Michael J. Telch

Peer victimization and internalizing problems in children: A meta-analysis of longitudinal studies

OBJECTIVE A recent meta-analytic review of cross-sectional studies examining correlations between peer victimization and indices of internalizing problems indicates that victims of bullying are highly distressed. However, the reliance on cross-sectional studies precludes interpretation of the direction of effects. The present study was designed to investigate if internalizing problems are antecedents of victimization, consequences of victimization, or both. METHOD This paper provides a meta-analysis of 18 longitudinal studies examining prospective linkages between peer victimization and internalizing problems (n=13,978). Two prospective paths were examined: the extent to which peer victimization at baseline predicts changes in internalizing problems, as well as the extent to which internalizing problems at baseline predict changes in peer victimization. RESULTS Results revealed significant associations between peer victimization and subsequent changes in internalizing problems, as well as significant associations between internalizing problems and subsequent changes in peer victimization. Several moderator effects were observed. CONCLUSIONS Internalizing problems function as both antecedents and consequences of peer victimization. These reciprocal influences suggest a vicious cycle that contributes to the high stability of peer victimization. PRACTICE IMPLICATIONS This study should further encourage steps to reduce bullying at schools.

The schema questionnaire: Investigation of psychometric properties and the hierarchical structure of a measure of maladaptive schemas

Although schemas play a central role in cognitive conceptualizations of personality disorders, research devoted to the assessment of schemas has been scarce. This article describes the preliminary validation of a measure of schemas relevant to personality disorders. The Schema Questionnaire (SQ) was developed using five independent samples (N=1,564). In study 1, factor analyses using a student sample revealed 13 primary schemas. A hierarchical factor analysis revealed three higher-order factors. In study 2, factor analyses using a patient sample revealed 15 primary schemas. The patient and student samples produced similar sets of primary factors which also closely matched the rationally developed schemas and their hypothesized hierarchical relationships (Young, 1991). The primary subscales were found to possess adequate test-retest reliability and internal consistency. In study 3, the SQ was found to possess convergent and discriminant validity with respect to measures of psychological distress, self-esteem, cognitive vulnerability for depression, and personality disorder symptoms.

Group cognitive-behavioral treatment of panic disorder

The present study examined the efficacy of an 8-wk, cognitive-behavioral group treatment for panic disorder. Patients meeting DSM-III-R criteria for panic disorder with or without agoraphobia were randomly assigned to treatment (N = 34) or delayed treatment control (N = 33). The treatment consisted of: (a) education and corrective information; (b) cognitive therapy; (c) training in diaphragmatic breathing; and (d) interoceptive exposure. At posttreatment, 85% of treated Ss were panic free, compared to 30% of controls. Treated Ss also showed clinically significant improvement on indices of anxiety, agoraphobia, depression and fear of fear. Recovery, as estimated conservatively by the attainment of normal levels of functioning on each of the major clinical dimensions of the disorder (i.e. panic, anxiety and avoidance), was achieved in 64% of the treated Ss and 9% of the controls. At the 6 month follow-up, 63% of the treated patients met criteria for recovery. These findings mirror those from recently-completed trials of individually-administered cognitive-behavioral treatment, and suggest that CBT is a viable alternative to pharmacotherapy in the treatment of panic disorder.

Prospective linkages between peer victimization and externalizing problems in children: a meta-analysis

Previous meta-analytic research has shown both concurrent and prospective linkages between peer victimization and internalizing problems in youth. However, the linkages between peer victimization and externalizing problems over time have not been systematically examined, and it is therefore unknown if externalizing problems are antecedents of victimization, consequences of victimization, both, or neither. This study provides a meta-analysis of 14 longitudinal studies examining prospective linkages between peer victimization and externalizing problems (n = 7,821). Two prospective paths were examined: the extent to which peer victimization at baseline predicts future residualized changes in externalizing problems, as well as the extent to which externalizing problems at baseline predict future residualized changes in peer victimization. Results revealed significant associations between peer victimization and subsequent residualized changes in externalizing problems, as well as significant associations between externalizing problems and subsequent residualized changes in peer victimization. Hence, externalizing problems function as both antecedents and consequences of peer victimization.

Psychological approaches in the treatment of specific phobias: A meta-analysis ☆

Data from 33 randomized treatment studies were subjected to a meta-analysis to address questions surrounding the efficacy of psychological approaches in the treatment of specific phobia. As expected, exposure-based treatment produced large effects sizes relative to no treatment. They also outperformed placebo conditions and alternative active psychotherapeutic approaches. Treatments involving in vivo contact with the phobic target also outperformed alternative modes of exposure (e.g., imaginal exposure, virtual reality, etc.) at post-treatment but not at follow-up. Placebo treatments were significantly more effective than no treatment suggesting that specific phobia sufferers are moderately responsive to placebo interventions. Multi-session treatments marginally outperformed single-session treatments on domain-specific questionnaire measures of phobic dysfunction, and moderator analyses revealed that more sessions predicted more favorable outcomes. Contrary to expectation, effect sizes for the major comparisons of interest were not moderated by type of specific phobia. These findings provide the first quantitative summary evidence supporting the superiority of exposure-based treatments over alternative treatment approaches for those presenting with specific phobia. Recommendations for future research are also discussed.

Modifying smoking behavior of teenagers: a school-based intervention.

Tenth grade health classes in three high schools received a special program focusing on the immediate physiological effects of cigarette smoking and the social cues influencing adoption of the smoking habit, and classes in two control schools received standard information on the long-term effects of smoking. Only subjects in the special program reported a decrease in smoking from pre to post-test; they also scored higher than controls on a knowledge test. Carbon monoxide levels were significantly lower for subjects in the special group at post-test.

Combined pharmacological and behavioral treatment for agoraphobia.

Thirty-seven severely-disabled agoraphobics were randomly assigned to (1) Imipramine-no exposure. (2) Imipramine + exposure or (3) Placebo + exposure groups. To provide a more stringent test of the pharmacological effects of imipramine independent of exposure to phobic stimuli, Ss in the Imipramine-no exposure condition received antiexposure instructions during the first 8 weeks of therapy. Assessments were conducted at 0, 8 and 26 weeks. At 8 weeks, the group receiving imipramine combined with exposure therapy displayed more improvement than the other two groups, and was the only group to show a reduction in panic attacks. Ss receiving imipramine with antiexposure instructions showed little improvement on phobic indices, no reduction in panic, but significant improvement in anxiety and dysphoric mood. At 26 weeks Ss receiving the combined imipramine + exposure treatment exhibited further improvement resulting in a significant superiority of Imipramine + exposure over Placebo + exposure across a number of different outcome indices. Ss who had received imipramine with antiexposure instructions showed some improvement during the subsequent 18 weeks in which the antiexposure instructions were no longer in effect. However, neither this group nor the Placebo + exposure group showed a reduction in panic attacks. The results of the present trial provide support for the beneficial effects of combining intensive exposure with imipramine, but call into question the thesis that imipramine exerts its effect through a pharmacological blocking of panic attacks. Alternative hypotheses concerning the mode of action of imipramine are presented.

The effects of safety-seeking behavior and guided threat reappraisal on fear reduction during exposure: an experimental investigation

We examined the effects of safety-seeking behavior and guided threat focus and reappraisal on fear reduction during exposure. Participants (N=46) displaying marked claustrophobic fear were randomized to one of three 30-min exposure conditions: (a) guided threat focus and reappraisal; (b) safety-behavior utilization; or (c) exposure only control. Tripartite outcome assessments during a behavioral approach test, along with measures of suffocation and restriction fears were obtained at pre- and post-treatment, and at a 2-week follow-up. Treatment process measures were collected throughout treatment and consisted of indices of fear activation; within and between-trial fear habituation; and suffocation and entrapment expectancies. Measures of safety behavior utilization and attentional focus were also collected to assess the integrity of the experimental manipulations. Consistent with prediction, those encouraged to utilize safety-behaviors during exposure showed significantly more fear at post-treatment and follow-up relative to those encouraged to focus and reevaluate their core threat(s) during exposure. Moreover, growth curve analyses of treatment process data analyses revealed that safety-behavior utilization exerted a detrimental effect on between-trial habituation; whereas guided threat reappraisal enhanced between-trial habituation.

Mechanism of Change in Cognitive-Behavioral Treatment of Panic Disorder: Evidence for the Fear of Fear Mediational Hypothesis.

Numerous clinical trials have demonstrated the efficacy of cognitive-behavioral treatment (CBT) for panic disorder. However, studies investigating the mechanisms responsible for improvement with CBT are lacking. The authors used regression analyses outlined by R. M. Baron and D. A. Kenny (1986) to test whether a reduction in fear of fear (FOF) underlies improvement resulting from CBT. Pre- and posttreatment measures were collected from 90 CBT-treated patients and 40 wait-list control participants. Overall, treatment accounted for 31% of the variance in symptom reduction. The potency of FOF as a mediator varied as a function of symptom facet, as full mediation was observed for the change in global disability, whereas the effects of CBT on agoraphobia, anxiety, and panic frequency were partially accounted for by reductions in FOF. Clinical implications and future research directions are discussed.

Role of cognitive appraisal in panic-related avoidance

The present study examined several dimensions of panic cognitions to test whether panic appraisals predict phobicity among panic sufferers. Thirty-five patients meeting DSM-III-R criteria for panic disorder with minimal or no phobic avoidance were compared to 40 patients meeting DSM-III-R criteria for panic disorder with agoraphobia (severe). The two groups looked strikingly similar on measures of panic symptoms, panic frequency and panic severity. As expected, patients diagnosed as having panic disorder with agoraphobia reported significantly more depression and phobic avoidance than patients with PD. Striking differences emerged on each of the following panic appraisal dimensions: (a) anticipated panic, (b) perceived consequences of panic, and (c) perceived self-efficacy in coping with panic. In each case, patients with panic disorder and agoraphobia reported significantly more dysfunctional panic appraisals than patients with panic disorder and no avoidance. Of those panic appraisal dimensions studied, anticipated panic emerged as the most potent correlate of agoraphobic avoidance. These findings support the hypothesis that cognitive appraisal factors may play an important role in the genesis or maintenance of phobic avoidance among panic patients.