Susan H. Spence

Cognitive—Behaviour Therapy with Depressed Primary School Children: A Cautionary Note

Thirty-one children, aged 7 to 11 years, were selected on the basis of depressive symptomatology over a two week period, as assessed by self-report questionnaires and a diagnostic interview. Subjects were randomly assigned to one of three groups, namely Social Competence Training (SCT), Attention Placebo Control (APC) and No Treatment Control (NTC). Intervention was conducted on a group basis for eight, weekly sessions. The results indicated a decline in depression scores during the treatment period for subjects in all conditions, and this continued during the two month follow-up period to within the normal range. The SCT programme did not produce significantly greater reductions in depression than either the APC or NTC conditions and was not effective in producing improvements on measures of social competence.

Cognitive-behavior therapy in the management of chronic, occupational pain of the upper limbs.

Forty five subjects who experienced chronic, occupational pain of the upper limbs were randomly assigned to one of three conditions; individual cognitive-behaviour therapy (ICBT), group cognitive-behaviour therapy (GCBT) and WLC. Significant benefits were found for both ICBT and GCBT on measures of anxiety, depression, coping strategies, impact on daily living, pain and distress caused by pain. These gains were not evident in the WLC and were maintained at the 6 month follow-up Minimal difference was found between ICBT and GCBT on measures of pain and psychopathology, although client evaluation ratings at the end of treatment favoured ICBT.

Rapid versus Gradual Scheduling of Therapeutic Contact in a Family Based Behavioural Weight Control Programme for Children

Forty-five overweight children aged 6 to 13 were randomly assigned to one of four conditions: a behavioural programme occurring on a rapid schedule, the same behavioural programme presented on a schedule of gradually decreasing frequency, a non-specific control procedure and a waiting list control group. Experimental procedures required subjects to attend eight sessions, accompanied by a parent. The behavioural approach was found to lead to significantly greater reductions in obese status as measured by absolute weight loss and percentage overweight for age, sex and height, in comparison to both the non-specific control procedure and the waiting list group during treatment. This difference was maintained at the 11 week follow-up. Comparison between the rapid and gradual scheduling of behavioural sessions revealed little difference in outcome in the long term, other than effects which reflected differences in duration since the onset of treatment. Skinfold measures were found to be less sensitive to change, with differences between groups being evident only in the longer term assessments.

Cognitive-behaviour therapy in the treatment of chronic, occupational pain of the upper limbs: a 2 yr follow-up

Nineteen Ss who experienced chronic, occupational pain of the upper limbs and who had previously completed a programme of either individual or group cognitive-behaviour therapy were followed up 2 yr later. Significant improvements on measures of depression, anxiety, coping strategies and interference in daily living were found following treatment. Such improvements were not evident for the waiting list control Ss and no difference was found between group vs individual applications of therapy. A 2 yr follow-up, significant improvements from pre-treatment levels were evident for depression, coping strategies, significant other report of disability, self monitored pain and distress caused by pain. While there was generally little evidence of relapse, a significant decline from post-treatment levels was found for the individual therapy condition compared to the group therapy condition on measures of self monitored pain and interference caused by pain. Since post-treatment levels tended to be somewhat superior for the individual therapy condition, the overall finding at 2 yr follow-up was of minimal difference in outcome for group vs individual forms of cognitive-behaviour therapy. Despite improvements from pre-treatment levels, the vast majority of Ss still reported significant and distressing levels of pain at 2 yr follow-up.

Site-specific muscle hyper-reactivity in musicians with occupational upper limb pain

Fourteen musicians who reported a history of pain in the upper limb associated with the playing of their instruments were compared with a sample of pain-free musicians, matched for age, sex and musical instrument. Four tasks were presented in random order and included neutral, general stressor, personal stressor and pain stressor tasks. Ratings of stressfulness and recordings of skin conductance level confirmed the effectiveness of the experimental manipulations for both subject groups. No differences were found between groups or tasks for frontalis surface electromyograph (EMG) activity. Evidence was found, however, of EMG elevation in flexor and trapezius muscles on the pain side for the pain subjects, in response to the task involving recall of a pain experience. This elevation was not found for the pain-free controls or for other stressor tasks, although some elevation in response to the pain stressor task was found for pain subjects in the trapezius muscles of the non-pain side. The duration of return to baseline of EMG following the pain stressor task was found to be extended in pain subjects for the trapezius, but not for the flexor muscles of the pain side. The findings suggest that site-specific muscle hyper-reactivity may play a role in the development and maintenance of occupational upper limb pain in musicians.

Effectiveness of Booster Sessions in the Maintenance and Enhancement of Treatment Gains Following Assertion Training.

Forty-six unassertive Ss were randomly assigned to assertion training (AT) or waiting-list control conditions. Ss receiving AT showed significantly greater improvements from pretreatment to post-treatment on 8 out of 10 questionnaire measures of assertiveness and 3 out of 5 direct behavioral observation measures compared with the waiting-list group. 27 Ss who had completed the AT program were then randomly assigned to 1 of 3 booster conditions, namely, monthly assertion training boosters (ATB), monthly attention placebo boosters (APB), or no boosters (NB). At the 3-month follow-up there was minimal difference between booster conditions. By the 6-month follow-up the results favored the ATB condition. Although the APB procedure was effective in preventing the relapse shown by the NB subjects, the ATB group actually showed further improvements on some measures of assertiveness during the 6-month follow-up period.

Group versus individual applications of reciprocity training for parent-youth conflict.

Abstract Thirty families in which parent-child conflict was identified as a problem were randomly assigned to an individual-family-based reciprocity training condition, a group-family-based reciprocity training condition and a waiting-list control (WLC) group. The results provided some support for the effectiveness of reciprocity training as measured by the Achenbach Aggressiveness factor and decreases in parent-recorded child problem behaviour. Both group and individual methods of presentation were superior to the WLC group on these measures from pre- to post-training. Benefits produced by training were maintained at the 2-month follow-up. Improvements were evident for all conditions on the Parent Attitude Survey. Family Relationship Index and Child Perception of Parent Behaviour Questionnaire, with no superiority of treatment conditions over the WLC group. Minimal difference in outcome was found between individual and group methods of family reciprocity training.

Group versus individual treatment of primary and secondary female orgasmic dysfunction

Abstract The effectiveness of group vs individual applications of behavioural procedures were assessed for primary and secondary female orgasmic dysfunction. Twenty-five primary cases and twenty-five secondary cases were randomly assigned to either a Group procedure, an Individual procedure or a Waiting-list Control (WLC). Both Group and Individual procedures were superior to no treatment in terms of attainment of orgasm by primary S s and generalization of orgasm to intercourse by secondary S s, with the Individual approach producing slightly superior results to the Group condition. Contrary to previous findings however, the results were relatively poor for primary S s, whereas secondary S s responded well to the programme. There was no evidence of a more disturbed partner relationship, as rated by the woman, for secondary S s as compared to primary orgasmic dysfunction clients. No changes over time were found for any experimental conditions on measures of heterosexual anxiety, sexual activities or attitude towards masturbation. Improvements in sexual arousal and ratings of satisfaction with the sexual relationship were found across all experimental conditions, including the WLC.

Behavioural versus cognitive social-skills training with intellectually-handicapped adults.

Abstract Forty-eight moderately intellectually-handicapped, institutionalized adults were randomly assigned to a behavioural social-skills training (BSST), a cognitive social-problem-solving (SPS), attention-placebo control (APC) or no-treatment control (NTC) group. Significant improvement in basic social-skill performance was found for the BSST group but not for the SPS, APC or NTC groups, whereas significant increases in the generation of alternative solutions were found for the cognitive SPS group but not the BSST, APC or NTC groups. Neither training approaches produced lasting benefits, nor were skill improvements associated with changes in global ratings of social competence made by staff. The implications for future intervention with intellectually-handicapped adults are discussed.

Training Social Perception Skills with Primary School Children: A Cautionary Note

Forty-eight children from grades 3 to 6 of two inner city primary schools were selected on the basis of poor performance on a social perception test. Subjects were randomly assigned to one of three experimental conditions: social perception training (SPT); attention placebo control (APC; drama activities) or a no treatment control (NTC; assessment only). The SPT and APC groups participated in nine twice weekly sessions over a five week period. Children receiving SPT did not show a significantly greater improvement in social perception skills than either of the control conditions. There was also no significant effect of SPT on certain measures of behavioral functioning which have previously been associated with social perception skill, namely peer sociometric status, Walker Problem Behaviour Checklist or Childrens Depression Inventory. The findings are discussed in terms of implications for future research.