Social problem-solving skills training for incarcerated offenders. A treatment manual.

This article describes a social problem-solving skills intervention for incarcerated adult offenders. The program includes pragmatic, progressive skill building through the use of direct instructions, role-plays with performance feedback, modeling, behavior rehearsal, and positive reinforcement. In addition to these treatment components, the empirically derived approach employs standardized assessment measures to identify deficits and to evaluate treatment outcome. Assessment data are directly used to determine behavior change in such areas as conversational skills, positive and negative assertion, anger management, problem solving, empathy, and stress inoculation. Social skills training is included to modify verbal, nonverbal, and paralinguistic behavioral components. In addition, training elements related to anger reduction and stress management are utilized.

Treatment of reactivated post-traumatic stress disorder. Imaginal exposure in an older adult with multiple traumas.

A single-case analysis was used to assess the effects of imaginal exposure in a 57-year-old woman suffering from current and reactivated post-traumatic stress disorder (PTSD) following a transient ischemic attack. The client's responses to self-reported depression, anxiety, and PTSD symptoms were repeatedly recorded during four phases: (a) initial psychotherapy, (b) imaginal exposure, (c) skill generalization, and (d) fading of treatment. In addition to dramatic reduction in levels of depression and anxiety, results showed a significant improvement in PTSD symptoms relating to recent and remote traumatic experiences. Improvements were maintained approximately 16 months after imaginal exposure ended, despite ongoing external stressors.

Assessment of cognitive functioning in men who batter.

The present investigation examined neuropsychological functioning in 50 male batterers court-ordered into treatment and 23 nonpatient controls. Subjects were administered a neuropsychological screening battery consisting of the Screening Test for the Luria-Nebraska Neuropsychological Battery, the Stroop Color and Word Test, two memory subtests from the Luria-Nebraska Neuropsychological Battery-III (Figural Memory and Delayed Figural Memory), and two subtests from the Halstead-Reitan Neuropsychological Battery (Trails A & B). Subjects were categorized as having neuropsychological dysfunction if their scores exceeded the statistical cut offs on two or more subtests. Results indicated that 24 (48%) of the male batterers exhibited cognitive dysfunction, as compared to only 1 (4.3%) of the nonpatient controls. Inspection of individual neuropsychological measures indicated poorer performance across all subtests for impaired male batterers as compared to both nonimpaired batterers and normal controls. In contrast, no significant differences on any of these measures emerged between nonimpaired male batterers and normal controls. Implications for the appropriate screening and treatment of male batterers are discussed.

Identification of neuropsychological subtypes in a sample of delinquent adolescents.

Although research has long recognized a relationship between neurological dysfunction and delinquency, the nature of this relationship is unclear. Based on the theory that there may be clusters of delinquents with different types of neurological dysfunction which contribute to the delinquency in different ways, the present research attempted to identify these subtypes using neuropsychological testing. Seventy-seven such adolescents were administered the full Luria-Nebraska Neuropsychological Battery-III (LNNB-III) and a battery of assessments measuring behavioral functioning and substance use. A Hierarchical Cluster Analysis yielded four identifiable neuropsychological clusters: Verbal/Left-Hemispheric Deficits, Subcortical-Frontal Deficits, Mild-Verbal Deficits, and Normals. The distinctiveness of these subtypes was confirmed by univariate analyses. Results further indicated that the number of LNNB scales that were in the abnormal range differed per subtype, with each subtype differing significantly from one another. These neuropsychological subtypes were found to be associated with specific psychological and behavioral problems.

Substance refusal skills in a population of adolescents diagnosed with conduct disorder and substance abuse.

The present study examined substance refusal skills of 44 conduct-disordered male adolescents. Fifty percent of these adolescents were dually diagnosed with substance abuse/dependence. Substance refusal skills were assessed utilizing a role-play test that consisted of four interpersonal scenarios in which a confederate prompted youths to engage in illicit drug and alcohol activity. The test demonstrated adequate interrater agreement and validity. Overall skill in refusing alcohol was positively related to adolescents' perceptions of belonging and attention, and overall skill in refusing illicit drugs was positively related to school performance and social competence. Contrary to expectations, substance refusal skills of dually diagnosed adolescents were comparable to their non-substance-abusing counterparts. Clinical implications of this study are discussed.

Interpersonal and psychological correlates of marital dissatisfaction in late life: a review.

Developmental studies suggest that marital quality improves in old age (e.g., Guilford & Bengtson, 1979). However, many of the studies are replete with sampling biases that probably led to an overinflated positive report of marital satisfaction in older adults. Our review evaluated contemporary studies that have investigated interpersonal and psychological factors associated with dissatisfaction in long-term marriages. Recent investigations indicate that older marriages benefit from lower levels of conflict and greater sources of mutual pleasure following child-rearing cessation. Studies of social support in long-term marriages suggest that perceptions of spousal support are more strongly related to marital satisfaction and general well-being for older women than for men. A few investigations have found a significant relationship between depression and marital discord in older adult samples, and the causal flow between these two variables appears to be unidirectional in that depression has a detrimental impact on late-life marital quality. Indeed, depression has been found to mediate the link between many age-related stressors (e.g., ill health, retirement) and declines in marital adjustment. However, our preliminary analysis of marital adjustment within a depressed, older adult, outpatient sample of married individuals did not confirm statistically that marital discord is associated with depressive symptomatology. This, in part, was attributed to the very narrow range of older adults sampled (i.e., clinic patients suffering from depression). However, the majority of depressives characterized their marriages as discordant. The implications for these findings are discussed and future directions are offered.

Validation of the Keane MMPI-PTSD Scale against DSM-III-R criteria in a sample of battered women.

The Keane, Malloy, & Fairbank (1984) MMPI-PTSD Scale has proven to be a reliable and valid measure of posttraumatic stress disorder (PTSD) in combat veterans. However, few studies have examined the MMPI-PTSD Scale's validity in civilian trauma victims, including battered women. In the present study, 46 battered women who completed the MMPI-PTSD Scale were assigned to PTSD-Positive and PTSD-Negative groups based on a structured diagnostic interview and then contrasted on the MMPI-PTSD Scale. Significantly higher scores on the scale were found in the PTSD-Positive group. Also, a cutoff score of 22 on the MMPI-PTSD Scale correctly classified 80.4% of the sample. Correlations between the MMPI-PTSD and DSM-III-R criteria suggest that the scale is moderately sensitive to many of the symptoms particularly those involving intrusion and psychological arousal, comprising the diagnosis of PTSD. This investigation provides further support for the validity of the MMPI-PTSD Scale and its utility in screening battered women for PTSD.

Psychometric properties and diagnostic utility of the Beck Anxiety Inventory and the State-Trait Anxiety Inventory with older adult psychiatric outpatients.

In order to assess the psychometric properties and diagnostic utility of the Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI) with older adults, these measures were administered to 217 older adult outpatients with mixed psychiatric disorders. Both the BAI and STAI scales demonstrated high internal reliabilities. The BAI demonstrated good factorial validity, with a somatic anxiety and a subjective anxiety factor emerging. In contrast, the STAI did not evidence factorial validity, with analyses failing to support presence of state and trait anxiety factors. Both the BAI and Trait Anxiety scale of the STAI demonstrated discriminant validity in separating patients with a current anxiety disorder from patients without such a disorder. However, the State Anxiety scale of the STAI did not discriminate between these groups. When used to predict presence of an anxiety disorder, no single cutting score for either the BAI or STAI proved optimal, due to tradeoffs between sensitivity and specificity. Results suggest that both the subjective subscale and total score on the BAI can be somewhat useful as a quick screening instrument in detecting presence of a current anxiety disorder for older adult psychiatric outpatients, although results were not as strong as previous findings regarding screening tests for depression in the elderly.

Assessing the effects of violence on women in battering relationships with the Keane MMPI-PTSD Scale.

The Minnesota Multiphasic Personality Inventory (MMPI)-Keane Posttraumatic Stress Disorder (PTSD) Scale (PK) has proven to be a reliable and valid measure of PTSD in combat veterans. However, few studies have examined the scale's validity in battered women, who often present with PTSD. Using empirically derived cutoff scores for the PK Scale, 69 battered women were assigned to PTSD-Positive and PTSD-Negative groups and then compared on measures of PTSD, distress, social support, and history of abuse in and out of the battering relationship. The PTSD-Positive group scored significantly higher across all measures of PTSD and distress, supporting the concurrent validity of the PK Scale in this population. However, the two groups differed only for the frequency of death threats, suggesting that the PK Scale is only mildly sensitive to the level of trauma exposure. Finally, lower levels of perceived social support were found in the PTSD-Positive than the PTSD-Negative group. Implications of these findings for the assessment of PTSD in battered women are discussed.

Social skills training for depressed, visually impaired older adults. A treatment manual.

Late-onset visual impairment due to cataracts, glaucoma, macular degeneration, or diabetic retinopathy afflicts approximately 10% of people older than 65, and often results in depression and social dysfunction. Whereas the majority of sighted older adults are active participants in their community, individuals suffering from progressively worsening vision experience heightened levels of isolation and reduced social support, and participate in fewer reinforcing recreational activities. This article describes our social skills training package for the treatment of depressed, visually impaired, older adults. Our treatment focuses on increasing the frequency and level of assertiveness with which visually impaired older adults interact with each other. In addition to specified treatment methods, our empirically derived program employs standardized assessment measures to evaluate therapeutic progress. Sessions are implemented to reinforce efforts to apply social skills in the environment and reestablish skills that have begun to fade.

Social skills training in a depressed, visually impaired older adult.

A multiple baseline design was used to assess the effects of social skills training (SST) in a 65-year-old woman suffering from major depression and severe macular degeneration. Responses to role-played scenarios requiring assertiveness, in vivo request for assistance and social involvement, self-reported assertiveness, depression, and happiness were repeatedly recorded during baseline, treatment, and follow-up phases. Results showed progressive improvement in targeted social skills with SST in both clinic and home settings. Concurrent with enhanced levels of social skill were dramatic decreases of depression to a nonclinical level. Improved skill levels and diminished Geriatric Depression Scale scores were maintained during the 7-month follow-up period, except at the 6 month assessment after which booster treatment was applied to reinstate maximum improvement.

Remedying the Achilles heel of behavior research and therapy: prescriptive matching of intervention and psychopathology.

Recent calls for eclecticism in clinical practice have been fueled by the putative limitations of behavioral techniques in treating a variety of psychological problems. However, calls for such integration do not appear to be justified for two related reasons. First, the precise conditions under which behavioral interventions are and are not effective have not yet been adequately delineated. Consequently, rejection of behavioral interventions in favor of relatively indiscriminate application of cognitive strategies is premature. Second, behavior therapy has as its hallmark a thorough grounding in inductive empiricism, while cognitive/dynamic theories are wholly based in deductive rationalism. As a result, wholesale acceptance of alternative theories and techniques by behaviorists is both inconsistent and retrogressive. Cognitive interventions have their place, but only when cognitive distortions have been specifically identified. Therefore, refinement of behavioral treatments into prescriptive interventions is warranted. The parameters of prescriptive behavior therapy are described in this paper.

Behavioral assessment and treatment of social phobia. An evaluative review.

This article provides an empirically derived description of social phobia, including onset, prevalence, comorbidity, and issues of differential diagnosis. Assessment and behavioral treatment strategies for social phobia are reviewed. It was not until the past few years that structured clinical interviews and self-report inventories have been developed with adequate reliability and validity to specifically assess social phobia. Thus much of the treatment outcome research is confounded with heterogeneous samples that make generalization of results difficult to interpret. Heterogeneity of samples, lack of controlled comparisons with adequate statistical power to detect treatment differences, and inconsistent findings do not permit the drawing of any definitive conclusions concerning the efficacy of behavioral treatment procedures at this time. More treatment comparison studies for social phobia need to be performed using structured clinical interviews and standardized assessment devices specific for use with social phobia. Pre hoc power analyses should be performed to determine the number of subjects deemed adequate to detect differences when performing comparison studies. Assessment and treatment of social phobia with children is conspicuously nonexistent. Assessment and treatment procedures for social phobia need to be developed and standardized with children.

Cognitive distortions and adolescent affective disorder. Validity of the CNCEQ in an inpatient sample. Children's Negative Cognitive Error Questionnaire.

Despite a proliferation of recent research examining childhood and adolescent depression, the area still lags behind the adult depression field, particularly in the investigation of cognitive correlates of affective psychopathology. To advance cognitive research with youth, the Children's Negative Cognitive Error Questionnaire (CNCEQ) was developed to provide a measure of cognitive distortions or errors in children and adolescents. Yet, few studies have employed the CNCEQ and no evidence exists supporting the validity of its four component cognitive error scales. The purpose of the present study was to examine the construct validity of the CNCEQ and its constituent scales through the use of factor analysis and criterion-group comparisons. Groups of adolescent psychiatric inpatients, diagnosed as affective or disruptive disordered, completed the CNCEQ following admission. Results failed to support the implicit four-factor structure of the CNCEQ, instead suggesting the appropriateness of a single-factor solution labeled "negative thinking." Despite no diagnostic group differences on the CNCEQ total or other scale scores, affective disordered patients evinced more cognitive errors on the Overgeneralizing scale. Findings suggest that the CNCEQ in its current stage of development holds promise, yet requires refinement to produce a valid measure of cognitive functioning in youth.

Reliability of the Structured Clinical Interview for DSM-III-R: an evaluative review.

Research evaluating the reliability of the Structured Clinical Interview for DSM-III-R (SCID) is reviewed. Reliability procedures and studies are examined. Several versions of the SCID are covered, including the SCID-I (axis I disorders), SCID-II (axis II disorders), SCID-Positive and Negative Syndrome Scale (SCID-PANSS; functional-dimensional assessment for psychotic disorders), and SCID-Upjohn Version (panic disorder). The SCID has been found to yield highly reliable diagnoses for most axis I and axis II disorders. Suggestions for future research on the SCID are offered, particularly with respect to (1) the lack of studies in which SCID diagnoses are compared with diagnoses from unstructured interviews or other structured-interview formats, and (2) the need for a more natural evaluation of this instrument. Also, the importance of establishing norms and obtaining reliability data for underserved clinical populations is discussed.

Maltreatment in psychiatrically hospitalized children and adolescents with developmental disabilities: prevalence and correlates.

OBJECTIVE: The goals of this study were (1) to determine the prevalence of child maltreatment in hospitalized children and adolescents with developmental disabilities and concomitant psychiatric disorders, and (2) to identify the contribution of specific mother and child characteristics to the use of more severe disciplinary practices by mothers. METHOD: One hundred thirty-eight psychiatrically hospitalized children and adolescents with developmental disabilities and mothers were assessed using a semistructured interview (Child Abuse and Neglect Interview Schedule) examining factors associated with risk of child maltreatment, and questionnaires measuring maternal and child functioning. The Child Abuse and Neglect Interview Schedule and hospital charts were then used to derive ratings on the prevalence and severity of child maltreatment. RESULTS: Findings revealed that 61% of children had experienced some form of severe maltreatment by a care provider in their lifetime. Regression analysis indicated that interactions between high levels of social functioning and disruptive/oppositional behaviors and younger age in children, and low levels of social support and increased anger reactivity in mothers, were most predictive of mothers' use of severe disciplinary practices. CONCLUSIONS: Maltreatment in psychiatrically hospitalized children and adolescents with disabilities is very prevalent, and it warrants careful clinical assessment. In the psychiatric setting, families in which the child is younger, higher functioning, and behaviorally disruptive, and where mothers have little social support and exhibit increased anger reactivity, are at especially elevated risk.

Cognitive distortions and psychiatric diagnosis in dually diagnosed adolescents.

OBJECTIVE: The purpose of this study was to examine the characteristics and patterns of cognitive distortions among psychiatrically hospitalized adolescents. METHOD: Measures of cognitive distortions, depression, and hopelessness were administered to 135 adolescents on two psychiatric inpatient units. Subjects were grouped according to their Axis I diagnoses: depression only, conduct disorder only, depression and substance abuse, conduct disorder and substance abuse, all three diagnoses, and none of the three diagnoses. RESULTS: Multivariate analyses of covariance indicated that differently diagnosed adolescents exhibited varying levels of cognitive distorting as measured by the Children's Negative Cognitive Errors Questionnaire (CNCEQ). In particular, adolescents with multiple Axis I diagnoses tended to score highest. On all but one of four CNCEQ subscales, the depression only group evidenced as much cognitive distortion as did the group with multiple diagnoses. However, each diagnostic grouping demonstrated its own somewhat distinct distortions based on CNCEQ subscales. CONCLUSIONS: Findings are discussed in terms of the utility of differentiating cognitive styles for subsequent treatment. It is suggested that disparate cognitive interventions could be matched with adolescents displaying particular problems.

Diagnosis and assessment of substance abuse in older adults: current strategies and issues.

Alcohol and substance abuse in older adults until recently has received little empirical attention in the literature. However, in light of the increasing number of older adults in the population, clinicians and researchers alike are recognizing the importance of evaluating specific assessment and treatment strategies for such older substance abusers. Because distinctive biological, cognitive, and psychosocial variables appear to be correlated with substance abuse in older adults, evaluation and intervention methods employed with younger cohorts may be inappropriate or ineffective with individuals 55 and over. Our article, therefore, examines these characteristics as they pertain to the unique problems and service needs of the elderly. Relevant diagnostic and assessment strategies are reviewed. Finally, suggestions for future work in this area are outlined.

Behavioral interventions to reduce maladaptive responding in youth with dual sensory impairment. An analysis of direct and concurrent effects.

Many persons who have multiple sensory, physical, and developmental disabilities display behaviors that interfere significantly with adaptive functioning and social acceptance. In this investigation, the efficacy of multiple component behavioral interventions for reducing maladaptive responding exhibited by two individuals with dual sensory impairment and profound mental retardation was evaluated. Results indicated that differential reinforcement of other behavior (DRO) approaches were not effective in either case. However, when deceleration procedures (overcorrection or brief physical restraint) were added, target behaviors decreased quickly. Also, interventions were faded in such a way that gains were maintained for 6 months with only minimal effort by staff. Ongoing assessment of concurrent effects of behavior reduction strategies revealed increases in time on task or amount of work completed, even though these responses were not targeted specifically. Yet negative side effects (e.g., increases in self-stimulation) also were documented, highlighting the importance of evaluating multiple behaviors during intervention. Finally, despite the fact that objective assessments led to positive conclusions regarding treatment efficacy, ratings of baseline and treatment behavior samples by independent judges showed overall improvement in only one case. These findings suggest the need for multifaceted evaluation to determine the utility of interventions in applied settings.

Behavioral assessment of anxiety in older adults. Some comments.

The behavioral assessment of anxiety in older adults is reviewed in this article. Despite the high rate of anxiety symptoms uncovered during the course of large-scale epidemiological studies, the comprehensive evaluation of anxiety in this age group (55 and over) is not highly sophisticated at this juncture. In this review, diagnostic issues, psychometric evaluation, motoric assessment, and psychophysiological assessment are considered. Throughout the articles, gaps in the extant research are identified, and a research agenda for the future is developed.