Kurt Hahlweg

Parent Recruitment and Retention in a Universal Prevention Program for Child Behavior and Emotional Problems: Barriers to Research and Program Participation

Despite the potential of parent training as a prevention and behavioral family intervention strategy, there are a number of important issues related to implementation (e.g., recruitment and retention of families). This paper presents recruitment and retention data from families enrolling in a randomized controlled universal prevention trial for child behavior problems conducted in Germany. The recruitment rate averaged 31% (general project participation), with families of lower socioeconomic status (SES) participating at a lower rate. Project-declining families most often reported intrusion of privacy as their primary concern. In contrast, once parents were enrolled in the project, participation among those randomized to the parent training group averaged 77% (program/intervention participation); non-participation was mostly due to logistical issues. Parents accepting the offer of parent training were more likely to report child behavior problems than did declining parents. Although parents from more disadvantaged areas had a lower overall level of participation in the project once recruited, parents with children having higher levels of behavior problems indeed were more likely to participate in the intervention. Different recruitment methods may be required to engage high-risk families from socioeconomically disadvantaged areas to further improve community-level impact on child mental health.

The prediction and prevention of marital distress: an international perspective

Abstract This article presents the conceptual and empirical rationale for attention to the prevention of marital distress. The line of research for the United States, its history, and then the results of a German replication and extension study are presented. The results suggest the possibilities for preventing marital distress through teaching couples to improve communication and to handle conflict before problems develop. Implications for future research are discussed.

Effectiveness of an empirically supported treatment for social phobia in the field

This study examined the effectiveness of individual exposure combined with cognitive restructuring for social phobia in a clinical setting as well as the influence of sample restriction criteria on the effect size. Participants were 217 unselected patients with a primary diagnosis of social phobia who were treated by 57 therapists in four outpatient clinics of the Christoph-Dornier-Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy showed highly significant reductions in social phobic fears and avoidance as well as in general anxiety and symptoms of depression. However, patients who dropped out during therapy reported a significantly higher degree of depression. Results did not differ between the four outpatient clinics and are comparable with the average effect-sizes reported by meta-analytic studies of controlled efficacy research, using selected patients. Also, restricting the sample according to the selection criteria often applied in research settings did not result in higher effect sizes for the applied outcome measures. We conclude that individual cognitive behavioural therapy for social phobia can be transported from research settings to the field of mental health.

Are Waiting-List Control Groups Needed in Future Marital Therapy Outcome Research?

Behavioral couple therapy (BCT) is an efficacious treatment for maritally distressed couples. The current article includes a meta-analysis of BCT and waiting-list control groups from BCT outcome investigations. The findings indicate that, on average, distressed couples who are placed on waiting lists make no improvement during the waiting period. These results are consistent across 17 controlled investigations conducted in different countries. Given the consistency of these findings, the current investigators propose that marital therapy outcome investigators consider employing these effect-size estimates rather than using scarce resources to place distressed couples in waiting-list control conditions. Such a strategy circumvents the ethical dilemma of withholding efficacious treatment from clients and encourages effectiveness studies in real-world conditions.

Predicting marital distress and dissolution : Refining the two-factor hypothesis

Measures of communication, hostility, and neuroticism taken from 85 couples from Germany before marriage were used to predict marital outcomes 5 years later. Hostility and neuroticism discriminated between couples who separated or divorced after 5 years and those who remained married, whereas communication discriminated between married-satisfied and married- dissatisfied couples. Only hostility and neuroticism predicted marital satisfaction at 18 months, suggesting that these factors contribute to rapid, early declines in marital functioning. The authors conclude that poor communication alone cannot account for the full range of marital outcomes and that skill-based models of marriage can be strengthened by considering relatively rare exchanges between partners (e.g., aggression) and their enduring vulnerabilities (e.g., neuroticism).

Short- and Long-Term Effectiveness of an Empirically Supported Treatment for Agoraphobia

This study examined the effectiveness of individual high-density exposure (2-3 weeks, all day) for panic disorder with agoraphobia (PDAG). Participants were 416 unselected patients with a primary diagnosis of PDAG who were treated by 52 therapists in 3 outpatient clinics of the Christoph-Dornier Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy and at the 1-year follow-up showed highly significant reductions in anxiety symptoms, anxious cognition, agoraphobic avoidance, general symptomatology, and depressive symptoms. Results did not differ significantly between the 3 outpatient clinics and are comparable with the average effect sizes reported by meta-analytic studies of controlled efficacy research, using selected patients and specifically trained therapists. Effectiveness was not dependent on duration of disorder, number of treatment sessions, and therapist experience. The study suggests that high-density exposure can be transported from research settings to the mental health field.

Prävention kindlicher Verhaltensstörungen

Zusammenfassung. In dem vorliegenden Uberblicksartikel werden Programme zur universellen, selektiven und indizierten Pravention psychischer Storungen bei Vor- und Grundschulkindern beschrieben und hinsichtlich ihrer Effektivitat bewertet. Wenn man strenge Kriterien zur Beurteilung der empirischen Effizienz anlegt, dann gibt es international sieben universelle und 13 selektiv/indizierte wahrscheinlich wirksame Praventionsprogramme, die psychopathologischen Symptomen wie Aggression, Depression oder Angst bei Kindern vorbeugen konnen. In Deutschland gibt es nur wenige solche Ansatze, von denen sich die meisten noch im Evaluationsprozess befinden. Nur drei universelle Programme konnen als vermutlich effektiv eingestuft werden. Auf der anderen Seite werden eine Vielzahl von Programmen angeboten und verbreitet, die keine empirische Absicherung erfahren haben oder sich als nicht wirksam erwiesen haben. Es ist daher dringend notwendig, vorhandene Ansatze einer Wirksamkeitsprufung zu unterziehen und die Verbreitun...

Das Brief Symptom Inventory (BSI) als Instrument zur Qualitätssicherung in der Psychotherapie

Zusammenfassung. Anhand einer Stichprobe von N = 1252 Patienten, die in einer von drei Ambulanzen der Christoph-Dornier-Stiftung fur Klinische Psychologie behandelt wurden und hauptsachlich unter Angststorungen litten, wurde die Reliabilitat und Validitat des Brief Symptom Inventory (BSI; Derogatis, 1993) untersucht. Vergleiche mit Daten der Symptom-Check-Liste (SCL-90-R) zeigten ahnliche psychometrische Qualitaten fur beide Instrumente. Fur die Primardimensionen des BSI ergaben sich befriedigende interne Konsistenzen von .70 bis .89 mit einem α = .96 fur den Global Severity Index (GSI). Die konvergente Validitat zeigte hohe Korrelationen zu inhaltsnahen klinischen Selbstbeurteilungsskalen. Mit Hilfe der Pra-Post-Daten von N = 617 Patienten, die kognitiv-verhaltenstherapeutisch behandelt wurden, konnten vergleichbare Effektstarken fur die SCL-90-R und das BSI ermittelt werden. Die Generalisierbarkeit der Befunde ist durch das Vorherrschen von Angstpatienten in dieser Stichprobe eingeschrankt.

Prevention of marital instability and distress. Results of an 11-year longitudinal follow-up study.

Divorce and destructive couple conflict are major risk factors for many forms of dysfunction and psychopathology in the family. Couple relationship education has been offered in an attempt to reduce those risks and enhance couple outcomes. The current effectiveness study had two aims: to assess (a) the long-term effects of relationship education and (b) the ability of partners to remember the skills typically taught during the communication skills training. One hundred and one couples from two studies, in which the effectiveness of the EPL (Ein Partnerschaftliches Lernprogramm für Paare [A Learning Program for Married Couples]) was investigated, were followed-up 11 years after the training. In the first study, EPL-takers had a significantly lower divorce and separation rate (27.5%) than non-EPL-takers (52.6%). This finding was replicated in a second study, showing a 20% dissolution rate in EPL-takers. For those couples still together, the rate of happy relationships was 80% at the eleven-year follow-up - thus, there is optimism for longer married couples who are willing to focus on improving their relationships. Only about 55% of the partners could remember at least one speaker skill whereas 70% remembered at least one listening skill taught during EPL. Consequences for prevention programs in the couple domain are discussed.

Long-term outcome of a randomized controlled universal prevention trial through a positive parenting program: is it worth the effort?

BackgroundApproximately 20% of children experience internalizing or externalizing DSM-IV-TR disorders. This prevalence rate cannot be reduced through treatment only. Effective preventive interventions are therefore urgently needed. The aim of the current investigation is to evaluate the two-year efficacy of the group Triple P parenting program administered universally for the prevention of child behavior problems.MethodsBased on their respective preschool, N = 280 families were randomly assigned either to the parent training or to the control group. The efficacy was analyzed using multi-source assessments, including questionnaires by mother and father, behavioral observation of mother-child interaction, and teacher evaluations.ResultsAt the 2-year follow-up, both parents in the Triple P intervention reported significant reductions in dysfunctional parenting behavior, and mothers also an increase in positive parenting behavior. In addition, mothers reported significant reductions in internalizing and externalizing child behavior. Single-parent mothers in the Triple P intervention did not report significant changes in parenting or child problem behavior which is primarily due to inexplicable high positive effects in single parent mothers of the control group. Neither mother-child interactions nor teacher ratings yielded significant results.ConclusionsThe results support the long-term efficacy of the Triple P - group program as a universal prevention intervention for changing parenting behavior in two-parent households, but not necessarily in single-parent mothers.