Brief report: a cognitive behavioral intervention for distressed adolescents with type I diabetes.

OBJECTIVE: To examine the impact of a cognitive behavioral intervention for distressed adolescents with Type I diabetes. METHODS: Six youths with elevated levels of anxiety, anger, or diabetes stress received training in cognitive restructuring and problem solving in individual sessions. A multiple baseline design across participants was used. Treatment effectiveness was assessed through measures of anxiety, anger expression, and diabetes stress. RESULTS: Four youths displayed some improvement on one or more variables for which they had elevated levels during baseline, while others showed no impact. CONCLUSIONS: Cognitive behavioral interventions show some promise for distressed youths with Type I diabetes. Individual youths responded to treatment differently. Further research is needed in developing procedures to better meet the needs of youths, improve youth participation, and enhance treatment effectiveness.

A stress management intervention for adolescents with type 1 diabetes.

PURPOSE: The purpose of this project was to examine the effectiveness of a stress management training program in helping adolescents with diabetes cope with stress. METHODS: Youths who displayed evidence of metabolic control problems received training in the use of both cognitive-restructuring and problem-solving strategies. Treatment impact was assessed on measures of coping, anxiety level, diabetes-specific stress, and metabolic control. RESULTS: Analyses of covariance showed no differences between the training group and a control group at posttest and follow-up. However, the small sample size and within-group variability may have precluded finding significant results. Therefore, within-group comparisons were conducted, and improvements were found in the training group on pretest to posttest and pretest to follow-up comparisons for anxiety, stress, and coping measures. No differences were found in the control group. CONCLUSIONS: Results suggest that the intervention had some positive impact, although this interpretation must be considered preliminary. Future research should replicate this study and explore the applicability and effectiveness of this intervention in specific populations.

Cognitive behavioral interventions for adolescents with cystic fibrosis.

Examined the effectiveness of a cognitive behavioral intervention to help adolescents with cystic fibrosis (CF) cope with daily stressors. Five youths were referred for the therapy by medical staff because of perceived problems with anxiety or coping. Treatment impact was assessed on measures of coping, anxiety, perceptions of functional disability, and parental reports of behavior. A multiple baseline design across subjects was used. Reductions in anxiety, a decrease in maladaptive coping efforts with CF-related problems, and an increase in positive coping with CF-related problems were obtained. Youths also reported a decrease in functional disability due to CF after the initiation of the intervention. Follow-up assessment indicated that most youths maintained gains in anxiety and perceived functional disability, but not coping efforts. Results suggest that cognitive behavioral treatment is a viable intervention for anxious youths with CF.

Effect of music on ambulatory surgery patients' preoperative anxiety.

The authors investigated music as a method to reduce ambulatory surgery patients' preoperative anxiety. They assigned 42 patients to either an experimental or a control group and compared the patients' vital signs and self-reports of anxiety, which were measured using the state portion of the State-Trait Anxiety Inventory. The study results indicate that music can be more beneficial than preoperative instruction alone in reducing ambulatory surgery patients' anxiety. Patients who listened to their choice of music before surgery in addition to receiving preoperative instruction had significantly lower heart rates than patients in the control group who received only preoperative instruction. Differences in experimental and control group patients' blood pressure measurements and respiratory rates approached significance. The authors suggest that perioperative nurses offer music as a viable option to reduce anxiety in ambulatory surgery patients who believe music is a method of relaxation.

A stress inoculation training program for adolescents in a high school setting: a multiple baseline approach.

This study examined the effectiveness of stress inoculation training with adolescents in a high school setting using a multiple baseline approach. Through this intervention procedure, youths were trained in cognitive restructuring, anxiety management, and problem solving skills. Self-reports of state and trait anxiety were gathered during baseline and each training session. Five of the six youths displayed improvement on state and trait anxiety scores with the initiation of treatment. In addition, significant improvements were noted on pre- to post-assessments of state and trait anxiety and trait anger. Non-significant decreases were evident on self-reports of total, daily, and major negative stress events. No changes occurred on measures of depression, self-esteem, and anger expression. Similar patterns were obtained at a 3 month follow-up.

Social cognitive skills and behavioural adjustment of delinquent adolescents in treatment.

Social cognitive skills (i.e. problem-solving, self-control, locus of control, rational attributions) were examined in aggressive and non-aggressive delinquent youths at two levels of behavioural functioning (high versus low). Behavioural functioning was defined in terms of the youths' standing within a 10-level behavioural token economy programme. Inventories and questionnaires were used to measure the skills of interest. A significant interaction was found on problem-solving skills, with higher functioning, non-aggressive youths performing better than their lower functioning counterparts, while no differences occurred within the aggressive groups. No differences were obtained on the other measures.

The effects of a cognitive strategy intervention on the problem-solving abilities of delinquent youths.

Social problem-solving skills and a self-evaluation procedure were taught to institutionalized delinquent adolescents as part of a cognitive-behavioral therapy program. A multiple-baseline design across subjects and an alternating-treatments design were used. Five youths participated in the program in which hypothetical social dilemmas were presented in individual sessions. In addition, the effects of intervention on the youths' self-recorded personal problem-solving was assessed. Training involved the acquisition of a problem-solving strategy for the hypothetical dilemmas. Self-evaluation was later introduced through a checklist procedure. All youths showed improvement during the training of problem-solving on the hypothetical dilemmas. The self-evaluation procedure had little effect on performance. Some youths generalized their use of the problem-solving strategy to the untrained problems during the alternating-treatments condition. Follow-up data suggested that maintenance of treatment gains occurred for all youths. The generalization of improved skills to personal problem-solving also occurred for some youths. General improvements in youths' social behavior outside of therapy sessions were suggested by anecdotal information that showed improved rates of progress through the institution's behavioral level system.

The development of social cognitive processes among juvenile delinquents and nondelinquent peers.

Using 10-11- and 14-15-year-old delinquents and nondelinquents, the present project was intended to investigate: (a) the extent of delinquent-nondelinquent differences on moral reasoning tasks; (b) whether delinquents display less knowledge about social problem solving, or social metacognition, in comparison to nondelinquents; (c) whether the deficiency by delinquents on a social problem-solving task could be lessened with clues to be more strategic; and (d) whether age differences would be observed on these tasks and whether age would interact with delinquency. Developmental differences for age, but not for delinquency, were observed in mortal judgment and prosocial moral reasoning. Under certain conditions, older nondelinquents performed better than other groups while considering some dimensions of social problem solving. Age differences were also noted on the social problem-solving task. When subjects were provided with clues as an organizing strategy on this latter task, all groups scored at levels higher than their no-clues performances. All groups except younger delinquents displayed comparable knowledge about strategies to solve social problems. The findings are discussed in terms of Flavell's processing model of social cognition.

Moral and cognitive development in delinquent and nondelinquent children and adolescents.

Moral and cognitive development of delinquents and nondelinquents were investigated--96 boys and girls at three ages: 10-11, 12-13, and 14-15-16 years. Moral judgment was assessed via the Defining Issues Test, and moral conduct by a resistance to temptation task. General cognitive development was explored with Piagetian-like tasks: two concrete operational tasks, two formal tasks, and a role-taking task. With the exception of role-taking, the delinquents were found generally to lag behind nondelinquents in terms of moral and cognitive development. With increasing age, disparate performances between the two groups were consistently shown, with delinquents always lower than nondelinquents. The delinquents were also less likely to resist temptation than the nondelinquents, though no age differences were noted.

Individual differences in habituation rates and object concept performance.

The scores from object concept tasks for 15 infants at 14 months of age were analyzed with respect to their habituation rates at 4 months of age. Partitioning of the data according to subjects categorized as fast and slow habituators brought some organization consistent with the notion that the former are more advanced than the latter. Statistical differences between groups did not obtain, but a significant correlation between ranked task scores and habituation ratios offers some support to the interpretation. The possibility of using habituation rates or ratios as an index of differences in processing, perhaps with some predictive value, may be considered if further evidence of relations to later cognitive performanceis found.