Behaviour Therapy

Formal diagnostic systems (DSM-IV, ICSD, and ICD-10) do not provide adequate quantitative criteria to diagnose insomnia. This may not present a serious problem in clinical settings where extensive interviews determine the need for clinical management. However, lack of standard criteria introduce disruptive variability into the insomnia research domain. The present study reviewed two decades of psychology clinical trials for insomnia to determine common practice with regard to frequency, severity, and duration criteria for insomnia. Modal patterns established frequency (Ն3 nights a week) and duration (Ն6 months) standard criteria. We then applied four versions of severity criteria to a random sample and used sensitivity-specificity analyses to identify the most valid criterion. We found that severity of sleep onset latency or wake time after sleep onset of: (a) Ն31 min; (b) occurring Ն3 nights a week; (c) for Ն6 months are the most defensible quantitative criteria for insomnia. 

This study was meant to investigate the psychometric properties and clinical utility of the Lehrer Woolfolk Anxiety Symptom Questionnaire (LWASQ), an instrument for assessment of somatic, behavioral and cognitive aspects of anxiety. Confirmatory factor analysis on data from social phobics (n = 108), normal adults (n = 103) and normal adolescents (n = 650) showed that the three original factors were strongly replicated in each sample. The three subscales appeared to have high internal consistency, while data on convergent and divergent validity were satisfactory. In addition, the subscales did very well in discriminating between phobic patients and normals, and were able to detect treatment effects. In the discussion the instrument is compared with other self report measures of anxiety dimensions, like the Cognitive Somatic Anxiety Questionnaire (CSAQ) and the Worry-Emotionality Scale (WES). It is suggested that similar questionnaires, adjusted to the separate anxiety disorders, should be developed.

Although the use of schema modes in schema-focused therapy (SFT) has been very popular since its introduction, Young's schema mode concept remained largely empirically untested. In order to provide insight into the mode conceptualization of personality disorders (PDs), the current study assessed the relationships between 14 schema modes and all PDs. Relationships between dimensional PD scores and selfreported mode scores were tested in a mixed study group of 489 participants, consisting of axis I and axis II patients, and non-patients. Psychopathology was assessed by means of the Structured Clinical Interview for DSM-IV axis I and axis II disorders (SCID I and SCID II) or the Structural Interview for DSM-IV Personality Disorders (SIDP-IV), and modes were assessed by the Schema Mode Inventory. Kendall's partial tau coefficients, controlling each PD-mode correlation for all other PD scores, indicated unique mode profiles for all PDs and corroborated most of the hypothesized PD-mode correlations, supporting the construct validity of the mode model. Nevertheless, the high number of correlations found for some PDs raises concerns about the specificity of the mode model. Implications for both research and therapy are discussed.

An animal model of sexual fetishism was developed with male Japanese quail based on persistence of conditioned sexual responding during extinction to an inanimate object made of terrycloth (Experiments 1 and 3). This persistent responding occurred only in subjects that came to copulate with the terrycloth object, suggesting that the copulatory behavior served to maintain the fetishistic behavior. Sexual conditioning was carried out by pairing a conditioned stimulus (CS) with the opportunity to copulate with a female (the unconditioned stimulus or US). Copulation with the CS object and persistent responding did not develop if the CS was a light (Experiment 1) or if conditioning was carried out with a food US (Experiment 2). In addition, subjects that showed persistence in responding to the terrycloth CS did not persist in their responding to a light CS (Experiment 3). The results are consistent with the hypothesis that conditioned copulatory behavior creates a form of self-maintenance that leads to persistent responding to an inanimate object. The development of an animal model of such fetishistic behavior should facilitate experimental analysis of the phenomenon. #

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis-stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children (n ¼ 515) over a 6 month period (Time 1-Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism-critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionismstriving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.

The effects of 5.4 months of inpatient behavioral treatment and of 20 sessions of outpatient behavioral therapy were studied in a quasi-experimental design with 22 inpatient and 43 outpatient obsessive-compulsives. Within each group there was a significant drop in scores on the Maudsley Obsessive-Compulsive Inventory after the therapy. Even after controlling-through covariance analysisfor initial differences between groups. no differences emerged between inpatient and outpatient treatment effects. Considering the clinical and economical relevance of the issue, and acknowledging the quasiexperimental nature of the present study, it is argued that controlled tests are justified.

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Using Ecological Momentary Assessment, the within patient associations between drive for thinness, emotional states, momentary urge to be physically active and physical activity were studied in 32 inpatients with an eating disorder. Participants received an electronic device and had to indicate at nine random times a day during 1 week their momentary drive for thinness, positive and negative emotional states and their urge to be physically active and physical activity. Multilevel analyses indicated that patients with higher mean levels for urge to be physically active were characterized by lower body mass index (BMI) and chronically negative affect whereas patients with higher mean levels for physical activity were characterized by lower BMI and higher dispositions for drive for thinness. In addition, within patient relations between drive for thinness and urge to be physically active were moderated by BMI and chronically negative affect whereas within patient relations between drive for thinness and physical activity were moderated by BMI. Finally, also positive emotional states were significantly associated with physical activity within patients. By using a daily process design, characteristics of physical activity were revealed that have not been identified with assessment methods that have a lower time resolution. r

The present study investigated the contribution of parental modeling to the fearfulness of children. Forty children (aged 9-12) who were referred to an outpatient treatment centre filled out the trait version of the Spielberger State-Trait Anxiety Inventory for Children (STAIC) and the revised version of the Fear Survey Schedule for Children (FSSC). The parents of the children completed adult versions of the STAI-trait and the FSS. In addition, parents rated to what extent they generally expressed fears to their children. Results showed that trait anxiety in children was positively associated with trait anxiety of both the mother (r = 0.34, P < 0.05) and the father (r = 0.31, P < 0.05). Fearfulness of the children was only related to fearfulness of the mother (r = 0.56, P < 0.001). Most importantly, the data showed that modeling played a role in this relationship. A linear association between FSSC scores and mothers' rating of expressing fears to their children was found. That is to say, children of mothers who never expressed their fears had the lowest FSSC scores, children of mothers who often expressed their fears had the highest FSSC scores, whereas children of mothers who sometimes expressed their fears scored in between.

Six adults with non-insulin dependent diabetes mellitus participated in a laboratory procedure to determine the effects of an acute stressor, mental arithmetic, on blood glucose, cardiovascular, and subjective indices of stress. They then completed 12 days home monitoring of stressful events, subjective stress, and blood glucose. Diet and activity were controlled to evaluate the direct effects of stress on blood glucose in the natural environment. Laboratory results showed significant increases in blood glucose, cardiovascular (HR and SBP), and subjective stress ratings during the mental arithmetic task when compared to a resting condition. Home monitoring data were consistent with the laboratory findings; blood glucose range tended to be greater on high vs low stress days, especially when the difference between high and low stress was greatest. These findings suggest that the laboratory stress induction procedure was externally valid and that in the natural environment, stress has a hyperglycemic effect on blood glucose. INTRODUCITON Diabetes mellitus has ranked among the ten leading causes of death since 1932, and is associated with increased risk for new blindness, renal failure, and cardiovascular and peripheral vascular disease (Kovar, Harris; & Hadden, 1987). Although the biochemical mechanisms responsible for such complications are not entirely clear, it is generally believed that they result from chronic hyperglycemia (high blood glucose levels), and that they can be prevented or delayed if adequate control of blood glucose levels is achieved and maintained (Pohl, Gonder-Frederick & Cox, 1984). Factors that disrupt diabetic control are, thus, a major concern for individuals with diabetes. In the present study, we investigated the effects of psychological stress on blood glucose control among adults with Type II (non-insulin dependent) diabetes mellitus. Data from varied sources support the hypothesis that stress disrupts diabetic control and causes hyperglycemia. Animal models, for example, have implicated stress in the development of Type I (insulin dependent) diabetes (Carter, Hemnan, Stokes & Cox. 1987). and in causina a hvneralvcemic resuonse in Type II diabetes (Surwit, Feinglos, Livingston, Kuhn & McCubbin,' 1984): Epinephrine infusion s&dies also support the-hypothesis that stress disrupts metabolic processes leading to hyperglycemic episodes (Gerich, Lorenxi, Tzalikian & Karam, 1976). Finally, studies measuring naturally-occurring life strcssors have shown that higher levels of stressful events are reported among newly diagnosed diabetics vs nondiabetic controls (Robinson & Fuller, 1985). and among poorly-vs well-controlled diabetic patients (Schwartz, Springer, Flaherty UC Kiani, 1986). It is theorized that such stress effects occur via enhanced sympathetic nervous system and neuroendocrine activity

The present study investigated the contribution of parental modeling to the fearfulness of children. Forty children (aged 9-12) who were referred to an outpatient treatment centre filled out the trait version of the Spielberger State-Trait Anxiety Inventory for Children (STAIC) and the revised version of the Fear Survey Schedule for Children (FSSC). The parents of the children completed adult versions of the STAI-trait and the FSS. In addition, parents rated to what extent they generally expressed fears to their children. Results showed that trait anxiety in children was positively associated with trait anxiety of both the mother (r = 0.34, P < 0.05) and the father (r = 0.31, P < 0.05). Fearfulness of the children was only related to fearfulness of the mother (r = 0.56, P < 0.001). Most importantly, the data showed that modeling played a role in this relationship. A linear association between FSSC scores and mothers' rating of expressing fears to their children was found. That is to say, children of mothers who never expressed their fears had the lowest FSSC scores, children of mothers who often expressed their fears had the highest FSSC scores, whereas children of mothers who sometimes expressed their fears scored in between.

The present study sought to determine the convergent validity of two macroscopic marital interaction coding systems: the Marital Interaction Coding System-Global and the Global Couple Interaction Coding System. The sample consisted of 40 couples who completed the Dyadic Adjustment Scale, the Potential Problem Checklist and a 30-min problem solving interactional task. Filmed interactions were coded by separate teams of observers using the Marital Interaction Coding System-Global and the Global Couple Interaction Coding System. Results showed that interobserver agreement, as assessed through intraclass correlations, was satisfactory for both coding systems. Between-system comparisons revealed that convergent validity coefficients were moderate; thus, it seems premature to conclude that macroscopic coding systems are interchangeable. Finally, multiple regression analyses indicated that both systems contained significant non-redundant behavioral predictors of marital adjustment. Implications of these results are discussed.

The PRIDE programme aims to establish a suite of transdiagnostic psychological interventions organised around a stepped care system in Indian secondary schools. This paper describes the development of a low-intensity, first-line component of the PRIDE model. Method: Contextual and global evidence informed an intervention 'blueprint' with problem solving as the primary practice element. Successive iterations were tested and modified across two pilot cohort studies (N = 45; N = 39). Participants were aged 13-20 years and presenting with elevated mental health symptoms in New Delhi schools. Results: The first iteration of the intervention, based on a guided self-help modality, showed promising outcomes and user satisfaction when delivered by psychologists. However, delivery was not feasible within the intended 6week schedule, and participants struggled to use materials outside 'guidance' sessions. In Pilot 2, a modified counsellor-led problem-solving intervention was implemented by less experienced counsellors over a 3-4 week schedule. Outcomes were maintained, with indications of enhanced feasibility and acceptability. High demand was observed across both pilots, leading to more stringent eligibility criteria and a modified sensitisation plan. Discussion: Findings have shaped a first-line intervention for common adolescent mental health problems in lowresource settings. A forthcoming randomised controlled trial will test its effectiveness.

Eating disorders may be viewed from a transdiagnostic perspective and there is evidence supporting a transdiagnostic form of cognitive behaviour therapy (CBT-E). The aim of the present study was to compare CBT-E with interpersonal psychotherapy (IPT), a leading alternative treatment for adults with an eating disorder. One hundred and thirty patients with any form of eating disorder (body mass index &gt;17.5 to &lt;40.0) were randomized to either CBT-E or IPT. Both treatments involved 20 sessions over 20 weeks followed by a 60-week closed follow-up period. Outcome was measured by independent blinded assessors. Twenty-nine participants (22.3%) did not complete treatment or were withdrawn. At post-treatment 65.5% of the CBT-E participants met criteria for remission compared with 33.3% of the IPT participants (p &lt; 0.001). Over follow-up the proportion of participants meeting criteria for remission increased, particularly in the IPT condition, but the CBT-E remission rate remained hig...

In the present study, we examined the effect of an internet cognitive behavior therapy (ICBT) program on anxiety, stress, and depressive symptoms in university students. Data were analyzed for 17 participants undergoing ICBT and 11 control group participants. An ANOVA of intention-to-treat analysis and per protocol (PP) analysis indicated that the interaction between group and measurement time was significant for the state-trait anxiety inventory (STAI) scores and that idiosyncratic anxiety was significantly improved. Through the results of PP, a moderate effect size for changes in STAI scores in the intervention group was observed (d = 0.62) based on Cohen's (1988) classifications. A large effect was also observed for improvements in idiosyncratic anxiety (d = 0.91). Based on the results of the analyses, a significant interaction was observed for the STAI scores. In the intervention group, STAI scores and individual anxiety were significantly reduced after implementing the ICBT program. It was suggested that the ICBT program may positively influence thinking about anxiety and stress from an objective viewpoint.

No studies to date have examined the effect of counselor techniques on smoking cessation over the course of treatment. To address this gap, we examined the degree to which the use of specific Acceptance and Commitment Therapy (ACT) counseling techniques in a given session predicted smoking cessation reported at the next session. The data came from the ACT arm of a randomized controlled trial of a telephone-delivered smoking cessation intervention. Trained raters coded 139 counseling sessions across 44 participants. The openness, awareness and activation components of the ACT model were rated for each telephone counseling session. Multilevel logistic regression models were used to estimate the predictive relationship between each component during any given telephone session and smoking cessation at the following telephone session. For every 1-unit increase in counselors' use of openness and awareness techniques there were 42% and 52% decreases in the odds of smoking at the next counseling session, respectively. However, there was no significant predictive relationship between counselors' use of activation techniques and smoking cessation. Overall, results highlight the theoretical and clinical value of examining therapists' techniques as predictors of outcome during the course of treatment.

Attentional biases in the processing of threatening facial expressions in social anxiety are well documented. It is generally assumed that these attentional biases originate in an evaluative bias: socially threatening information would be evaluated more negatively by socially anxious individuals. However, three studies have failed to evidence a negative evaluative bias in the processing of emotional facial expression (EFE) in socially anxious individuals. These studies however suffer from several methodological limitations that the present study has attempted to overcome. Twenty-one out-patients diagnosed with generalized social phobia have been compared to 20 out-patients diagnosed with another anxiety disorder and with 39 normal controls matched for gender, age and level of education. They had to decode on seven emotion intensity scales a set of 40 EFE whose intensity and emotional nature were manipulated. Although sufficient statistical power was ensured, no differences among groups could be found in terms of decoding accuracy, attributed emotion intensity, or reported difficulty of the task. Based on these findings as well as on other evidences, we propose that, if they exist, evaluative biases in social anxiety should be implicit and automatic and that they might be determined by the relevance of the stimulus to the person's concern rather than by the stimulus valence. The implications of these findings for the interpersonal processes involved in social phobia are discussed. r

Objective: Cognitive behavior therapy (CBT) and medication can be administered in combination in treating tic disorders but there are no studies evaluating the effectiveness of CBT with and without medication. The current study compares the efficacy of CBT in combination with medication and without medication. Method: CBT was administered in a consecutively referred sample of 76 people diagnosed either with Gilles de la Tourette Syndrome or chronic tic disorder. The sample was divided into a medicated and a non-medicated group. Twenty three were stabilized on medication and 53 were not receiving medication. Measures administered pre-and post-CBT in both groups included: main outcome measure of Tourette Syndrome Global Scale and measures of mood. Results: Repeated measures analysis of variance on the initial sample revealed no difference between medicated and non-medicated groups in outcome. A further analysis comparing the 23 receiving medication with 23 not receiving medication matched on baseline clinical variables also yielded no significant group differences, either in treatment outcome on main tic outcome measures or on other clinically relevant questionnaires. Discussion: CBT for tic disorders is an effective treatment administered either in combination with medication or alone.

The present study explores driving skills in a group of 50 media-recruited driving-fearful and 50 control drivers, all of whom were women. Participants completed an on-road practical driving assessment with a professional driving instructor. Diagnostic as well as pre-post self-report and instructor driving assessments were conducted. Fearful drivers made more errors on the driving assessment than controls. However, the pattern of errors was identical for both groups, indicating that fear and anxiety may be associated with the number rather than the type of driving errors made. These differences remained when factors such as driving history, current driving frequency, and diagnosis were controlled using case selection. More research is needed to replicate the findings in more diverse samples. Additional work should also aim to clarify the specific role of driving skills in driving fear, which will facilitate treatment planning for exposure-based treatments and help identify cases where driving skills assessment may be appropriate. r

Separation anxiety and social phobia are intertwined to a considerable degree, and high comorbidity rates have been reported. The present study used latent class analysis (LCA) to investigate if classes of children and adolescents withsimultaneously-high rates of separation anxiety and low rates of social anxiety symptoms, or vice versa, could be identified. Eight-to 18-year-olds from a large general population (n ¼ 1000) and referred sample (n ¼ 735) were assessed with the Multidimensional Anxiety Scale for Children (MASC). With LCA, a separate class of referred 8-11-year-old children with high separation anxiety scores, and simultaneously lower social anxiety scores was identified, next to a class of children with high scores on separation anxiety and social anxiety. In the other groups (referred 12-18-year-olds and children and adolescents from the general population), a class with individuals who specifically scored high on separation anxiety could not be revealed. The results indicated that separation anxiety represents a different construct than social anxiety in referred children (but not in referred adolescents or in the general population). It can be concluded that, in referred children, research regarding etiology and treatment outcome of anxiety symptoms should be aimed specifically at separation anxiety and social anxiety, instead of just investigating a broader anxiety dimension. r

The relationship between repeated body checking and its impact on body size estimation and body dissatisfaction is of interest for two reasons. First, it has importance in theoretical accounts of the maintenance of eating disorders and, second, body checking is targeted in cognitive-behavioural treatment. The aim of this study was to determine the impact of manipulating body checking on body size estimation and body dissatisfaction. Sixty women were randomly assigned either to repeatedly scrutinize their bodies in a critical way in the mirror ("high body checking") or to refrain from body checking but to examine the whole of their bodies in a neutral way ("low body checking"). Body dissatisfaction, feelings of fatness and the strength of a particular self-critical thought increased immediately after the manipulation among those in the high body checking condition. Feelings of fatness decreased among those in the low body checking condition. These changes were short-lived. The manipulation did not effect estimations of body size or the discrepancy between estimations of body size and desired body size. The implications of these findings for understanding the influence of body checking on the maintenance of body dissatisfaction are considered.

One-year treatment outcome results are reported for 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating 'Individualized Behavior Therapy (IBT)' techniques. Initially, subjects had been assigned to a controlled drinking or non-drinking (abstinence) treatment goal, and then were randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment. One year follow-up results demonstrated that IBT treated subjects had functioned significantly better than control subjects. Dependent variable measures included daily drinking dis~sition, general emotional adjustment, vocational satisfaction, occupational status, driving status and an index of residential status and stability. The results support the view that some 'alcoholics' can acquire and maintain controlled drinking behavior over at least a 1-yr follow-up interval.

Many smokers and ex-smokers worry about their health. Given that worry keeps attention focused on the threat, it was expected that worrying about health in smokers would motivate them to quit and in exsmokers may prevent relapse. Furthermore, worry was expected to influence the process of smoking cessation in interaction with self-efficacy, which is a measure of control over smoking, and with disengagement beliefs, which distorts the threatening meaning of potential motivating information. In the present study 380 smokers and 324 ex-smokers were recruited to join a prospective study with a follow-up of eight months. At T1, smoking/quitting behavior, worry and the other psychological constructs were assessed. At T2 quitting activity in smokers and relapse in ex-smokers were assessed. As expected, smokers who worried about the health effects of smoking reported higher quitting activity at T2. The three-way interactions between worry, self-efficacy and disengagement beliefs in the prospective prediction of quitting activity and relapse were significant: Among smokers with high self-efficacy combined with strong disengagement beliefs, worry led to more quitting activity. Among ex-smokers with low self-efficacy combined with strong disengagement beliefs, worry led to more relapse. The present results suggest new ways of approaching the stimulation of quitting and the prevention of relapse. 

Recent years have seen increasing interest in the construct of attention bias variability (AB-Var). However, little is known about the cognitive underpinnings of this construct, with some research suggesting that AB-Var may represent an artefact of other processes. The present study examined the underlying role of attention control and response time variability in explaining the relationship between anxiety and two commonly computed measures of AB-Var (‘moving average’ and ‘trial-level bias score’ measures). Participants (final n=195) completed measures of anxiety symptomatology, antisaccade performance (attention control), a stand-alone measure of response-time variability, and a probe task measure of attentional bias. Both measures of AB-Var were significantly associated with anxiety, response time variability, and attention control. Attention control was the single significant statistical mediator of the relationship between anxiety and the trial-level bias score measure of AB-Va...

Swnmnry--18 myopes and I8 emmetropes were randomly assigned in pairs to either Fading and Feedback training or a no-treatment control condition. The emmetropes were fitted with plus lenses equivalent to the spherical correction of the paired myope to simulate myopic visual acuity. Extensive visual acuity measures were obtained pre-and post-training. Data analyses indicated significant increases in recognition visual acuity for trained subjects, compared to no-treatment controls. The myopia/emmetropia variable did not interact with training even though there were noticably greater increases in visual acuity for trained myopes compared to the other conditions. Resolution visual acuity did not change as a function of training. These data are discussed in terms of their implications for better understanding the mechanisms responsible for visual acuity increases following behavioural training.

During adolescence, rates of depression dramatically increase and girls become twice as likely as boys to develop depression. Research suggests that overgeneral autobiographical memory and rumination are vulnerability factors for depressive symptoms in adolescence that may be triggered by stressful life events. The current longitudinal study included 160 early adolescents (M age = 12.44 years, 60.0 % African American, 40.0 % Caucasian, and 56.2 % female). At baseline, adolescents completed measures of current depressive symptoms, rumination, and specificity of autobiographical memories. Approximately 9 months later, the adolescents completed measures of current depressive symptoms and stressful life events that had occurred between baseline and follow-up. Analyses indicated that girls with more overgeneral autobiographical memories in combination with higher levels of rumination were most vulnerable to experiencing increases in depressive symptoms following stressful life events. Additionally, retrieving more specific autobiographical memories appeared to buffer against the impact of negative life events on depressive symptoms among both boys and girls. Memory specificity may play a protective role in depression risk, suggesting that memory specificity training interventions may prove beneficial for adolescents.

Objective: To assess whether changes in negative trauma-related cognitions play an important role in reducing symptoms of posttraumatic stress disorder (PTSD) and depression during prolonged exposure therapy for adolescents (PE-A). Method: Secondary analysis of data from a randomized controlled trial comparing PE-A with clientcentered therapy (CCT) for PTSD. Participants were 61 adolescent female sexual assault survivors ages 13e18 who received 8e14 weekly sessions of PE-A or CCT at a community rape crisis center. PTSD severity was assessed at baseline, mid-treatment, post-treatment, and 3-months post-treatment. Participants also completed self-report measures of negative posttraumatic cognitions and depressive symptoms at the same assessment points. Results: Cross lag panel mediation analyses showed that change in negative trauma-related cognitions mediated change in PTSD symptoms and depressive symptoms whereas change in PTSD and depressive symptoms did not mediate change in negative cognitions. Conclusion: Our findings support EPT and suggest that change in negative trauma-related cognitions is a mechanism of both PE-A and CCT.

The aim of this investigation was to examine the effectiveness of a graded exposure in vivo treatment with behavioural experiments as compared to usual graded activity in reducing pain-related fears, catastrophising and pain disability in chronic low back pain patients reporting substantial fear of movement/(re)injury. Included in the study were four consecutive CLBP patients who were referred for outpatient behavioural rehabilitation, and who reported substantial fear of movement/(re)injury (Tampa Scale for Kinesiophobia scoreϾ40). A replicated single-case cross-over design was used. After a no-treatment baseline measurement period, the patients were randomly assigned to one of two interventions. In intervention A, patients received the exposure first, followed by graded activity. In intervention B, the sequence of treatment modules was reversed. Sixty-three daily measures of pain-related cognitions and fears were recorded with visual analogue scales. Before and after the treatment, the following measures were taken: pain-related fear, pain catastrophising, pain control and pain disability. Using time series analysis on the daily measures of pain-related cognitions and fears, we found that improvements only occurred during the graded exposure in vivo, and not during the graded activity, irrespective of the treatment order. Analysis of the pre-post treatment differences also revealed that decreases in pain-related fear concurred with decreases in pain catastrophising and pain disability, and in half of the cases an increase in pain control.

An attributional analysis of reactions to poverty is presented. The article begins by discussing the perceived causes of poverty and their taxonomic properties (locus, stability, and controllability). One antecedent of causal beliefs, political ideology, is then examined in detail, followed by a review of the effects of causal beliefs on emotions and behavior. It is contended that helping the poor is a moral issue, but the moral evaluation concerns the targeted recipient of aid rather than the potential help giver. Persons perceived as responsible for their plight, a dominant construal for conservatives, elicit anger and neglect. In contrast, those seen as not responsible for their financial hardship, an outlook predominantly endorsed by liberals, arouse sympathy and help giving. Sympathy is the most important proximal determinant of aid. This analysis is extended to reactions to achievement failure, abortion, and rape. Policy implications are also examined.

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Few treatment outcome studies of Obsessive Compulsive Disorder (OCD) have employed Behavioral Avoidance Tests (BATs) to assess changes in symptomatology, probably because of the difficulty of constructing such tests for a disorder which has widely varying symptoms. The few studies that have examined the psychometric properties of BATs for OCD have found mixed evidence for validity but good treatment sensitivity. The present study presents psychometric findings for a multi-step/ multi-task BAT that assessed percentage of steps completed, subjective anxiety, global avoidance, and rituals. This measure was used with 50 clients diagnosed with OCD whose symptoms varied widely. The BAT demonstrated good convergent and divergent validity, as well as treatment sensitivity according to effect size calculations. A composite score combining steps, anxiety level, avoidance and rituals also performed well in psychometric tests. Strategies to reduce the complexity of scoring are presented, along with examples of several BAT tasks to enable researchers to employ this behavioral measure.

Acceptance and commitment therapy (ACT) interventions for persons with chronic pain have recently received empirical support. ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions, sensations, and thoughts. The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain. A total of 76 patients with chronic pain were included in the study and randomized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum. Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness. Measurements were provided with the primary outcome variable Chronic Pain Acceptance Questionnaire which was in favour of the treatment group. Reductions were found on other measures of pain-related distress, anxiety and depressive symptoms. A six month follow-up showed maintenance of improvements. We conclude that an acceptance based internetdelivered treatment can be effective for persons with chronic pain.

There are few experimental investigations of the effects of social-skills training (SST) on sexual deviation. This study used a multiple baseline across 4 subjects with undesired sexual arousal to investigate the effects of heterosocial-skills training and covert sensitization on heterosocial skills and sexual-arousal patterns. SST produced large increases in heterosocial skills but it had unclear effects on sexual arousal. Subsequently, covert sensitization tended to reduce remaining deviant arousal but did not increase appropriate arousal significantly. These data generally support the view that individual components of sexual arousal require separate assessment and intervention.

Attention is drawn to the relatively high rate of breakdown of token economy programmes, and the reasons for this are considered. Reference is made to the results of a questionnaire circulated to British token economy programmes. Reasons for breakdown are considered in five categories, these being: nonexistent or poor patient selection; inadequate selection and training of nursing and ward staff; lack of definition of the functions of the supervising psychologist; poor co-operation from, and communication with, administrative staff; and active interference by the community. Solutions to these problems are suggested. The value of alternative or additional theoretical frameworks in promoting positive control of token systems is discussed.

The Approach–Avoidance Task (AAT) was employed to indirectly investigate avoidance reactions to stimuli of potential social threat. Forty-three highly socially anxious individuals (HSAs) and 43 non-anxious controls (NACs) reacted to pictures of emotional facial expressions (angry, neutral, or smiling) or to control pictures (puzzles) by pulling a joystick towards themselves (approach) versus pushing it away from themselves (avoidance). HSAs showed

Cognitive studies about anxiety suggest that the interplay between automatic and strategic biases in attention to threat is related to the persistence of fear. In the present study, the time-course of attention to pictures with varying threat levels was investigated in high trait anxious (HTA, n ¼ 21) and low trait anxious (LTA, n ¼ 22) students. In a visual probe detection task, high and mild threat pictures were presented at three durations: 100, 500, and 1250 ms. Results indicated that all individuals attended to the high threat pictures for the 100 ms condition. Differential responding between HTA and LTA individuals was found for the 500 ms condition: only HTA individuals showed an attentional bias for mild threatening stimuli. For the 1250 ms condition, the HTA individuals attended away from high and mild threat pictures. The observed pattern of differential attention to threatening pictures may explain the persistence of fear in HTA individuals. r

Acceptance and commitment therapy (ACT) interventions for persons with chronic pain have recently received empirical support. ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions, sensations, and thoughts. The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain. A total of 76 patients with chronic pain were included in the study and randomized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum. Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness. Measurements were provided with the primary outcome variable Chronic Pain Acceptance Questionnaire which was in favour of the treatment group. Reductions were found on other measures of pain-related distress, anxiety and depressive symptoms. A six month follow-up showed maintenance of improvements. We conclude that an acceptance based internetdelivered treatment can be effective for persons with chronic pain.

Scruggs and Mastropieri (Behoviour Research and Th~rupy, 3X879-883, 1994) take issue with criticisms of their PND (Percent of Nonoverlapping Data) statistic that we offered in our recent article (Allison & German, &h&our Research and Tl%a~y, 31, 621-631, 1993). which advocated a regressionbased method for obtaining effect sizes in single-subject studies. They contend that their PND approach has several advantages over our approach because: (I) they believe that, unlike ours, it can take advantage of the smafl number of observations that are typically available in single-case studies;