Effectiveness of booster sessions in the maintenance and enhancement of treatment gains following assertion training

Forty-six unassertive Ss were randomly assigned to assertion training (AT) or waiting-list control conditions. Ss receiving AT showed significantly greater improvements from pretreatment to post-treatment on 8 out of 10 questionnaire measures of assertiveness and 3 out of 5 direct behavioral observation measures compared with the waiting-list group. 27 Ss who had completed the AT program were then randomly assigned to 1 of 3 booster conditions, namely, monthly assertion training boosters (ATB), monthly attention placebo boosters (APB), or no boosters (NB). At the 3-month follow-up there was minimal difference between booster conditions. By the 6-month follow-up the results favored the ATB condition. Although the APB procedure was effective in preventing the relapse shown by the NB subjects, the ATB group actually showed further improvements on some measures of assertiveness during the 6-month follow-up period.     

Effectiveness of behavioral therapy for chronic low back pain: a component analysis

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildly disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments.     

Change in health-related quality of life and social cognitive outcomes in obese,older adults in a randomized controlled weight loss trial: Does physical activity behavior matter?

This article compared the effect of dietary weight loss administered alone (WL) or in combination with aerobic training (WL + AT) or resistance training (WL + RT) on health related quality of life, walking self-efficacy, stair climb self-efficacy, and satisfaction with physical function in older adults with cardiovascular disease or the metabolic syndrome. Participants (N = 249; M _age = 66.9) engaged in baseline assessments and were randomly assigned to one of three interventions, each including a 6-month intensive phase and a 12-month follow-up. Those in WL + AT and WL + RT engaged in 4 days of exercise training weekly. All participants engaged in weekly group behavioral weight loss sessions with a goal of 7–10% reduction in body weight. Participants in WL + AT and WL + RT reported better quality of life and satisfaction with physical function at 6- and 18-months relative to WL. At month 6, WL + AT reported greater walking self-efficacy relative to WL + RT and WL, and maintained higher scores compared to WL at month 18. WL + AT and WL + RT reported greater stair climbing efficacy at month 6, and WL + RT remained significantly greater than WL at month 18. The addition of either AT or RT to WL differentially improved HRQOL and key psychosocial outcomes associated with maintenance of physical activity and weight loss. This underscores the important role of exercise in WL for older adults, and suggests health care providers should give careful consideration to exercise mode when designing interventions.     

Measurement of assertive behavior: construct and predictive validity of self-report, role-playing, and in-vivo measures.

Examined the predictive validity and construct equivalence of the three major procedures used to measure assertive behavior: Self-report, behavioral role-playing, and in-vivo assessment. Seventy-five Ss, who spanned the range of assertiveness, completed two self-report measures of assertiveness, the Rathus Assertiveness Scale (RAS) and the College Self-Expression Scale (CSES); two scales from the Endler S-R Inventory of General Trait Anxiousness, the interpersonal and general anxiety scales; eight role-playing situations that involved the expression of positive and negative assertiveness; and a telephone in-vivo task. In general, the study revealed the following: (1) assertiveness measures are task-dependent in that there was more overlap within task than between tasks; (2) there is a moderate degree of correspondence between self-report and role-playing measures, although this was true only for negative assertion; (3) positive and negative assertion do not appear to have the same topography of responding; and (4) there appears to be no consistent relationship between the in-vivo measure and any other type of assertiveness measure.     

Group cognitive-behavioral treatment for the nonpurging bulimic: an initial evaluation

This study tested the initial effects of cognitive-behavioral therapy for binge eating in Ss who do not purge. Forty-four female binge eaters were randomized to either cognitive-behavioral treatment (CB) or a waiting-list (WL) control. Treatment was administered in small groups that met for 10 weekly sessions. At posttreatment a significant difference was found, with 79% of CB Ss reporting abstinence from binge eating and a 94% decrease in binge eating compared with a nonsignificant reduction (9%) in binge eating and zero abstinence rate in WL Ss. Following the posttest assessment, WL Ss were treated and evidenced an 85% reduction in binge episodes and a 73% abstinence rate. Binge eating significantly increased at 10-week follow-up for initially treated Ss; however, the frequency remained significantly improved compared with baseline levels.     

Effects of videotaped preparatory information on expectations, anxiety, and psychotherapy outcome.

This study examined whether preparation decreases clients' state anxiety and improves therapy outcome and clarified the relations among preparation, expectations, and state anxiety. Ss were 138 adults referred for outpatient psychotherapy. Half of the Ss viewed an 11-min preparatory videotape, while the control group waited an equivalent period before their 1st appointment. Pre-post measures confirmed that Ss who viewed the videotape had more accurate expectations about psychotherapy and lower levels of state anxiety than the control Ss. However, at 2-month follow-up, the prepared group had significantly better outcomes on only 1 of 10 outcome measures. It is suggested that more powerful designs may be necessary to detect long-term effects of preparation and that the short-term benefits demonstrated warrant further study.     

The desensitization derby: in vivo down the backstretch, imaginal at the wire?

Recontacted 17 Ss who had undergone successful imaginal or in vivo desensitization for snake phobia and had been evaluated pre- and posttreatment for a 9-month follow-up. Main findings were that: (a) overall treatment gains were maintained through the follow-up period; (b) differential gains in favor of the in vivo technique on one behavioral and two self-report snake-specific criteria were dissipated; and (c) imaginal Ss registered a reduction in self-rated fear during an approach task from posttesting to follow-up. Results are discussed in relation to the notion of cognitive rehearsal as a means of self-reinforcing treatment gains.     

Relationship among physical impairment,distress, and well-being in older adults

The relationship between activity limitation and self-report on a variety of mental health measures was investigated through a longitudinal study of 124 noninstitutionalized older adults between 60 and 80 years of age, recruited either as recently disabled (N=62) or as a matched control (N=62). Fifty-five of these respondents (disabled, n=28; controls, n=27) selected persons who could be contacted to provide informant information. Results showed the relationship between disability and mental health measures to be highly significant and stable across time. Further older adults classified as severely disabled experienced higher levels of anxiety, suicidal ideation, and overall distress than did the moderately disabled participants. Evidence was found for reciprocal causal relationships between health and mental health. Informants' reports supported findings based on self-report.An earlier version of this paper was presented at the 95th annual convention of the American Psychological Association, New York, August 1987.     

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims

Ninety-six female assault victims with chronic posttraumatic stress disorder (PTSD) were randomly assigned to 4 treatment conditions: prolonged exposure (PE), stress inoculation training (SIT), combined treatment (PE-SIT), or wait-list control (WL). Treatment consisted of 9 twice-weekly, individual sessions. Independent evaluations were conducted at pretreatment; posttreatment; and 3-, 6-, and 12-month follow-ups. All 3 active treatments reduced severity of PTSD and depression compared with WL but did not differ significantly from each other, and these gains were maintained throughout the follow-up period. However, in the intent-to-treat sample, PE was superior to SIT and PE-SIT on posttreatment anxiety and global social adjustment at follow-up and had larger effect sizes on PTSD severity, depression, and anxiety. SIT and PE-SIT did not differ significantly from each other on any outcome measure.     

A self-report measure of assertiveness in young adolescents

Reported a self-report measure of adolescents' assertiveness. Items for this scale were presented to young adolescents (N = 78) and subsequently were subjected to a factor analysis that revealed factors of submissiveness, aggressiveness, and assertiveness. Teacher ratings and behavioral responses during a role-play test also were obtained and provide additional validational evidence in support of the scale. After the validational study, a small assertiveness training program was conducted to evaluate the efficacy of standard treatment procedures with this population. Results indicated that training effects were obtained and that the effects generalized to situations that had not been employed during training.     

Race as an interpersonal variable in negative assertion

Investigated assertive behavior among black male psychiatric patients under white vs. black interpersonal partner conditions. Twenty-four high and 24 low scorers in level of measured general assertiveness served as Ss (N = 48). Responses to familiar and unfamiliar interpersonal stimuli in two conditions, role-play, and in vivo, were videotaped and rated. Dependent variables in the role play condition were: (1) Request for new behavior; (2) compliance; (3) affect; and (4) overall assertiveness; and (1) expression of negative opinion; (2) compliance; and (3) overall assertiveness for the in vivo condition. Although MANOVA revealed no main effect for race, Ss in the unfamiliar condition were more assertive (p less than .05) than those in the familiar role play condition. Also, Ss' responses in role play were more assertive (p less than .05) in the unfamiliar-white prompter condition as compared to Ss' responses in the unfamiliar-black prompter condition. In the in vivo situation for overall assertiveness, responses were rated as more assertive in the white prompter condition. In addition, although Ss were more likely to express negative opinions in the black prompter condition, they were more likely to comply with an unreasonable request in the white prompter condition.     

Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up

The Queensland Early Intervention and Prevention of Anxiety Project evaluated a child- and family-focused group intervention for preventing anxiety problems in children. This article reports on 12- and 24-month follow-up data to previously reported outcomes at posttreatment and at 6-month follow-up. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After diagnostic interviews, 128 children were selected and assigned to either a 10-week school-based child- and parent-focused psychosocial intervention or a monitoring group. Both groups showed improvements immediately at postintervention and at 6-month follow-up; the improvement was maintained in the intervention group only reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. At 12 months, the groups converged, but the superiority of the intervention group was evident again at 2-year follow-up. Severity of pretreatment diagnoses, gender, and parental anxiety predicted poor initial response to intervention, whereas pretreatment severity was the only predictor of chronicity at 24 months. Overall, follow-up results show that a brief school-based intervention for children can produce durable reductions in anxiety problems.     

A comparison of group treatments of women sexually abused as children

We randomly assigned 65 women who had been sexually abused by a father, stepfather, or other close relative to 1 of 3 treatment conditions: a 10-week interpersonal transaction (IT) group, a 10-week process group, or a wait list condition. Subjects were evaluated at pretreatment, posttreatment, and (if assigned to a group) a 6-month follow-up on measures of social adjustment, depression, fearfulness, and general distress. Results suggested that both the IT and process group formats were more effective than the wait list condition in reducing depression and in alleviating distress; changes were maintained at follow-up. Subjects in the process group format exhibited improvement in social adjustment, whereas subjects in the wait list condition actually deteriorated.     

Dose-response effects of cognitive-behavioral insomnia therapy: a randomized clinical trial

SUBJECT OBJECTIVE: To determine the optimal number of therapist-guided Cognitive-Behavioral Insomnia Therapy (CBT) sessions required for treating primary sleep-maintenance insomnia. DESIGN AND SETTING: Randomized, parallel-group, clinical trial at a single academic medical center. Outpatient treatment lasted 8 weeks with final follow-up conducted at 6 months. PARTICIPANTS: 86 adults (43 women; mean age 55.4 +/- 9.7 years) with primary sleep-maintenance insomnia (nightly mean wake time after sleep onset [WASO] = 93.4 +/- 44.5 minutes). INTERVENTIONS: One (week 1), 2 (weeks 1 and 5), 4 (biweekly), or 8 (weekly) individual CBT sessions scheduled over an 8-week treatment phase, compared with an 8-week no-treatment waiting period (WL). MEASUREMENT: Sleep diary and actigraphy measures of total sleep time, onset latency, WASO, total wake time, and sleep efficiency, as well as questionnaire measures of global insomnia symptoms, sleep related self-efficacy, and mood. RESULTS: Statistical tests of subjective/objective sleep measures favored the 1- and 4-session CBT doses over the other CBT doses and WL control. However, comparisons of pretreatment data with data acquired at the 6-month follow-up showed only the 4-session group showed significant long-term improvements in objective wake time and sleep efficiency measures. Additionally, 58.3% of the patients receiving 4 CBT sessions met criteria for clinically significant improvement by the end of treatment compared to 43.8% of those receiving 1 CBT session, 22.2% of those provided 2 sessions, 35.3% of those receiving 8 sessions, and 9.1% of those in the control condition. CONCLUSION: Findings suggest that 4 individual, biweekly sessions represents the optimal dosing for the CBT intervention tested. Additional dose-response studies are warranted to test CBT models that contain additional treatment components or are delivered via group therapy.     

Parent-child interaction therapy: a comparison of standard and abbreviated treatments for oppositional defiant preschoolers

Families of 54 behaviorally disturbed preschool-aged children (3 to 5 years) were randomly assigned to 1 of 3 treatment conditions: standard parent-child interaction therapy (PCIT; STD); modified PCIT that used didactic videotapes, telephone consultations, and face-to-face sessions to abbreviate treatment; and a no-treatment waitlist control group (WL). Twenty-one nondisturbed preschoolers were recruited as a social validation comparison condition. Posttreatment assessment indicated significant differences in parent-reported externalizing behavior in children, and parental stress and discipline practices from both treatment groups on most measures compared with the WL group. Clinical significance testing suggested a superior effect for the STD immediately after intervention, but by 6-month follow-up, the two groups were comparable. The findings indicate that abbreviated PCIT may be of benefit for families with young conduct problem children.     

Short-term structured treatment for avoidant personality disorder

Forty-two men and 34 women (mean age 27.5 years) who met DSM-III criteria for avoidant personality disorder were randomly assigned to 1 of 3 treatment conditions or to a waiting-list control group. Treatment Ss who participated in a 10-week group treatment program displayed significantly greater improvement on a variety of self-report and behavioral measures than did untreated control subjects. The inclusion of skills-training procedures did not contribute to the effects of graduated exposure procedures alone. The gains made during treatment were maintained over the follow-up period, but few further improvements were made. Clinical significance was evaluated by both the subjective evaluation method and the social comparison method. These procedures indicated that although significant improvements had been made, these avoidant Ss were not functioning at the level of normative comparison samples at treatment termination.     

The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents.

This study evaluated the efficacy of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) with depressed adolescents in Puerto Rico. Seventy-one adolescents meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria for a diagnosis of depression were randomly assigned to 1 of 3 conditions: CBT, IPT, or wait list (WL). Pretreatment, posttreatment, and 3-month follow-up measures of depression symptoms, self-esteem, social adjustment, family emotional involvement and criticism, and behavioral problems were completed. Results suggest that IPT and CBT significantly reduced depressive symptoms when compared with the WL condition. IPT was superior to the WL condition in increasing self-esteem and social adaptation. Clinical significance tests suggested that 82% of adolescents in IPT and 59% of those in CBT were functional after treatment. The results suggest that both IPT and CBT are efficacious treatments for depressed Puerto Rican adolescents. IPT's impact in other levels of outcome is discussed in terms of its consonance with Puerto Rican cultural values.     

Cognitive behavioral stress management effects on mood,social support,and a marker of antiviral immunity are maintained up to 1 year in HIV-infected gay men

Numerous herpesvirus infections are associated with clinically relevant outcomes as well as an accelerated HIV replication rate and subsequent disease progression. Stress managementinterventionsmayimprovemarkersofcellularimmunecontroloverlatent herpesvirus infections and these changes appear to be mediated by perceptions of increased social support availability. We examined the effects ofagroup-based cognitive behavioral stress management (CBSM) intervention on distress, dysphoria, perceived socialsupport,andherpesvirus immunoglobulin G (IgG) antibody titers during the 6to 12 months following the intervention. Of those who were initially randomized, 49 HIV-infected men were followed during the 6-to 12-month period after randomization to either a 10-week CBSM intervention (n=31) or amodified wait-list control condition (n = 18). Measures of distress, dysphoria, social support, and blood samples for herpesvirus Ig Gtiters were taken at baseline,immediately following CBSM and at-6-to 12-month follow-up. Men in CBSM displayed maintenance of previously observed intervention effects on dysphoria, reliable alliance support, and herpesvirus IgG antibody titers (i.e., Epstein-Barr virus capsid antigen; EBV-VCA). Intervention-related changes in EBV-VCA were unrelated to changes in lymphocyte subsets (i.e., CD4+, CD8+, and CD4+:CD8+) or changes in measures of dysphoria and social support during the investigation period. Data indicate that HIV-infected men participating in a CBS Mintervention maintain better psychosocial status and immunologic control of latent EBV infection up to 1 year after its conclusion. This research was supported by National Institute of Mental Health Grants P50 MH4355 and T32 MH18917.     

Covert modeling vs. Behavior rehearsal in the training and generalization of assertive behaviors: a crossover design

Twenty-four underassertive individuals from the community were assigned randomly to two treatment orders that included covert modeling and behavior rehearsal in a crossover design. Dependent measures included two self-report inventories and a behavioral assertiveness test. This test included a self-rating scale, two nonverbal measures, and eight measures of speech content. No measurable differences between treatments were found, and both significantly improved assertive skills on 10 of the 13 measures. However, Ss had greater expectations of improvement from behavior rehearsal both during and after treatment. Generalization of assertive skills from trained to untrained situations occurred on 8 of the 11 behavioral measures. Suggestions were made for exploring the use of covert modeling as a personal coping procedure capable of enhancing generalization and maintenance.     

Variations in children's assertiveness due to trainer asertion level

The influence of the trainer's personal assertiveness on the outcome of an assertiveness training program for children was evaluated. Nine paraprofessional trainers were rated either high or low in assertiveness using behavioral, self-report, and supervisors'ratings of assertiveness. A twelve-week assertion training intervention program was conducted for 74 fourth and fifth grade children. Results indicated that training by highly assertive trainers significantly increased the child subject's trust and liking of the group and perceptions of his/her behavioral changes. The assertiveness of subjects trained by highly assertive trainers was significantly higher immediately following treatment and at one year. However, subjects trained by trainers judged less assertive showed significantly higher scores on the interpersonal problem-solving test and the Group Decision Task immediately following treatment. The results are discussed in terms of advantages and disadvantages of directly modeling assertive behaviors and the importance of distinguishing the quality of alternatives generated on the interpersonal problem-solving tasks involving assertiveness.