Behavior Therapy

Weight gain remains a well recognized yet difficult to treat adverse effect of many anti-psychotic drugs including agents of the first and second generation. The weight gain liabilities of antipsychotic drugs are partly associated with their ability to increase appetite. Most behavioral interventions for weight control remain of limited efficacy, possibly because they do not specifically target the neuroendocrine factors regulating appetite. Identifying new weight management interventions directly acting on the biochemical and neuroendocrine mechanisms of anti-psychotic induced weight gain may help to improve the efficacy of behavioral weight management programs. Such potentially specific strategies include (1) using diets which do not increase appetite despite calorie restriction; (2) countering thirst as an anticholinergic side-effect; (3) discouraging cannabis use and (4) adding metformin to a behavioral intervention. In view of our currently rather limited treatment repertoire i...

In this study, measures of irrational beliefs based on the principles of Rational Emotive Behavior Therapy (REBT) were reviewed and contrasted based on psychometric characteristics and quality of guidelines for interpretation. The use of measures of irrational beliefs is an important component of the assessment of presenting problems in psychotherapy and may inform clinical decision making. Additionally, these measures are a helpful way to identify change in irrational beliefs and to measure the effectiveness of specific interventions to facilitate such change. While there are a number of measures of beliefs, there is considerable variability in their psychometric properties and utility for assessment. The majority of the tests are not produced by a publishing company, nor do they provide test manuals. The reliability and validity evidence presented in the publications varies considerably as do the size and quality of standardization samples, which impacts upon the ability to draw normative conclusions. Analyses demonstrated that most measures of irrational beliefs do not provide the evidence needed to adequately address the Standards for Educational and Psychological Testing (Standards; American Educational Research Association [AERA], American Psychological Association [APA], National Council on Measurement in Education [NCME] 1999). Discussion of the implications of this review for the development of future measures of irrational thinking by researchers as well as recommendations in the test selection process for an REBT practitioner is offered.

Objective. Very little research has focused on the efficacy of Adderall (Shire-Richwood Inc, Florence, KY) in the treatment of children with attentiondeficit/hyperactivity disorder (ADHD), and no studies have compared it with standardized doses of Ritalin (Novartis Pharmaceuticals, East Hanover, NJ). It is thought that Adderall has a longer half-life than Ritalin and might minimize the loss of efficacy that occurs 4 or 5 hours after Ritalin ingestion. We compared two doses of Ritalin and Adderall in the treatment of ADHD in children in an acute study and assessed the medications' time courses.

This article develops the hypothesis that intervention strategies that cultivate positive emotions are particularly suited for preventing and treating problems rooted in negative emotions, such as anxiety, depression, aggression, and stressrelated health problems. Fredrickson's (1998) broaden-and-build model of positive emotions provides the foundation for this application. According to this model, the form and function of positive and negative emotions are distinct and complementary. Negative emotions (e.g., fear, anger, and sadness) narrow an individual's momentary thought-action repertoire toward specific actions that served the ancestral function of promoting survival. By contrast, positive emotions (e.g., joy, interest, and contentment) broaden an individual's momentary thought-action repertoire, which in turn can build that individual's enduring personal resources, resources that also served the ancestral function of promoting survival. One implication of the broaden-and-build model is that positive emotions have an undoing effect on negative emotions. By broadening the momentary thought-action repertoire, positive emotions loosen the hold that negative emotions gain on an individual's mind and body by undoing the narrowed psychological and physiological preparation for specific action. Indeed, empirical studies have shown that contentment and joy speed recovery from the cardiovascular aftereffects of negative emotions . Stepping off from these ideas and findings, a range of intervention and coping strategies are reviewed, including relaxation therapies, behavioral therapies aimed at increasing rates of pleasant activities, cognitive therapies aimed at teaching optimism, and coping strategies marked by finding positive meaning. These strategies optimize health and well-being to the extent that they cultivate positive emotions. Cultivated positive emotions not only counteract negative emotions, but also broaden individuals' habitual modes of thinking and build their personal resources for coping.

Mindfulness can be understood as consciousness, encompassing both attention and awareness; it is paying reflexive attention to the present moment. It is an attempt to actively focus on the present, but non-judgmentally, and without interfering with the sensations and perceptions experienced moment to moment. As a therapeutic procedure, it seeks acceptance and the full experience of emotional aspects or any

THE MODERN ERA in medicine has brought a turning away from a quality of doctor-patient interactions that had persisted over centuries. When there were few efficacious remedies, doctors relied upon the healing power of the doctor-patient relationship. Hippocrates observed, "The patient, though conscious that his condition is perilous, may recover his health simply through his contentment with the goodness of the physician."~ More recently, Balint reaffirmed the importance of doctor-patient interaction, asserting that by far the most frequently used drug in medical practice is the doctor himself, z With its potential impact on patient outcomes, it would seem that the doctor-patient relationship should be taken seriously in its own right. Yet, with modern diagnostic and therapeutic techniques, the healing potential of this relationship has been deemphasized, as if it were a relic of an unscientific past. There are other reasons for the de-emphasis of the importance of the doctor-patient relationship. Engel argues that the biomedical model, the basis for practice of Western medicine, limits our thinking about the causes and cures of disease to biological, quantifiable variables, s Almy points out that present fee schedules offer physicians excessively strong incentives to furnish technical services and discourage performance as the patient's advisor, counselor, and health advocate. 4 Jenson has identified the "dehumanizing process of medical education" as discouraging physicians from awareness of their own and their patients' needs, s Medical students for the most part learn patient care in tertiary care institutions, where the healing effects of their relationships with patients are less evident. Though some progress has been made, there are many deficiencies in the teaching of doctor-patient communication in medical schools and residency programs, s Physicians use their relationships with patients to enhance therapy. Few pause, though, to identify the therapeutic elements of their patient encounters, explaining their effectiveness by their use of the "art of medicine." Yet if using the healing power of the doctor-patient relationship is an art, physicians

Background: Informal caregivers of palliative patients took part in existential behavioral therapy (EBT), a group intervention comprising mindfulness exercises to reduce psychological distress and improve quality of life. Objectives: This study examined which aspects of EBT were perceived as helpful during the first year of bereavement and how mindfulness was understood and transferred into daily life. Design: Sixteen problem-centered, semi-structured interviews were evaluated with content analysis. Results: Two main categories were found: social support and self-regulation. Social support includes sense of belonging as well as emotional, cognitive, and practical help experienced from others. Mindfulness and acceptance, a clear focus on the positive, and orientation toward the future were helpful strategies of selfregulation; these were also part of the EBT intervention. Mindfulness was understood as permitting emotions and acceptance of one's inner processes, even if they were not pleasant, and was found to be helpful to stop ruminative thinking. Conclusions: The categories considered as being helpful parallel core elements of EBT and recent grief theories. The intervention was found to be supportive and met the needs of the participants. The interviewees appreciated the continuity of EBT support from palliative care into bereavement.

Objective: To follow distressed married couples for 5 years after their participation in a randomized clinical trial. Method: A total of 134 chronically and seriously distressed married couples were randomly assigned to approximately 8 months of either traditional behavioral couple therapy (TBCT; or integrative behavioral couple therapy (IBCT; Jacobson & Christensen, 1998). Marital status and satisfaction were assessed approximately every 3 months during treatment and every 6 months for 5 years after treatment. Results: Pre-to posttreatment effect sizes on marital satisfaction were d ϭ 0.90 for IBCT and d ϭ 0.71 for TBCT, which were not significantly different. However, data through 2-year follow-ups revealed statistically significant superiority of IBCT over TBCT in relationship satisfaction, but subsequent data showed increasing similarity and nonsignificant differences in outcome. At 5-year follow-up for marital satisfaction relative to pretreatment, effect sizes were d ϭ 1.03 for IBCT and d ϭ 0.92 for TBCT; 50.0% of IBCT couples and 45.9% of TBCT couples showed clinically significant improvement. Relationship status, obtained on all 134 couples, revealed that 25.7% of IBCT couples and 27.9% of TBCT couples were separated or divorced. These follow-up data compared favorably to other, long-term results of couple therapy. Conclusion: TBCT and IBCT both produced substantial effect sizes in even seriously and chronically distressed couples. IBCT produced significantly but not dramatically superior outcomes through the first 2 years after treatment termination but without further intervention; outcomes for the 2 treatments converged over longer follow-up periods.

Behavioral treatment of drooling is advocated widely, but evidence of its effectiveness is lacking. In a center-based case-series study, 10 participants with severe drooling were taught self-management skills to reduce drooling. Following treatment, all participants remained dry for intervals of 30-60 min, while being engaged in daily activities. Generalization to the classroom occurred in each participant. For three participants, maintenance of treatment effect was established at 6 and 24 weeks. Seven participants failed to maintain self-management skills at follow-up. Although the selfmanagement procedure showed promising results, further adaptations are required to improve efficacy, generalization, and maintenance.

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system induded self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.

The case study is based on qualitative data, reflection sheets, and interview and field notes from the Guided Self-Determination training. The patient's new insight developed in a process from resistance to receptiveness and then from doubt to reaching a new system in his thoughts.

Recent laws in the United States incent healthcare practices to adopt electronic health records (EHRs). While there is extensive research related to EHRs generally, there is a dearth of EHR research specific to collaborative care settings. This study reports responses from 101 collaborative care offices who completed a 13-question online survey. The mixed-methods analysis provides insights as to the satisfaction, obstacles, and solutions to interdisciplinary collaboration in the presence of an EHR. Respondents reported highest satisfaction with medical billing, interdisciplinary communication, and scheduling. Satisfaction was lower as it relates to time consumption, difficult learning curve, creation of appointment notes, and health registries. This research reveals varied and conflicting approaches to addressing confidentiality and HIPAA within the EHR. Recommendations for improving EHR to better support collaborative care include the addition of modules common in mental health-specific EHR, enhanced tracking of mental health outcomes, templates for joint appointments, and improvements in population-based registry functions.

Objective: In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD (MTA), the effects of medication management (MedMgt), behavior therapy (Beh), their combination (Comb), and usual community care (CC) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm (Comb+MedMgt) over those that did not (Beh+CC). This report examines 36-month outcomes, 2 years after treatment by the study ended. Method: For primary outcome measures (attention-deficit/hyperactivity disorder [ADHD] and oppositional defiant disorder [ODD] symptoms, social skills, reading scores, impairment, and diagnostic status), mixed-effects regression models and orthogonal contrasts examined 36-month outcomes. Results: At 3 years, 485 of the original 579 subjects (83.8%) participated in the follow-up, now at ages 10 to 13 years, (mean 11.9 years). In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months, treatment groups did not differ significantly on any measure at 36 months. The percentage of children taking medication 950% of the time changed between 14 and 36 months across the initial treatment groups: Beh significantly increased (14% to 45%), MedMed+Comb significantly decreased (91% to 71%), and CC remained constant (60%Y62%). Regardless of their treatment use changes, all of the groups showed symptom improvement over baseline. Notably, initial symptom severity, sex (male), comorbidity, public assistance, and parental psychopathology (ADHD) did not moderate children's 36-month treatment responses, but these factors predicted worse outcomes over 36 months, regardless of original treatment assignment. Conclusions: By 36 months, the earlier advantage of having had 14 months of the medication algorithm was no longer apparent, possibly due to age-related decline in ADHD symptoms, changes in medication management intensity, starting or stopping medications altogether, or other factors not yet evaluated.

The relationship between early maternal responsivity and later child communication outcomes in young children with fragile X syndrome was investigated. Data were obtained from 55 mother–child dyads over a 36-month period. Performance data were obtained at each measurement point from video observations of four different contexts. These were coded for (a) child communication behaviors, (b) parent responsivity, and (c) behavior management behaviors. Results indicate that early maternal responsivity predicts the level of four important child language outcomes at 36 months of age after controlling for child developmental level and autism symptomology.

Objective. Ten to 30% of students engage in bullying behavior. Bullies stand out on account of increased anger, poor interpersonal relationships, and poor quality of life. Our aim was to determine the effectiveness of outpatient family psychotherapy as a monotherapy for anger reduction and improvement of behavior and interpersonal relationships and of health-related quality of life in male youths with bullying behavior. Methods. Twenty-two boys with bullying behavior took part in a family therapy program for 6 months. The control group was also composed of 22 youths and took part in a placebo intervention program. Every 2 weeks, results were checked with the Adolescents Risky-Behavior Scale (ARBS), the State-Trait Anger Expression Inventory (STAXI), the Inventory of Interpersonal Problems (IIP-D), and the SF-36 Health Survey (SF-36). Follow-up testing took place 12 months after treatment. Results. In comparison with the control group (according to the intention-to-treat principle), ...

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.

Headache in children and adolescents represents a number of complex and multifaceted pain syndromes that can benefit from psychological intervention. There is good evidence for the efficacy of cognitive behavioral therapy, relaxation training, and biofeedback. The choice of intervention is influenced by patients' age, sex, family and cultural background, as well as the nature of stressors and comorbid psychiatric symptoms. Management must always be family-centered. Psychological treatments are essential elements of the multidisciplinary, biopsychosocial management of primary headache disorders, particularly for those with frequent or chronic headache, a high level of headache-related disability, medication overuse, or comorbid psychiatric symptoms. Future studies of efficacy and effectiveness of psychological treatment should use the International Headache Society's definition and classification of headache disorders, and stratify results by headache type, associated conditi...

Nurses have been employed as behavioural psychotherapists for over 25 years. The first training in this field was established at The Maudsley Hospital ( Marks et al. 1977 ). Since then there have been a number of courses producing many specialist nurse behavioural psychotherapists (NBTs) ( Duggan et al. 1993 ). Nurse behavioural therapy is taken to mean nurses working as behavioural psychotherapists. This title does not mean they are practising a separate form of therapy from other professionals such as psychologists. In Australia there is no such training, with nurse behavioural psychotherapists working here having trained first in UK. Initially NBTs were trained to treat people with anxiety disorders. Over the past 25 years this emphasis has remained, but many NBTs have gone on to provide help to people with other problems. This paper will demonstrate the practical application of behavioural psychotherapy with problem gamblers, and how specialist trained nurses can provide such treatment. The paper will look briefly at nurse behavioural psychotherapy from its initial inception to its current status in Australia. The outcomes of the treatment programme carried out at Flinders Medical Centre for Problem Gamblers will be discussed with a view to nurses carrying out therapy. Finally, the future of nurse behavioural psychotherapy in Australia and how nurses can apply such skills across a wide range of problems, including gambling, will be reviewed.Aspects of this paper were first presented to the 7th NAGS conference, Adelaide 1996.

A brief positive practice overcorrection procedure was used as a method of eliminating head-banging in a profoundly mentally retarded adult. Treatment produced an immediate reduction in head-banging episodes, with near zero occurrence of behavior during the third phase of treatment. One year later data collection was resumed on the subject for an 11-week period. Data from the long-term follow-up revealed that head-banging continued to occur, but mean weekly levels of episodes (M = 5.8) were still well below those recorded during the baseline period (M = 18.8). The overcorrection procedure produced immediate short-term effects and, in this case, was also effective in the long-term. Variables related to the maintenance of response suppression are discussed with respect to this intervention's success.

Despite the negative consequences of depressive rumination, little is known about the factors that may be linked to a predisposition to ruminate. Wells and Matthews (1994) suggested that rumination is associated with underlying metacognitive beliefs. Papageorgiou and Wells ...

Thrombocytopoiesis of 21 multiple myeloma patients undergoing single or double transplant regimen was characterized by measuring the level of reticulated platelets and plasma glycocalicin. Since reticulated platelets are an index of thrombopoietic activity and glycocalicin plasma values are related to platelet damage and turnover, it may be possible to perform a novel type of analysis of the thrombopoietic compartment during the mobilizing regimen and during transplantrelated chemotherapy. Patients underwent mobilizing therapy and first transplant. Some randomized patients also underwent a second transplant with mobilized peripheral blood stem cells. The results show that the percentage of reticulated platelets decreased after therapy and then gradually increased in the recovery phase either during first or second transplant. By contrast, the percentage of reticulated platelets increased until day +8 and then gradually decreased during the mobilizing regimen. The glycocalicin index (glycocalicin plasma value normalized for the individual platelet count) increased significantly both during the course of mobilization and after transplant-related chemotherapy when the platelet number was at its nadir. However, the glycocalicin index was more elevated after transplantrelated chemotherapy than after the mobilizing regimen. Our findings suggest that chemotherapy-related thrombocytopenia may be due to a dual mechanism: thrombocytopenia results from decreased platelet production in addition to increased platelet damage and possible destruction.

We evaluated the effects of an enriched environment, based on a paired-choice preference assessment, on both rates of self-injurious behavior (SIB) and percentage of session intervals during which signs of negative affect were displayed by a woman with mental retardation and a mood disorder. Results suggested that SIB and signs of negative affect were highly correlated and that the enriched environment effectively reduced both.

A concurrent-operants design was used to analyze the repetitive behavior of observing reflective surfaces while simultaneously engaging in erratic gross-motor body movements (EBMs) exhibited by a young boy diagnosed with autism. The assessment involved an evaluation of preference for controlled (i.e., the participant controlled the visual activity on a TV screen) versus uncontrolled (i.e., the participant viewed a previously recorded tape from the controlled condition) TV footage of his EBMs. The analysis indicated that both observing and EBMs were maintained by the direct correspondence between the body movements and the visual stimulation they produced when controlled by the participant. Thus, the EBMs appeared to be maintained on a conjugate schedule of reinforcement.

Patients with panic disorder and patients with vestibular disorders often share symptomatology, such as dizziness, spatial disorientation, and anxiety in particular environments. Because of the similar clinical presentations, it is not always apparent whether these symptoms are due primarily to a vestibular disorder or to panic disorder. Depending on where and how these patients enter the medical system, their symptoms may be remedied by treatment from behavioral therapists or physical therapists trained in vestibular rehabilitation. Although vestibular rehabilitation developed independently of behavioral treatment for anxiety disorders, there are remarkable similarities in treatment conceptualization and implementation. For example, both use exposure procedures designed to produce habituation of dizziness and disorientation, as well as enhancing functional compensation. Furthermore, there appears to be a subset of individuals with panic disorder who also have vestibular pathology and thus, may benefit from both interventions. In this paper, similarities and differences in the clinical presentation, treatment goals, and specific interventions for patients with panic disorder or vestibular pathology is examined, and future implications are discussed. D Dizziness, spatial disorientation, and unsteadiness are common complaints among individuals with vestibular dysfunction and/or those with panic disorder 0887-6185/01/$ ± see front matter D 2001 Elsevier Science Inc. All rights reserved. PII: S 0 8 8 7 -6 1 8 5 ( 0 0 ) 0 0 0 4 6 -3

Abbreviations: CHD, coronary heart disease; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

The efficacy of amitriptyline as a pharmacological adjunct to behavioral modification in the clinical management of aggressive behaviors in dogs was evaluated in two phases. Twelve dogs presenting for aggressive behaviors were treated sequentially with amitriptyline (2 mg/kg body weight, per os [PO] bid) and a placebo for 4 weeks in a prospective, randomized, double-blind, placebo-controlled trial. Standardized protocols for behavior modification were implemented throughout the trial. Owners maintained behavioral records and reported on the number of aggressive incidents as well as the dog's overall improvement at the end of each 4-week period. In the second phase, 27 cases of dogs presenting for aggressive behaviors and treated with amitriptyline were reviewed, and clients were contacted to record each dog's response to treatment. Reports were compared to those for dogs receiving behavior modification alone (i.e., placebo phase of prospective study). No significant differen...

The study aim was to test whether a brief motivational intervention, with or without a booster session, would improve drinking-related outcomes more than standard Emergency Department (ED) treatment. The study population consisted of 539 (78% male) injured patients treated in the ED and discharged to the community following their treatment. Injured patients met inclusion criteria if they were assessed as hazardous or harmful drinkers by scoring eight or more on the AUDIT and/or having alcohol in their system at the time of their injury or ED visit. Patients were randomly assigned to either standard care (SC), brief intervention (BI) or brief intervention plus a booster session (BIB). At 1-year follow-up, 447 patients (83% of the sample) were re-interviewed to measure alcohol-related negative consequences, injuries and drinking. Patients receiving BIB, but not B1 patients, reduced alcohol-related negative consequences and alcohol-related injuries more than did those in the SC group. ...

Since fetal alcohol syndrome was first described over 35 years ago, considerable progress has been made in the delineation of the neurocognitive profile in children with prenatal alcohol exposure. Preclinical investigators have made impressive strides in elucidating the mechanisms of alcohol teratogenesis and in testing the effectiveness of pharmacological agents and dietary supplementation in the amelioration of alcohol-induced deficits. Despite these

Objective To test a theoretical model examining processes through which a parent-focused educationalbehavioral intervention [Creating Opportunities for Parent Empowerment (COPE)] relates to children's posthospital adjustment problems. Methods Mothers (n ¼ 143) and their 2-7-year-old children, unexpectedly hospitalized in two pediatric intensive care units, were randomized to COPE or control conditions. Maternal measures included parental beliefs, anxiety, negative mood, and child adjustment 3 months post discharge. Observers rated maternal support of their children during hospitalization. Results Structural equation modeling suggested that the model tested provided a reasonable fit to the data [w 2 (97 df) ¼ 129.43; p ¼ .016; root mean square error of approximatio n ¼ .048; comparative fit index ¼ .95]. COPE effects on children's post-hospital externalizing behaviors were indirect, via associations with parental beliefs and maternal negative mood state. Furthermore, COPE participation was associated with more maternal support of their children, which was also associated with less internalizing and externalizing behaviors 3 months post discharge. Conclusion Implementing COPE may help avert future mental health problems in this high risk population. Understanding the processes by which an already empirically validated program relates to child outcomes is likely to aid clinicians and administrators in the widespread uptake of the COPE program.

This study assessed the efficacy of FaceSay, a computer-based social skills training program for children with Autism Spectrum Disorders (ASD). This randomized controlled study (N = 49) indicates that providing children with low-functioning autism (LFA) and high functioning autism (HFA) opportunities to practice attending to eye gaze, discriminating facial expressions and recognizing faces and emotions in FaceSay's structured environment with interactive, realistic avatar assistants improved their social skills abilities. The children with LFA demonstrated improvements in two areas of the intervention: emotion recognition and social interactions. The children with HFA demonstrated improvements in all three areas: facial recognition, emotion recognition, and social interactions. These findings, particularly the measured improvements to social interactions in a natural environment, are encouraging.

The frequency of verbal perseverations of two children with severe visual impairment was reduced using differential reinforcement of appropriate speech coupled with extinction of perseverative utterances. A reversal design in which baseline and intervention were alternated in an A–B–A–B sequence was employed to show the functional relationship between the target behaviors and the treatment procedure. There was a marked increase in appropriate utterances and a correlated decrease in perseverative ones. These findings suggest that this singular feature of the language of certain children with visual impairment is, under natural conditions, probably maintained by the attention provided by their caregivers.

The management of school refusal behavior in children and adolescents has long been a nettlesome process for clinicians. However, a functional analytic model of school refusal behavior has been proposed to assist clinicians in organizing, assessing, and treating this heterogeneous population. The present study examined, on a preliminary controlled basis, the treatment utility of this functional model and the School Refusal Assessment Scale (SRAS). Specifically, participants with acute school refusal behavior were initially assigned prescriptive (n = 4) or nonprescriptive (n = 4) treatment from child and parent SRAS ratings. Those receiving nonprescriptive treatment did so in a lagged design prior to prescriptive treatment. Results indicated that nonprescriptive treatment led to worsened percentage of time out of school and daily ratings of anxiety and depression. However, prescriptive treatment substantially ameliorated these problems. In addition, improvements were seen across child self-report measures and parent and/or teacher ratings of internalizing and externalizing behavior. Using a functional model, treatment may thus be assigned efficiently and effectively for this population.

Controlled trials have established the efficacy of cognitivebehavior therapy (CBT) for depression. However, the relative effectiveness of individual versus group treatment formats in real-world settings is less well established. The current study evaluated the effectiveness of group CBT (n = 157) compared to individual CBT (n = 77) for depressed outpatients in a naturalistic setting. Symptom improvements for depression, anxiety, and quality of life were compared between treatment formats in intent-to-treat and completer analyses. Effect sizes and rates of recovery were examined. Results showed that both individual and group CBT were effective, even in the presence of high levels of comorbidity. Whereas individual CBT was associated with larger effect sizes and significantly higher rates of recovery, group CBT compared favorably to outcomes established by past research. A broad-spectrum group CBT program may be a viable treatment option when depression symptoms are less severe and when this format of treatment delivery is desirable.

This study investigated whether in time-delay discrimination training, the performance of impulsive children can be improved by requiring self-monitoring of the correctness of nonwait responses, and to what extent these improvements are a function of the dimensions of the prompts. Four experiments, in each of which multiple prompts were used, one for each stimulus (S +, S-), were done. Comparisons between time delay of distinctive-and nondistinctive-feature prompts, with and without self-monitoring, were made across and within subjects. Time delay of distinctive-feature prompts without self-monitoring did not produce learning. The added requirement of selfmonitoring nonwait responses led to a dramatic improvement in performance, but only when distinctive-feature cues were used for prompting and selfmonitoring.