ABSTRACT
In a study designed to maximize the effectiveness of treatment by allowing participants to select the target of treatment, 40 depressed older adults were randomly assigned to a waiting-list control condition or to conditions in which the target of treatment was either chosen or assigned. All participants received self-management therapy and the choice was between changing behavior or changing cognition. It was found that individually administered self-management therapy was effective in treating depression for older adults. There were no differences in outcome between versions of self-management therapy that targeted behavioral or cognitive change. Among those who completed treatment, there were no differences in outcome between those who received a choice and those who did not. Individuals who were given a choice of treatment options, however, were less likely to drop out of treatment prematurely.
Subject(s)
Behavior Therapy , Depression/therapy , Geriatric Psychiatry , Goals , Patient Participation/methods , Self Care , Aged , Aged, 80 and over , Analysis of Variance , Behavior Therapy/methods , Behavior Therapy/standards , Chi-Square Distribution , Choice Behavior , Cognitive Behavioral Therapy/methods , Cognitive Behavioral Therapy/standards , Female , Follow-Up Studies , Geriatric Psychiatry/methods , Geriatric Psychiatry/standards , Humans , Male , Middle Aged , Patient Compliance , Patient Satisfaction , Prospective Studies , Self Care/methods , Self Care/standards , Self Efficacy , Treatment OutcomeABSTRACT
The validity of the Cognitive Coping Strategy Inventory (CCSI; Butler et al., 1989) was tested in a prospective fashion. Subjects were randomly assigned to one of three conditions. Some were "matched" to a strategy for which they received a high CCSI score, some were "mismatched" to a strategy for which they received a low CCSI score, and some were given a choice of strategies. Those subjects using a matched strategy obtained better threshold and tolerance times on the cold pressor than subjects who used a mismatched strategy. Despite clear differences in exposure to the cold pressor these conditions did not differ from each other in self-reported levels of pain. It was concluded that the CCSI appears to be a valid and useful tool for selecting a coping strategy to help particular individuals manage acute pain. Though the CCSI is relatively easy to administer and score, the comparative costs and benefits of using it must be weighed against the somewhat more efficient approach of simply offering the subject a choice of treatments. Subjects given a choice of strategies performed as well as subjects matched to a strategy on the basis of CCSI scores.
Subject(s)
Adaptation, Psychological , Pain/psychology , Adult , Female , Humans , Male , Prospective Studies , Research Design , Surveys and QuestionnairesABSTRACT
Undergraduate student volunteers either were given a choice of coping strategies or were assigned to a coping strategy which was used to help them tolerate the cold pressor. Subjects who were given a choice of coping strategies reported their strategy to be more credible and perceived a greater sense of control than subjects who were not given a choice. Improved pain tolerance, however, did not result directly from being given a choice. Increases in pain tolerance depended on locus of control. Subjects who had a high internal health locus of control reported a greater strength of self-efficacy and demonstrated increased pain tolerance following a choice of strategies. In comparison, subjects who reported a more external health locus of control did not benefit from receiving a choice. This study has implications for our understanding of the role of choice in therapy and for improving the effectiveness of our interventions with individuals.
