George A. Clum

A meta-analysis of self-help treatment approaches

Abstract We conducted a meta-analysis of 40 self-help studies examining 61 treatments which used as control groups no-treatment, wait-list, or placebo comparisons. We found an overall treatment effect size for self-help interventions of 0.76 at posttreatment and an effect size of 0.53 at follow-up. Studies that used a more stringent control group — placebo — had a lower mean effect size than studies utilizing a no-treatment control. No differences were found for unadulterated self-help treatments and those with minimal contact from a therapist or which were in fact therapist-assisted. Some target problems were more amenable to self-help approaches, including skills deficits and diagnostic problems, such as fears, depression, headache, and sleep disturbance. Habit disturbances such as smoking, drinking, and overeating, were less amenable to self-help treatments. Compliance with the treatment regimen was found to improve treatment effects. While effect size was negatively related to duration of treatment, this effect was largely a function of duration being confounded with type of problem. Results were examined from the perspective of problems that are targetable with self-help approaches. Recommendations for improvements in research design for future studies are also made.

Imaginal flooding as a supplementary treatment for PTSD in combat veterans: A controlled study

The present study examined the incremental effectiveness of imaginal flooding (IF) over standard psychotherapeutic and pharmacologic approaches in the treatment of combat-related PTSD. Evidence was found supportive of IFs effectiveness with regard to self-report symptoms directly related to the traumatic event(s), state anxiety, subjective anxiety in response to traumatic stimuli, and sleep disturbance. Flooding had no effect on level of depression or trait anxiety, indicating that it is a useful adjunctive treatment for PTSD but cannot likely be used as the sole vehicle of change.

Revictimization rates and method variance: a meta-analysis

The present meta-analytic review examined revictimization rates and sources of variance among rates provided by 19 empirical studies of adult females. In this review, revictimization refers to the occurrence of at least one incident of childhood sexual abuse followed by a subsequent incident of adult sexual victimization. Studies were included in the review if they provided rates of revictimization and had a comparison sample of nonrevictimized women. The overall effect size for revictimization was .59, a moderate effect, suggesting a definite relationship between childhood victimization and adult victimization experiences. The overall effect size was heterogeneous and various study characteristics and definition issues were examined to determine their effect on revictimization rates. The most striking, although not surprising finding, was that studies in which more inclusive definitions of abuse were utilized yielded smaller effect sizes than studies that used more restrictive definitions of abuse. Studies that examine victimization or revictimization are often concerned with learning more about the phenomenon with the expectation that by understanding the underlying mechanism, prevention and treatment can be better focused. The interpretation given to results from past and future studies should take into account those factors found to influence estimations of revictimization rates.

Psychological distress associated with interpersonal violence: A meta-analysis

Abstract The present meta-analytic review examined the relationship between interpersonal violence and psychological distress, utilizing 50 published or prepublication empirical studies. Studies were included in the review if they quantified psychological distress following childhood sexual or physical abuse, rape, criminal assault, or partner (domestic) physical abuse or rape. The overall effect size, though heterogeneous, was clinically and practically significant, demonstrating empirically that interpersonal violence has deleterious effects on psychological functioning. Within victimized groups, specific objective and subjective stressor-related factors were examined for the magnitude of their effect on resulting psychological distress. Subjective factors, such as general appraisal, self-blame, and perceived life threat, contributed twice as much to the magnitude of psychological distess as did objective factors, such as physical injury, force, and use of a weapon. Generally, psychological distress in the domains of intra- and interpersonal functioning emerged as theoretically and clinically important avenues for further research.

A comparison of bibliotherapy and group therapy in the treatment of panic disorder

This study investigated 2 methods of disseminating a cognitive-behavioral intervention for panic disorder (PD). Thirty-six Ss who met diagnostic criteria for PD according to the Anxiety Disorders Interview Schedule-Revised were randomly assigned to 1 of 3 conditions: bibliotherapy (BT), group therapy (GT), or a waiting-list control (WL) condition. Interventions lasted 8 weeks and were followed by a posttest, along with 3- and 6-month follow-up assessments. Results indicated that both the BT and GT treatments were more effective than the WL condition in reducing frequency of panic attacks, severity of physical panic symptoms, catastrophic cognitions, agoraphobic avoidance, and depression and that the BT and GT treatments were more effective in increasing self-efficacy. Both interventions maintained their effects throughout the follow-up periods and produced clinically significant levels of change among the majority of treated Ss.

Treatment of suicide ideators: A problem-solving approach *

Social problem-solving therapy is based on research indicating that suicidal individuals have deficits in problem-solving skills in general and in interpersonal problemsolving skills, in particular. The present study evaluated the effectiveness of social problem-solving therapy compared to supportive therapy for treating suicidal older adolescents. The results indicated that problem-solving therapy was more effective than supportive therapy for reducing depression, hopelessness, and loneliness at three month follow-up, but not significantly better at reducing suicidal ideations. This study provides an example of systematic treatment research with suicidal individuals.

The use of bibliotherapy in the treatment of panic: A preliminary investigation

The present study examines the effectiveness of a self-help approach with minimal therapist contact that targeted a panic-disordered population with mild agoraphobia. Thirty-one individuals meeting the criteria for panic disorder were randomly assigned to one of three experimental conditions: (1) Wait-list control (WL); (2) Bibliotherapy using a self-help book (BT); and (3) Individual therapy using Guided Imaginal Coping (ITGIC). Total experimenter contact time for subjects in the WL and BT groups was for assessment purposes only and was 2.5 and 3.0 hours, respectively; ITGIC subjects required 10.5 hours. Results indicate that, in general, subjects in the BT group were significantly more improved than subjects in WL, and not significantly different from those in ITGIC. Implications for the treatment of panic-disordered individuals are discussed.

Measures of life stress and social support specific to an Asian student population

We designed two new measures—the Index of Life Stress (ILS) and the Index of Social Support (ISS)—to assist in the prediction of cultural adjustment for an Asian international student population. In the present study, these two measures were administered to 101 Asian international students. Stability estimates over 1 month were high: .97 for the ILS and .81 for the ISS. Construct validity, assessed via factor analyses, and concurrent validity, assessed via regression analyses to criteria of depression, hopelessness, and suicide ideation were satisfactory. Incremental validity for these two measures relative to extant measures of life stress and social support were computed. Results from these analyses indicated that these two measures added incrementally to the prediction of adjustment beyond that offered by existing measures.

Self-help plus minimal therapist contact in the treatment of panic disorder: A replication and extension

A self-help (SH) treatment for panic disorder was compared to a wait-list (WL) control. The SH treatment consisted of reading the book Coping With Panic, watching a 15-minute videotape providing information regarding panic attacks and instruction in diaphragmatic breathing, and being provided with a relaxation tape that taught progressive muscle relaxation. Evidence strongly supported the effectiveness of SH relative to WL both at posttreatment and at 2-month follow-up. The results provide support for the possible treatment of panic disorder with SH methods.

Psychological interventions vs. Drugs in the treatment of panic

The comparative effectiveness of psychological interventions and pharmacologic treatments on panic attacks was examined for a composite group comprised primarily of individuals with a diagnosis of panic disorder or agoraphobia with panic attacks. This was accomplished utilizing a comprehensive approach which examined treatment termination, treatment success/failure, and treatment relapse as three criteria of treatment outcome. Treatment outcome studies were often inadequate to this task in that they did not report dropout or relapse data or utilized experimental designs which did not permit such analyses. Claims of superiority for psychological or pharmacologic interventions in the treatment of panic are premature. Nonetheless, behavioral therapies specifically developed to ameliorate panic have the highest success rates and lowest relapse rates. Behavioral treatments which target panic attacks have higher success rates than exposure-based treatments. Agoraphobic individuals with panic attacks have, in general, higher dropout rates and lower success rates than individuals with panic disorders without avoidance, regardless of the treatment utilized.