages of change in therapy. The need to modify the Prochaska and DiClemente model of change has come out of our own experiences in working with patients with a variety of mental health issues. The addition of these new stages reflect the experiences of clients and therapist both in and out of the therapeutic process. The original model has guided not only our therapy but our research as well. We now face times of increasing scrutiny of our therapeutic process and a reliance on research based outcome evaluation. This increased scrutiny requires us to provide models with more precision to truly describe what we do and how we do it. The development of this expanded model of change was designed to fulfill that very purpose of more precision. This model will hopefully provide the clinician, the researcher, the third party payer and ultimately the patient with a more experience centered focus from which to make their decisions.

Computer-Assisted Therapy in the Treatment of Flight Phobia: A Case Report
Xavier Bornas, Miquel A. Fullana, Miquel Tortella-Feliu, Jordi Llabrés, Gloria García de la Banda, University of the Balearic Islands

The efficacy of computer-assisted exposure (CAE) therapy for the treatment of flight phobia was examined. The subject was a 34-year-old man with severe fear and almost complete avoidance of flying. Six 50-minute CAE sessions and two 20-minute booster sessions were conducted over a period of 1 month. All self-reported measures of the fear of flying decreased following CAE, and before the subject took a one-hour flight with minimal distress. A follow-up after 6 months revealed that he had flown three times without anxiety. The implications of CAE for treatment of flight phobia are discussed.

Cognitive Therapy for Panic Disorder: The Impact of Medication Discontinuation on Symptoms
Gregory K. Brown, University of Pennsylvania School of Medicine, Peter J. Bieling, University of Pennsylvania School of Medicine and McMaster University, Aaron T. Beck, Cory F. Newman, and Samantha J. Levy, University of Pennsylvania School of Medicine

Little is known about the impact of withdrawal and discontinuation of medication during cognitive treatment for panic disorder. This naturalistic study was designed to gather initial evidence on this question. The sample for this study consisted of patients who had participated in a comparative outcome study on cognitive therapy for panic disorder. Of 21 patients who were taking medication while receiving cognitive therapy, 9 were able to withdraw from their medication by termination, and remained medication-free at 1-year follow-up. The results revealed a significant decrease in the frequency of panic attacks and improvement on other symptom measures at termination and at 1-year follow-up, regardless of medication status. Withdrawal and discontinuation of medication did not result in relapse and did not reduce the effectiveness of cognitive therapy. Implications for clinical decision making are described.

SPECIAL SERIES: Primary Prevention of Eating Disorders: A Noble Calling or an Unrealistic Ideal?

J. Scott Mizes, West Virginia University School of Medicine, and Deanne Zotter Bonifazi, West Chester University

This special series on prevention of eating disorders offers an expanded discussion of a laudable effort at eating disorders prevention, the Body Logic Program, highlighting both the successful aspects of the program and the disappointments and challenges. Three experts in eating disorders prevention then provide commentaries on the Body Logic Program in view of the current status of the research, competing conceptual models, and real-world challenges of prevention of eating disorders.

Development and Implementation of the Body Logic Program for Adolescents: A Two-Stage Prevention Program for Eating Disorders
Paula J. Varnado-Sullivan, Nancy Zucker, Donald A. Williamson, Deborah Reas, Jean Thaw, Louisiana State University, and Susan B. Netemeyer, Southeastern Louisiana University

It has been hypothesized that targeting adolescents who are at risk for developing eating disorders may result in more effective prevention efforts. The Body Logic Program is a two-stage prevention program, which included a school-based intervention component for all students within the school setting, as well as a more intensive intervention for students identified as at risk for developing eating disorders. The efficacy of the program was tested using a controlled treatment outcome design. Participants were 157 female and 130 male sixth and seventh graders from two private schools (School 1: n = 122; School 2: n = 165). The school-based intervention led to decreases in scores for students in School 1 on the Fear of Fatness scale of the Multiaxial Assessment of Eating Disorder Symptoms (MAEDS) for all female participants, as well as female participants identified as at risk, and the Avoidance of Forbidden Foods scale of the MAEDS (all females), which were maintained at 10.5-week follow-up. Efforts to attract the students identified as at risk for eating disorders (n = 55) and their parents for participation in the intensive family-based intervention proved unsuccessful. No significant effects for the intervention were noted for male participants, but baseline scores for boys were quite low, which limits the conclusions that can be drawn.

The Body Logic Program: Discussion and Reflections
Niva Piran, The Ontario Institute for Studies in Education of the University of Toronto

This paper suggests that the development, implementation, and evaluation of the Body Logic Program, described by Varnado-Sullivan and her colleagues (2001), raise key issues in the prevention of eating disorders and the assessment of its impact. These issues include the consideration of the social context within which body shape preoccupation develops, the development of general resilience among students, the construction of positive norms regarding body weight and shape in schools and families, working with teachers and parents, securing commitment from the school community and administration, the selection of outcome measures, and the timing of outcome evaluation. Varnado-Sullivan et al.'s work represents a commendable effort toward the development of this new field.

Rethinking Prevention Efforts in Eating Disorders
Debra L. Franko, Harvard Eating Disorders Center, Harvard Medical School and University of Massachusetts at Dartmouth

The prevention of eating disorders has been a complicated and elusive goal for researchers. Using an innovative design, the Body Logic Program (Varnado-Sullivan et al., 2001) was found to successfully reduce fear of fatness and decrease intentions to diet in a study of adolescent girls. Previous researchers have recommended separating universal (primary) and indicated (secondary) prevention. However, the authors found that this was not easily accomplished. When at-risk girls were identified and invited to participate in an intensive program, only 1 (of 55) elected to do so. Future prevention efforts will need to examine innovative approaches to reach these at-risk girls, including the use of incentives for participation, a focus on advocacy and action, the involvement of parents, and an integration of eating disorders prevention with other adolescent health concerns.

Commentary on Varnado-Sullivan et al.'s (2001) "Development and Implementation of the Body Logic Program for Adolescents: A Two-Stage Prevention Program for Eating Disorders"
Michael P. Levine, Kenyon College

This commentary offers a critical evaluation of the Body Logic Program for the prevention of eating disorders (Varnado-Sullivan et al., 2001). This ambitious project was designed to affect middle-school students in general (universal prevention), as well as high-risk students and their parents (selective prevention). The evaluation includes a consideration of, and appreciation for, the challenges of this type of research, what the researchers accomplished in the way of universal prevention, and the nature of the project as seen in the context of three different models of prevention. Ways that this type of prevention program could be improved and expanded are discussed. Special attention is given to various forms of participatory action designed to engage students, teachers, parents, and other adults in the process of changing group and community norms so as to reduce negative sociocultural effects on female body images and to foster personal and collective resilience in the participants.