The efficacy of problem-solving communication training alone, behavior management training alone, and their combination for parent-adolescent conflict in teenagers with ADHD and ODD.

Two family therapies were compared using teens with attention-deficit/hyperactivity disorder. Ninety-seven families were assigned to either 18 sessions of problem-solving communication training (PSCT) alone or behavior management training (BMT) for 9 sessions followed by PSCT for 9 sessions (BMT/PSCT). Both treatments demonstrated significant improvement in ratings of parent-teen conflicts at the midpoint but did not differ. By posttreatment, both produced improvement on ratings and observations but did not differ. Significantly more families dropped out of PSCT alone than out of BMT/PSCT. At most, 23% of families showed reliable change either by midpoint or by posttreatment, with no differences between therapies. Yet 31%-70% of families were normalized. Group-level change and normalization rates support treatment efficacy, whereas indices of reliable change are less impressive.     

Cognitive-behavioral therapy and relationship therapy in the treatment of children referred for antisocial behavior

The present study evaluated alternative treatments for children (N = 112, ages 7-13) referred for severe antisocial behavior. Children were randomly assigned to one of three treatments: problem-solving skills training (PSST), problem-solving skills training with in vivo practice (PSST-P), which included therapeutically planned activities to extend training to settings outside of treatment, or client-centered relationship therapy (RT). PSST and PSST-P children showed significantly greater reductions in antisocial behavior and overall behavior problems, and greater increases in prosocial behavior than RT children. These effects were evident on measures obtained immediately after treatment and at a 1-year follow-up, and on measures of child performance at home and at school. PSST-P children showed greater changes than PSST children on measures of functioning at school at posttreatment, but these differences were no longer evident at follow-up. Children in both PSST conditions showed significant reductions in deviant behavior and improvements in prosocial behavior from pretreatment to follow-up, whereas RT children tended to remain at their pretreatment level of functioning. Notwithstanding the significant improvements, comparisons with nonclinic (normative) samples revealed that the majority of youth remained outside of the normal range of deviant behavior. Possible directions for improving treatment for antisocial youth are highlighted.     

Social support and treatment outcome in behavioral family therapy for child conduct problems.

This study assessed the role of social support in the outcome of child management training (CMT) for single parents of conduct problem children and assessed the impact of adjunctive ally support training (AST) on treatment outcome. Single parents (N = 22) with a child diagnosed as oppositional or conduct-disordered received CMT or CMT plus AST. Each group received the same 6-week parent training program and the AST group received an extra social support intervention. Measures of parent behavior, child deviance, social support (SS), and parental depression were obtained at pre- and posttreatment and at 6-month follow-up. Both groups improved, and changes maintained at follow-up. AST produced no extra gains. Responders from either group were more likely than nonresponders to report high levels of SS from friends. Results emphasize the importance of SS and the difficulty of incorporating changes in SS into treatment programs.     

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.     

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.     

Effects of different stepwise reduction taper protocols on cycling performance.

This study examined the effects of different 7-day taper protocols on simulated 20-km time trials (20TT). Following 3 weeks of baseline training, 11 male cyclists (.VO2max = 4.78 +/- 0.66 L.min-1) were randomly assigned to one of three stepwise reduction tapers in which training volume was reduced by 30% (T30, n = 5), 50% (T50, n = 6), or 80% (T80, n = 6) of baseline training with intensity (85% .VO2max) maintained. Cardiorespiratory measurements were collected every 5 km during the 20TT. Results revealed a significant (5.4%, 0.05) improvement in 20TT performance in the T50 protocol with concomitant increases in .VO2 and O2 pulse. No significant differences were found in T30 or T80. These results showed that a moderate (50%) reduction in weekly training volume appeared to be optimal in terms of enhancing performance. This confirms the contention that proper placement of training volume during tapering, while maintaining exercise intensity, can elicit performance improvements.     

An interactive psychoeducational intervention for women at risk of developing an eating disorder

This study evaluated a synchronous Internet-delivered intervention (chat room) for improving eating habits and body image in college-age women at risk for developing an eating disorder. Sixty at-risk women (mean age = 18.9, SD = 2.4; 65.0% Caucasian, 19% Latino/Hispanic, 8% Asian/Pacific Islander, 3% African American, 5% other; mean body mass index = 25.6, SD = 5.7) were randomly assigned to intervention (n = 30) or control (n = 30) groups. Once a week for 8 weeks, participants used a private chat room for a 1-hr moderated discussion focused on improving body image and eating behaviors. Additional treatment components included psychoeducation, asynchronous support, homework, and summaries. Assessments were conducted at baseline, posttreatment, and 10 weeks after posttreatment. Participants indicated high satisfaction with the intervention mode. Intervention participants significantly reduced eating pathology and improved self-esteem over controls at follow-up. These findings suggest that synchronous, Internet-delivered programs are efficacious and have potential to reduce problematic attitudes and behaviors that may lead to eating disorders among college-age women.     

A randomized controlled trial of goal choice interventions for alcohol use disorders among men who have sex with men

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N = 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n = 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI + CBT). Other participants (n = 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI + CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed.     

Efficacy of a self-directed behavioral health change program: Weight,body composition,cardiovascular fitness,blood pressure,health risk,and psychosocial mediating variables

This study assessed the efficacy of a comprehensive behavioral health program designed to promote self-initiated change in overweight healthy middle-aged adults (M=49 years). Three treatment groupss (total n=25) differing in type of social support provided (i.e., group plus professional versus group plus peer versus group only) received 13 treatment sessions and 6 maintenance sessions scheduled over a full year. A self-directed change intervention taught several cognitive-behavioral techniques as they applied to exercise adherence, weight reduction/maintenance, and stress management. Combined treatment groups (n=25) improved significantly more than an assessment only control group (n=9) in weight, percentage body fat, cardiovascular fitness, exercise adherence, health-risk appraisal, chronic tension (MBHI, scale A), and systolic and diastolic blood pressure at both post-treatment and 6-month follow-up assessments. Self-motivation, group treatment attendance, and health-risk appraisal significantly related (r's=.30–.56) to several posttreatment and follow-up measures of behavioral health change. No significant differences were found among the three treatment groups on any of the outcome measures.This study was partially funded by the Crescenta-Canada YMCA.     

Mid-term effectiveness of behavioral and psychodynamic inpatient treatments of severe obesity based on a randomized study

BACKGROUND: The objective of this study was to compare the effectiveness of psychodynamic and behavioral inpatient treatments of severely obese patients regarding weight and distress. METHODS: In a longitudinal study obese patients (body mass index, BMI >or=35) were randomly assigned to behavioral or to psychodynamic inpatient treatment. Mostly female (n = 267; 85%) obese patients with psychiatric and somatic comorbidity (age 20-64 years, BMI 35-74) were examined with standardized self-report scales on distress (SCL-90R), interpersonal problems (Inventory of Interpersonal Problems), eating behavior (Fragebogen zum Essverhalten) and body image (Fragebogen zum Korperbild). RESULTS: During 49 days (mean) of inpatient treatment, patients lost an average of 5.6 kg (4.4%) in the behavioral (n = 130) and 5.7 kg (4.4%) in the psychodynamic setting (n = 137). In both settings, eating behavior, well-being and body image also improved significantly. One year after discharge, return rate was 73%. Forty percent had further reduced their weight (by more than 5% compared to intake), 36% had regained weight, but were still below intake level, and another 24% had increased weight above intake. CONCLUSION: Behavioral and psychodynamic treatments were equally effective reducing weight and distress over 1 year.     

Cognitive-behavioral therapy for anxiety disordered youth: a randomized clinical trial evaluating child and family modalities

This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support/ attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at posttreatment and 1-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Implications for treatment and suggestions for research are discussed.     

Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling

Rape victims with posttraumatic stress disorder (PTSD; N = 45) were randomly assigned to one of four conditions: stress inoculation training (SIT), prolonged exposure (PE), supportive counseling (SC), or wait-list control (WL). Treatments consisted of nine biweekly 90-min individual sessions conducted by a female therapist. Measures of PTSD symptoms, rape-related distress, general anxiety, and depression were administered at pretreatment, posttreatment, and follow-up (M = 3.5 months posttreatment). All conditions produced improvement on all measures immediately post-treatment and at follow-up. However, SIT produced significantly more improvement on PTSD symptoms than did SC and WL immediately following treatment. At follow-up, PE produced superior outcome on PTSD symptoms. The implications of these findings and direction for treatment and future research are discussed.     

Phonophoresis and the absorption of dexamethasone in the presence of an occlusive dressing

CONTEXT: Phonophoresis is purported to represent a method to apply topical medications through the skin to treat soft tissue injuries and inflammatory conditions. Few data are available to demonstrate the clinical effectiveness of the treatment. OBJECTIVE: To determine the effect of ultrasound on the transcutaneous absorption of dexamethasone when occluded with a dressing. DESIGN: Crossover design. SETTING: University general clinical research center. PATIENTS OR OTHER PARTICIPANTS: Ten healthy subjects (age = 29.2 +/- 8.8 years; height = 170.0 +/- 3.9 cm; mass = 67.5 +/- 18.4 kg). INTERVENTION(S): Two grams of 0.33% dexamethasone cream were applied to a 10-cm (2) area on the anterior forearm. The drug was applied to the skin and occluded with a dressing for 30 minutes before the ultrasound and sham ultrasound treatments. The treatments were applied over the drug and occlusive dressing. Ultrasound treatments were delivered at an intensity of 1.0 W/cm (2) (50% pulsed) at an output frequency of 3 MHz for 5 minutes and compared with sham ultrasound treatments that were delivered at an intensity of 0.0 W/cm (2) (50% pulsed) at an output frequency of 3 MHz for 5 minutes. All subjects received both the ultrasound and sham treatments, and the order in which subjects received the treatments was counterbalanced. MAIN OUTCOME MEASURE(S): Serum samples were drawn before treatment and immediately posttreatment and at 2, 4, 6, 8, and 10 hours posttreatment. Using high-performance liquid chromatography, we analyzed serum to determine dexamethasone concentrations. RESULTS: A 2-way repeated-measures analysis of variance (condition x time) revealed a significant main effect for ultrasound treatment ( P = .047). The rate of appearance and the total concentration of dexamethasone in the serum were greater in subjects after phonophoresis than after sham ultrasound. The sham group had only trace amounts of dexamethasone in the serum, indicating that drug absorption was negligible without the ultrasound energy. The effect size of the phonophoresis condition fell within a 95% confidence interval after the baseline measurement. CONCLUSIONS: We found that a phonophoretic effect occurred with dexamethasone when its application saturated the skin.     

Learning sobriety together: A randomized clinical trial examining behavioral couples therapy with alcoholic female patients

Married or cohabiting female alcoholic patients (n = 138) and their non-substance-abusing male partners were randomly assigned to 1 of 3 equally intensive interventions: (a) behavioral couples therapy plus individual-based treatment (BCT; n = 46), (b) individual-based treatment only (IBT; n = 46), or (c) psychoeducational attention control treatment (PACT; n = 46). During treatment, participants in BCT showed significantly greater improvement in dyadic adjustment than those in IBT or PACT; drinking frequency was not significantly different among participants in the different conditions. During the 1-year posttreatment follow-up, compared with participants who received IBT or PACT, participants who received BCT reported (a) fewer days of drinking, (b) fewer drinking-related negative consequences, (c) higher dyadic adjustment, and (d) reduced partner violence.     

Effect of training on central factors in fatigue following two- and one-leg static exercise in man

Leg strength and fatigue developed during 150 repeated two- and one-leg isometric maximal voluntary contractions were determined before and after a 5-week one- (n = 6) or two- (n = 7) leg training programme including a control group of five subjects. Two- and one-leg training increased two- and one-leg strength by 59 (range 8-107) and 36% (-1-69) respectively (P less than 0.01) with no significant difference between the two groups. Two-leg training decreased (P less than 0.05) fatigue only during two-leg maximal voluntary contractions (from 20 [11-26] to 13% [6-27]); and one-leg training fatigue only during one-leg maximal voluntary contractions (from 20 [15-23] to 11% [9-24]) despite the fact that both legs were trained. Surface electromyographic activity decreased during both repeated two- and one-leg maximal voluntary contractions (P less than 0.01) but a reduction in electromyographic decay was seen (P less than 0.05) during two-leg maximal voluntary contractions after two-leg training. Training increased fast-twitch b fibre size (P less than 0.01), and glycogen depletion was seen in fast-twitch (a and b) fibres, but the relative fast-twitch b area did not increase significantly. No training effects were seen in the control group. The results show that an approximately 47% increase in muscle strength may take place without a significant change in the relative percentage of muscle fibre types or in the average muscle fibre size. Furthermore, the specificity of the training response to fatigue developed during repeated two- and one-leg maximal voluntary contractions suggests a change in the nervous influence on the motor units.     

A School-Based, Nurse-Administered Relaxation Training for Children with Chronic Tension-Type Headache

Compared the efficacy of a school-based, nurse-administeredrelaxation training intervention to a no-treatment control conditionfor children (10–15 years old) with chronic tension-typeheadache and the outcome at posttreatment and a 6-month follow-up.The study was conducted in a controlled between-group designincluding 26 schoolchildren who were randomly assigned to thetwo treatment conditions. Results showed that headache activityin the children treated with relaxation training was significantlymore reduced than among those in the no-treatment control groupat posttreatment as well as the 6-month follow-up. At theseevaluations, 69% and 73% of the pupils, respectively, treatedwith relaxation had achieved a clinically significant headacheimprovement (at least a 50% improvement) as compared to 8% and27% of the pupils, respectively, in the no-treatment controlgroup. Thus, a school-based, nurse-administered relaxation trainingprogram seems to be a viable treatment approach for childrenwith chronic tension-type headaches.     

Benefits of the uncertainty management intervention for African American and white older breast cancer survivors: 20-Month Outcomes

In a 2 x 2 randomized block repeated measure design, this study evaluated the follow-up efficacy of the uncertainty management intervention at 20 months. The sample included 483 recurrence-free women (342 White, 141 African American women; mean age = 64 years) who were 5-9 years posttreatment for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during 4 weekly telephone sessions in which survivors were guided in the use of audiotaped cognitive-behavioral strategies and a self-help manual. Repeated measures MANOVAs evaluating treatment group, ethnic group, and treatment by ethnic interaction effects at 20 months indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, and a variety of coping skills. Importantly, the 20-month outcomes also demonstrated benefits for women in the intervention condition in terms of declines in illness uncertainty and stable effects in personal growth over time.     

12-year follow-up study of the Hamburg short psychotherapy experiment: an overview

In 1971/72 eighty-seven psychoneurotic and psychosomatic patients of the Psychosomatic Outpatient Department at the University Clinic of Hamburg-Eppendorf attained an indication for short-term psychotherapy. Nineteen patients did not accept our offer despite a sufficient prognosis; they form the nontreated control group. The remaining 68 patients were assigned at random to a psychodynamic conflict-centered (n = 34) or to a client-centered therapy (n = 34), each with a maximum of 30 sessions. In spite of this long interval of 12 years we gained information about 82.5% of our patients. The follow-up program consisted of a multidimensional approach to describe the posttreatment development of our patients: psychological tests, self-rating by the patient and assessments by the follow-up interviewer and independent ratings of experts. The efficacy of short psychotherapy is seen in the test scale 'extraversion' for both treatment groups, for 'depression' only for the client-centered therapy; for the psychodynamic therapy there is a tendency for late changes. The clinical ratings show no significant differences between the treatment and the control groups. Sex combination in the therapeutic dyads (i.e. same sex vs. opposite sex) is important for patients' posttherapeutic development.     

Efficacy of Hylan G-F 20 and Sodium Hyaluronate in the treatment of osteoarthritis of the knee -- a prospective randomized clinical trial

In this independent prospective randomized trial, we compared the clinical effectiveness, functional outcome and patient satisfaction following intra articular injection with two viscosupplementation agents - Hylan G-F-20 (n=199) and Sodium Hyaluronate (n=193) in patients with osteoarthritis (OA) of the knee. All patients were prospectively reviewed by blinded independent assessors at pre injection, 6 weeks, 3, 6, 12 months. Knee pain and patient satisfaction were measured on a visual analogue scale. Functional outcome was assessed using WOMAC, Oxford knee score and EuroQol EQ-5D scores. Knee pain on VAS improved from 6.7 to 3.2 by 6 weeks (p=0.02) and was sustained until 12 months (3.7, p=0.04) with Hylan G-F 20. In the Sodium Hyaluronate group, pain improved from 6.6 to 5.7 at 6 weeks (p>0.05) and to 4.1 at 3 months (p=0.04) but was sustained only until 6 months (5.9, p>0.05). Improvement in the WOMAC pain subscale was significantly superior in the Hylan G-F 20 group at 3 months (p=0.02), 6 months (p=0.01) and 12 months (p=0.007). There was no significant difference in the EQ-5D scores at 6 weeks and 3 months between the two groups. The numbers of treatment related adverse events were higher (39 vs. 30) in the Hylan G-F 20 group. One patient in the Hylan G-F 20 group who had a serious adverse event was also included in the final analysis. Although both treatments offered significant pain reduction, it was achieved earlier and sustained for a longer period with Hylan G-F 20. From this study, it appeared that the clinical effectiveness and general patient satisfaction are better amongst patients who received Hylan G-F 20.     

Self-help treatment for insomnia: a randomized controlled trial

STUDY OBJECTIVES: Insomnia is a prevalent health complaint that often remains untreated. Several interventions are efficacious but they are not widely available. This study evaluated the efficacy of a self-help behavioral intervention for insomnia. DESIGN: The study used a 2 (conditions; self-help treatment, no treatment control) x 3 (assessments; pretreatment, posttreatment, 6-month follow-up) mixed factorial design. SETTING: This study was part of a larger epidemiologic study conducted with a randomly selected sample of 2001 adults of the province of Quebec in Canada. PARTICIPANTS: One-hundred ninety-two adults (n = 127 women, 65 men; mean age, 46 years) with insomnia, selected from a larger community-based epidemiologic sample, were randomly assigned to self-help treatment (n = 96) or no-treatment control (n = 96). INTERVENTIONS: The self-help intervention included 6 educational booklets mailed weekly to participants and providing information about insomnia, healthy sleep practices, and behavioral sleep scheduling and cognitive strategies. MEASUREMENTS AND RESULTS: Participants completed sleep diaries and questionnaires at pretreatment, posttreatment, and 6-month follow-up. Significant but modest improvements were obtained on subjective sleep parameters for treatment but not control participants. Treated participants averaged nightly gains of 21 minutes of sleep and a reduction of 20 minutes of wakefulness, with a corresponding increase of 4% in sleep efficiency. Improvements were also obtained on measures of insomnia severity (Insomnia Severity Index) and of sleep quality (Pittsburgh Sleep Quality Index), and those changes were maintained at follow-up. CONCLUSIONS: A self-help behavioral intervention was effective in alleviating a broad range of insomnia symptomatology in a community sample. Self-help may be a promising approach to make effective intervention more widely available.