Journal of Behavior Therapy and Experimental Psychiatry

Threatening intrusive images are central to posttraumatic stress disorder. It has been suggested that intrusive imagery in the context of a sense of threat leads to the development and persistence of posttraumatic stress symptoms. This study investigates London school children's (N=76; age 10-11 years) self-reported posttraumatic stress symptoms in response to viewing the attacks of September 11, 2001 on television. Assessments were made at two time points. A minority of participants reported moderate-severe symptoms with functional impairment at 2 months (14.5%) and 6 months (9.2%) after viewing the September 11 events. After controlling for symptom stability, persistent symptoms were associated with peri-traumatic factors, notably perceiving that one's life was in danger. The combined effect of intrusive imagery and peri-traumatic life threat was associated with symptom persistence. Assessments of intrusive image content via checklist and free-report indicated that the images were directly related to September 11 and were fairly stable over time. Implications for treating children's intrusive images following stressful events are explored.

We sought to assess, through two case-studies, the strengths and limitations of a time-limited, family-based behavioral intervention for preschool-aged children with attention-deficit-hyperactivity disorder (ADHD). The families completed a ten week child management training program and attended a number of follow-up sessions. Changes in parent and child functioning were assessed with a variety of rating scales, interviews, and data collected by parents at home on targeted behavior problems. Improvements were found in parents' confidence in their child management ability and knowledge of behavioral principles, in certain child behavior problems, in parental ratings of hyperactivity, and in the parent-child relationship. Implications of the findings for the treatment of young children with hyperactivity are discussed.

The objective of this study is to compare the results of the Symptom Check List (SCL)-90-R and the General Health Questionnaire (GHQ)-28 administered on paper with the results of administration via Internet. Forty university students were asked to respond to the two questionnaires, first in one format (Internet or paper), and 1 week later in the other format. For the GHQ-28, no statistically significant differences were found between the two forms of presentation, Internet or paper, except in the social dysfunction subscale. In the case of the SCL-90-R, there were differences in the Positive Symptoms Distress Index (PSDI) and in the somatization and obsession-compulsion subscales. The effect of using the two formats in combination was also analyzed. Internal consistency of the instruments is high for both types of presentation (alpha=0.91 in GHQ-28; alpha=0.97 in SCL-90-R). Correlation between the two formats is also high, with values ranging between 0.76 and 0.92, p<0.001, except in the social dysfunction subscale. Finally, correlation between the GHQ-28 and SCL-90-R is also high, for both the paper and Internet results (r=0.88, p<0.01 on paper and r=0.83, p<0.01 via Internet). The differences found should be verified in future research with other types of sample.

The present study examined developmental patterns in children's interpretation of anxiety-related physical symptoms and emotional reasoning (i.e., the tendency to infer danger on the basis of physical response information). A sample of 171 children aged between 4 and 13 years were interviewed after listening to a number of vignettes in which the presence and absence of physical symptoms was systematically varied. Results revealed the expected developmental pattern for anxiety-related interpretations of physical symptoms. More precisely, from age 7, children were increasingly capable of linking physical symptoms to the emotion of anxiety. Furthermore, support was obtained for an emotional reasoning effect. That is, children rated vignettes with physical symptoms as more dangerous than vignettes without such symptoms. While the emotional reasoning effect was present in children of all ages, this phenomenon was more salient among older children. Finally, cognitive development as measured by Piagetian conservation tasks appeared to influence children's anxiety-related interpretations of physical symptoms and emotional reasoning. Altogether, these findings are relevant for researchers who are interested in "physical symptoms-based" theories of childhood anxiety.

The present study reports on the use of visual screening, a mildly aversive response suppression procedure, as a treatment for reducing compulsive behaviors in a four and one-half year-old developmentally disabled boy. Two distinct patterns of compulsive responding were observed: repetitive (stereotyped) shoe-related behaviors and a ritualistic shoe-related act. The effect of visual screening on repetitive shoe-related responses was initially evaluated in a laboratory setting under A-B-A-B-B1 experimental conditions and systematically extended to the classroom setting in multiple baseline fashion. Visual screening was also contingently applied as treatment for the shoe-related ritual, with the effects analyzed using a similar multiple baseline format across hospital residential unit and natural home settings. Results of the study indicated that visual screening was an effective treatment for suppressing both forms of the subject's compulsive responding and that it was an easily learned and administered procedure from both staff and parent perspectives. Follow-up data across 12 months were obtained and indicated that the effect of treatment was exceptionally durable.

This study tests the causal role of negative self-imagery in social anxiety. Low public-speaking anxious volunteers rehearsed a negative self-image, a positive self-image or a control image prior to giving a speech. As predicted, the negative image group felt more anxious, believed they performed less well and reported more negative thoughts than the positive image group. These findings do not appear to be due to changes in state anxiety, since they remained unchanged when anxiety was controlled in an analysis of covariance. The negative image group also reported more anxiety than the control group. Given that participants do not currently have anxiety problems, the findings are consistent with the idea that negative self-imagery has a causal role in the development and maintenance of social anxiety.

Three young women volunteers were trained through instructional feedback in two breathing procedures: diaphragmatic, derived from Eastern meditative techniques, and thoracic, involving opposite maneuvers. A single-subject reversal design was employed. Physiograph recordings of diaphragmatic expansion and mouth breathing provided the basis for feedback. Peripheral (digital) temperature was time-sampled at 1-min intervals and linear regression lines were fitted to the data. Temperature decreased throughout "normal" (baseline) breathing, probably due to warm outdoor and cool indoor temperatures. For two subjects, temperature during diaphragmatic breathing was generally stable; temperature during thoracic breathing showed significant decreases and did not differ from normal breathing. Within-session reversals showed dramatic changes in temperature as a function of breathing technique, which were maintained at follow-up, for these subjects. Temperature was more labile and decreased regardless of breathing procedure for the third subject. These data support a relationship between respiratory and vasomotor activity, and suggest that breathing strategy may be an uncontrolled variable in temperature biofeedback. It is further suggested that diaphragmatic breathing may facilitate temperature biofeedback or other types of relaxation training.

Self-injurious hand biting was reduced in an autistic girl by using fine water mist combined with a loud statement of "No!" following the behavior, and verbal praise for appropriate behavior. The subject was 6 years old when the interventions were implemented, and she had been in arm and head restraints since infancy. A fading procedure that moved from a large to smaller bottles allowed generalization across settings and people. Treatment was effective at a 6-month follow-up in both structured and unstructured settings.

The present maintenance study investigated whether the reduction in hypochondriacal complaints after initial treatment with CBT or paroxetine sustained during a follow-up period and whether psychiatric severity at pretest predicted the course of hypochondriacal symptoms. A naturalistic follow-up period of 18 months after a 16-week RCT consisting of 33 patients initially allocated to a CBT condition and 29 patients to a paroxetine condition. The main outcome measure was the Whiteley Index. The initial treatment effect of CBT and paroxetine sustained during the follow-up period. No significant differences between CBT and paroxetine were found. Treatment course could not be predicted by psychiatric comorbidity. CBT and paroxetine are both effective treatments for hypochondriasis in the long term.

The extent to which perceived control over anxiety-related events contributes to the experience of pain was investigated. It was hypothesized that perceived control over anxiety-related events would predict pain behaviors induced via a cold pressor task because perceived control may alter the meaning of a pain-inducing stimulus. Eighty undergraduate students completed the Anxiety Control Questionnaire. Pain Anxiety Symptoms Scale. State-Trait Anxiety Inventory, and Penn State Worry Questionnaire. Heart rate was assessed prior to hand immersion. Participants then immersed their dominant hand in ice water and rated pain intensity at their pain threshold and tolerance times. Results indicate that perceived control over anixiety-related events predicts pain tolerance and endurance (i.e., overt pain response) but not pain intensity. threshold, or heart rate. It appears that the psychological process variable of perceived control over anxiety-related events uniquely influences participants' ability to cope with the experience of pain by altering the perceived threat of the acute pain induced via a cold pressor task.

This topical bibliography covers that past decade of research into behavioral approaches to smoking cessation. Using multiple sources, including Psychological Abstracts, 335 reference were compiled from over 50 psychology, medicine, and related behavioral science journals. All references were comprehensively coded for each of 28 topical area of interest to behavioral researchers and clinicians. Topics include specific behavioral smoking cessation techniques (e.g. aversive smoking, relaxation techniques, stimulus control), treatment problems (e.g. maintenance problems and procedures, physiological correlates of smoking behavior, therapist and treatment factors influencing outcome). An index defining each topical and listing by number all articles related to each topic is included with the bibliography (Tables 1 and 2). With this index, users with specialized interests can quickly locate all citations concerning a particular topic or combination of topics. The preceding article (Orleans et al., 1981) gives guidelines for expanding this bibliography for personal reference use.

This article describes a topical bibliography presented in the subsequent article in this journal, covering the past decade of research into behavioral approaches to smoking cessation. Using multiple searches including Psychological Abstracts, over 300 references were compiled from over 50 psychology, medicine, and related behavioral science journals. All references were comprehensively coded to each of 28 topical areas of interest to behavioral researchers and clinicians. Topics include specific behavioral smoking cessation techniques (e.g. aversive smoking, relaxation techniques, stimulus control), treatment problems (e.g. maintenance problems and procedures, treatment "side-effects") and important research issues (e.g. predictors of treatment success, physiological correlates of smoking behavior, therapist and treatment factors influencing outcome. An index defining each topic and listing by number all articles related to each topic is included with the bibliography. With this index, users with specialized interests can quickly locate all citations concerning a particular topic or combination of topics, Directions for using the bibliography are given along with guidelines for extending and adopting it for personal use.

In a commentary on our paper entitled "Pulmonary function in panic disorder: evidence against the dyspnea-fear theory", Ley (1998) provides a critical analysis of our study. He concludes that our failed attempt to replicate a relationship between pulmonary function and the severity of panic-related symptoms in panic disorder patients may have been a consequence of a lack of comparability between studies, a statistical anomaly, and experimenter-demand effects. After discussing his comments (with most of them we do not agree) in depth, we maintain our conclusion that: (a) pulmonary impairment is not directly associated with panic symptoms; and (b) that the existence of a distinct subgroup of panic disorder patients with signs of actual airways obstruction leading to uncontrollable dyspnea and fear of suffocation remains questionable.

The Cognitive Behavioural Assessment-2.0 (CBA-2.0) Primary Scales is an automated assessment package investigating the cognitive-verbal response system. It consists of: (1) self-reports and questionnaires aimed at identifying and specifying patients' problems; (2) a group of programs and logical rules, implemented on personal computers, providing an editor with items, questionnaire scoring and an analysis of responses; (3) an intelligent program which analyzes the responses emerging from the questionnaires and forms hypotheses for the selection of Secondary Scales and for further assessment. The package is part of a research project aimed at reducing part of the decision-making process to an operational language and simulating behavioral therapists decisions in cases of clinical assessment.

This study explored the role of threat and contamination-related associations in spider phobia. Treatment-seeking (n=60) and non-phobic (n=30) individuals completed threat and disgust-related Implicit Association Tests (IATs). Phobic individuals were assessed before and after one session of 2.5h in vivo exposure. To differentiate actual treatment effects from test-retest effects on the IAT, half of the phobic individuals completed the IAT twice before treatment. Results showed that: (1) threat and contamination associations similarly distinguished between phobic and non-phobic participants on self-reports and IATs; (2) only self-reported threat associations incrementally predicted participants' overt avoidance behavior next to self-reported global affective associations; (3) self-reported associations were significantly reduced following treatment; (4) IAT-effects showed no significant reduction following treatment, and no evidence was found for an additional treatment-induced change over and above test-retest effects.

Exposure therapy is traditionally conducted with an emphasis on the elimination of safety behaviors. However, theorists have recently suggested that the judicious use of safety behaviors may improve the tolerability of this treatment without reducing its efficacy. The present study tested this notion by randomly assigning participants with high claustrophobic fear to receive a single-session intervention with or without access to safety aids during early exposure trials. Improvement was generally equivalent between the treatment conditions, and no reliable benefits or drawbacks were associated with the judicious use of safety behaviors. The theoretical and clinical implications of these findings are discussed.

Safety behaviours are widely held to impede the beneficial effects of exposure, certainly in OCD. Recently, Rachman, Radomsky, Shafran, and Zysk (2011) challenged this view. Healthy volunteers repeatedly touched a contaminant in two sessions. Half of the participants did not engage in safety behaviours after touching (exposure + response prevention), while the other half did (exposure + safety behaviours, i.e., cleaning hands with a hygienic wipe). Scores of contamination, fear, danger, and disgust decreased in both sessions and the effects were not impeded by safety behaviours. Three potential artefacts were identified in the Rachman et al. study: a no-treatment control group was lacking, the stop rules for ending exposure differed between conditions, and positive expectations may have been induced in the safety behaviours group. We tried to critically replicate the main findings. The Rachman et al. (2011) study was replicated, with 44 volunteers but stop rules and expectations were similar between treatments, and effects were also assessed in a no-intervention control group. Relative to the control condition, both exposure interventions induced reliable decreases in feelings of contamination, fear, danger, and disgust. The decline followed an exponential curve with the largest gains at the first trials of each session. Findings were obtained from a non-clinical sample. The findings attest to the robustness of the Rachman et al. findings, and challenge the notion that safety behaviours should be dismissed categorically in exposure treatments.

Two autistic children were taught to emit verbal tacts under two conditions--one employing verbal antecedent stimuli in the training process and the other employing so-called naturalistic antecedent stimuli. Although acquisition was more rapid when verbal antecedents were used, the generality of learning was substantially better for language taught under naturalistic stimulus control. Implications of these findings for the instruction of autistic children are considered in the context of current information on stimulus control.

Case histories are presented of 27 youngsters who had a major problem of stealing. The effectiveness of eight different treatments is examined in terms of proportion of follow-up time spent stealing. (Duration of follow-up was always more than 2 yr.) Clients given Individualized Combined Treatment spent 2 1/2% of follow-up time stealing, compared with 46% after other types of treatment.

Although imagery rescripting has long been part of cognitive behaviour therapy (CBT), recent years have seen a growing interest in the use of imagery rescripting interventions in CBT, especially with patients who struggle with distressing, intrusive imagery. This growth in the clinical applications of imagery has led to the creation of the current special issue of collected papers on imagery rescripting, which is designed to: (a) present research and clinical applications of imagery rescripting techniques to problematic mental imagery, (b) consider problematic imagery across a wide range of psychological disorders that might be a target for imagery rescripting (including novel areas such as mental contamination, bulimia and suicidality), (c) explore a variety of imagery rescripting techniques in the treatment of PTSD, as well as depression, social phobia, and snake phobia, and (d) stimulate interest for future treatment innovation in the use of imagery rescripting techniques to address other clinical disorders. The aim of this editorial is to summarise the collected papers presented and the links between them. A working definition of two types of imagery rescripting is provided, along with a heuristic framework for conceptualising the range of imagery techniques in cognitive therapy.

Background and objectives: Rumination has been proposed as a risk factor for depression, while mindful attention might be protective. Differential effects of these attention foci have so far only been examined in the laboratory. Therefore, we conducted an experimental ambulatory assessment study using ruminative and mindful attention inductions in everyday life to examine their effects in a natural context. Methods: Fifty young adults carried palmtops over three weekdays (rumination induction day, mindful attention induction day, noninduction day; randomized cross-over design). Ten times a day, participants rated ruminative self-focus and mood. On the induction days, they were additionally subjected to 3-min inductions of ruminative or mindful attention at each assessment. Results: The two induction modes exhibited differential immediate effects on ruminative self-focus and mood. While induced rumination immediately deteriorated valence and calmness, induced mindful attention specifically enhanced calmness. Depressive symptoms did not moderate these effects. While overall longer term effects of the inductions were missing, the mindful attention day was associated with slightly increasing positive valence over the day. Limitations: The results need to be replicated in high-risk and patient samples to demonstrate the clinical significance of identified effects. Conclusions: Results confirm the emotional relevance of rumination and mindful attention in real world settings. Future work may test whether adaptive attention-focusing instructions delivered in daily life can support clinical interventions.

This article describes the main characteristics and technical features of a novel psychotherapeutic strategy, well-being therapy. This paper outlines the background of its development, the structure of well-being therapy, its key concepts and technical aspects. Well-being therapy is based on Ryff's multidimensional model of psychological well-being, encompassing six dimensions: autonomy, personal growth, environmental mastery, purpose in life, positive relations and self-acceptance. The goal of this therapy is improving the patients' levels of psychological well-being according to these dimensions, using cognitive-behavioral techniques. It may be applied as a relapse-preventive strategy in the residual phase of affective (mood and anxiety) disorders, as an additional ingredient of cognitive-behavioral packages, in patients with affective disorders who failed to respond to standard pharmacological or psychotherapeutic treatments and in body image disturbances. The clinical studies supporting its efficacy are illustrated.

We tested whether the effectiveness of imaginal exposure (IE) treatment for posttraumatic stress disorder (PTSD) was enhanced by combining IE with imagery rescripting (IE+IR). It was hypothesized that IE+IR would be more effective than IE by (1) providing more corrective information so that more trauma-related problems can be addressed, and (2) allowing patients to express emotions that they had been inhibiting, such as anger. In a controlled study 71 chronic PTSD patients were randomly assigned to IE or IE+IR. Data of 67 patients were available. Treatment consisted of 10 weekly individual therapy sessions and treatment evaluation was conducted post-treatment and at 1-month follow-up. Results show that when compared with wait-list, treatment reduced severity of PTSD symptoms. More patients dropped out of IE than out of IE+IR before the 8th sessions, 51% vs. 25%, p=.03. Completers and intention-to-treat analyses indicated that both conditions did not differ significantly in reduction of PTSD severity. IE+IR was more effective for anger control, externalization of anger, hostility and guilt, especially at follow-up. Less strong effects were found on shame and internalized anger. Therapists tended to favor IE+IR as it decreased their feelings of helplessness compared to IE. Results suggest that the addition of rescripting to IE makes the treatment more acceptable for both patients and therapists, and leads to better effects on non-fear problems like anger and guilt.

The present study tested several predictions of a context-sensitivity panic vulnerability model emphasizing the interaction between threat context and threat sensitivities. Participants without a history of panic (N=47) completed both global and domain-specific panic relevant sensitivity measures and were then randomized to undergo a 35% CO2 inhalation challenge in the presence or absence of a cardiac defibrillator (threat context). As predicted by the model, cardiac sensitivity (but not trait anxiety or anxiety sensitivity) potentiated the effects of the presence of the defibrillator on CO2 fear responding. Moreover, as predicted by the model, the observed potentiation effects of cardiac sensitivity on CO2 fear responding were mediated by participants' threat appraisals connected to the presence of the defibrillator. Theoretical and clinical implications are discussed.

Experimental research has demonstrated that CO2 inhalation provides a valid laboratory model for acute panic. Earlier studies employed CO2/O2 mixtures that were not only hypercapnic but also hyperoxic, raising the question of the relative contribution of the hyperoxidity. A comparison between a hypercapnic/hyperoxic mixture (35% CO2/65% O2) and a hypercapnic/normoxic mixture (35% CO2/20% O2/45% N2) revealed no differences on self-reported panic symptoms or end tidal pCO2. It is concluded that findings from previous CO2/O2 inhalation studies should be attributed to the hypercapnic, rather than to the hyperoxic, nature of the mixtures.

The present study was designed to test whether OC tendencies are associated with indecisiveness and increased need for objective feedback in vague decision situations. This hypothesis was tested using a neutral color judgment task that places minimal demands on working memory. Sixty-one participants completed several measures of OC symptoms and tendencies. Indecisiveness was tested on a novel computerized task in which participants can move along a continuum marked by two colors at the extreme ends and are instructed to choose the color they judge to be the exact mid-point on the continuum. OC scores were positively correlated with indecisiveness on the task, as assessed by the amount of time it took participants to complete the task and the extent of their search through the color continuum. This association was most pronounced when feedback for performance was not routinely provided. Requests for feedback were also positively correlated with OC scores. OC scores were not associated with actual performance on the task (accuracy levels) or with confidence ratings. The study relies on non-clinical participants and the extent to which these results would extend to OCD patients in unknown. Some effects may be confounded by the fixed order in which the task phases were administered. The findings support the hypothesis that OC tendencies are associated with general indecisiveness and reliance on external feedback.

Explanations of dental anxiety in terms of either conditioning or personality predispositions alone are not sufficient to account for all individuals presenting with dental anxiety, since they are not a homogenous group. It was hypothesized that individuals, with wide ranging anxiety problems would be more likely to carry dental anxiety into old age. This prediction was supported by a comparison of older dentally anxious individuals with other older individuals who admitted to dental anxiety previously but were no longer dentally anxious. The results were interpreted in terms of Lang's bioinformation model of anxiety.

Eye movement desensitization (EMD) and a control procedure, image confrontation (IC) were compared in a group of 58 phobics, 31 of them arachnophobes. Subjects confronted disturbing images in a single-session crossover trial. Anxiety levels were recorded on the SUD Scale. Whenever practicable, SUDs to feared objects were also recorded. EMD and IC were equally effective in reducing anxiety levels. After 1 month, during which subjects were encouraged to use IC daily, improvement was maintained. Since exposure to the disturbing image is common to both methods it must be presumed to be the basis of change when EMD is used in cases of phobia.

Although extinction is highly effective in reducing a conditioned fear response, return of the fear response (renewal) outside the extinction context often occurs. The present study investigated whether US devaluation, through imagery rescripting during extinction, resulted in less renewal than mere extinction. Seventy psychology students were subjected to a fear conditioning paradigm. During fear acquisition CS+ was always followed by the US, whereas CS- was never followed by the US. For all groups the acquisition phase took place in context A. During extinction both CS+ and CS- were offered, but no US was presented. For three groups extinction was conducted in a different context, context B (ABA groups). The fourth group received extinction in the acquisition context (AAA group) in order to demonstrate that renewal indeed took place. During extinction, participants received either an imagery rescripting (IR) instruction to devaluate the US (ABAir), a US-unrelated imagination instruction to assess the general influence of imagination (ABAcont), or no instruction at all (ABAno and AAAno). Subsequently, testing occurred for all groups in the acquisition context A. The results indicated that renewal of the US expectancy ratings was reduced if imagery rescripting (ABAir) was added to mere extinction (ABAno). Next to the reduction in renewal, imagery rescripting (ABAir) also resulted in the devaluation of the US valence, indicating that the mental representation of the US had changed. These findings are not only in line with contemporary conditioning theories, but also suggest that adding imagery rescripting to extinction might be beneficial in the treatment of anxiety problems.

An economical, abbreviated overcorrection procedure was implemented to reduce several self stimulatory and self abusive behaviors of a severely retarded child. These were monitored, along with a non-targeted behavior, tantrum screams, during treatment sessions, and during non-treatment sessions with the experimenter present or absent. A withdrawal design demonstrated that substantial reductions in essentially all the behaviors were achieved during treatment sessions, with visible though less dramatic reductions occurring at other times. Although long-term follow-up observations showed a recovery of baseline performance, the behaviors again were rapidly brought under control when a modified form of the procedure was re-instituted.

As part of a broad focus on service accountability, increased attention has been devoted to the assessment of consumer judgments of treatment acceptability. Current treatment acceptability measures are limited by item complexity and time-intensiveness. These limitations were addressed with the modification of an existing instrument (Intervention Rating Profile; Witt & Elliott, Journal of Abnormal Child Psychology, 13, 59-67, 1985). Psychometric support was found for the revised measure (Abbreviated Acceptability Rating Profile; AARP) in an initial sample of parents (N = 60) who rated child treatments. Results were replicated in a cross-validation study of a second independent sample of parents (N = 80). A third sample of subjects was used to assess the time-intensiveness and readability of the AARP. The usefulness of the modified instrument is discussed.

This report demonstrates the effectiveness of two automatic cueing devices in the detection and subsequent modification of postural abnormality and rectal digging. Without their use a viable treatment plan would not have been possible.

Many aberrant behaviors exhibited by individuals with developmental disabilities are maintained by "automatic reinforcement". These behaviors are often difficult to treat, with the most effective behavioral interventions often resulting in only moderate success. However, a series of recent studies has advanced our ability to understand and treat these behaviors through the innovative use of behavioral assessment. We review the recent development of three categories of assessments: (a) nonhypothesis-based stimulus preference assessments, (b) hypothesis-based stimulus preference assessments, and (c) hypothesis-based assessments incorporating noncontingent reinforcement and sensory extinction procedures. We consider each category's contribution to both our ability to prescribe effective behavioral interventions and our ability to more fully understand the concept of automatic reinforcement.

Adipsia is an uncommon, life-threatening condition which refers to an absence of thirst or an abnormal avoidance of fluid consumption. A behavioral intervention was successfully used in the treatment of severe adipsia in a multi-handicapped adolescent whose water intake was almost entirely limited to the water content of the foods he consumed. Using edible reinforcement and a set of commercial measuring utensils (from 1/4 teaspoon to 1 cup), milk consumption was established through a behavior shaping regimen. Follow-up results over 1 year indicated that the behavioral progress was maintained, problems with dehydration were eliminated, and stimulus generalization to several other fluids occurred.

An emerging pattern of results from panic-relevant biological challenge studies suggests women respond with greater subjective anxiety than men, but only to relatively abrupt and intense challenge procedures. The current investigation examined the relation between biological sex and self-reported anxious reactivity following biological challenges of varying durations and intensity. Participants were 285 (152 females; M(age) = 21.38; SD = 5.92) nonclinical adults who completed one of three protocols: a 3-min voluntary hyperventilation challenge (VH), a 5-min 10% carbon dioxide-enriched air (CO(2)) challenge, or a 25-s 20% CO(2) challenge. As predicted, results indicated that the 20% CO(2) challenge elicited greater self-reported anxiety than the VH and 10% CO(2) challenges. Moreover, women endorsed greater anxious reactivity than men, but only following the 20% CO(2) challenge. Results are discussed in terms of processes likely to account for sex differences in anxious reactivity following relatively abrupt and intense biological challenges.

The present study used a directed forgetting paradigm to investigate whether socially anxious individuals show a memory bias for social information. Socially anxious and non-anxious participants viewed three types of words: socially negative, socially positive, and neutral. Each word was presented on a computer screen and was followed by a cue instructing participants to either remember or forget the word. A free recall test and a recognition test were then administered by asking participants to recall and recognize both "to-be-remembered" and "to-be-forgotten" words. When compared to non-anxious participants, socially anxious participants showed a greater directed forgetting effect for socially positive words in the free recall test, indicating that socially anxious individuals more easily forget socially positive words than do non-anxious individuals. This result suggests that socially anxious individuals lack the positive bias (i.e., difficulty in forgetting socially positive information) displayed by non-anxious individuals.

Drug-dependent people exhibit biases when evaluating discrete emotional facial expressions. Little is known about how drug abusers process multiple expressions presented simultaneously. The present study investigated the number perception of schematic emotional expressions by abstinent heroin abusers. Eighty-four heroin abstainers with varied lengths of abstinence (short-term, mid-term, and long-term) and twenty healthy controls were examined. A method of limits was deployed to obtain estimates (points of subjective equality) of perceived numbers of schematic faces (expressing positive, neutral, or negative emotion). Major results include the following: 1) heroin-abstinent participants showed significantly lower points of subjective equality for negative and neutral faces, but not for positive faces, compared to control participants; 2) heroin-abstinent participants showed lower points of subjective equality for negative faces and higher ones for positive faces when compared to neutral faces, while no such differences were found in control participants. Heroin abusers demonstrate an exaggerated perception of number when exposed to negative expressions, even after a period of abstinence as long as 10 months. In addition, the current results could also reflect an underestimated perception of number during exposure to positive expressions and a heightened baseline for neutral expressions, or the attribution of negative valence to neutral expressions by heroin abusers.

Drug dependents exhibit biases when evaluating emotional facial expressions; however little is known about their emotional biases appearing at the pre-awareness stage. The present study examined whether abstinent heroin abusers preferentially attended to facial expressions with particular emotion type. Thirty-seven abstinent heroin abusers (AH participants), twenty normal healthy controls (NC participants), and nineteen individuals with moderate anxiety/depression disorders (PC participants) were included in the study. Participants searched displays containing a varying number of schematic neutral faces for a unique schematic face expressing either a positive or a negative emotion. Results revealed that AH participants had generally shallower search slopes for locating the negative target face than those for locating the positive one, whereas no such difference was found on NC participants or PC participants. It suggested that abstinent heroin abusers are biased to attend to negative expression more effectively than attend to positive expression. We proposed that this may result from abstinent heroin abusers' repeated exposure to people's negative expressions in their living environment or a pre-existing emotional processing deficit which could initiate the development of drug abuse behaviour.

The present study examined the occurrence and content of auditory hallucinatory experiences in 41 non-clinical participants scoring high or low on the Oxford-Liverpool Inventory of Feelings and Experiences (brief version; OLIFE-B) measure of schizotypy. Participants listened to 10 1-min recordings of white noise, some of which contained embedded concrete or abstract words, and were asked to record the words that they had heard. High scorers on the unusual experiences (UE) scale of the OLIFE-B reported hearing more words, not actually present, relative to low scorers on that measure. In addition, high UE scorers showed a bias toward making hallucinatory reports of an abstract type over a concrete type. These results suggest a bias toward more auditory hallucinatory reports in high scorers in schizotypy, and particularly to those of an abstract type.

The prevalence of posttraumatic stress disorder (PTSD) was evaluated in 91 participants attending a community-based substance abuse program. The participants were classified as having PTSD, possible PTSD, or no PTSD using the modified PTSD symptom scale (MPSS; Falsetti, Resnick, H. S., Resnick, P. A. & Kilpatrick, 1993). These groups were then compared on measures of anxiety, depression, and fear using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Sensitivity Index (ASI), and the Fear Questionnaire (FQ). The results showed that 52.8% of participants had either PTSD (37.4%) or possible PTSD (15.4%). Findings also showed that those with PTSD experienced more potentially traumatic events (e.g., rape, being beaten-up) compared to the possible PTSD and no PTSD participants. The PTSD group also reported significantly greater scores on the ASI, BAI, and BDI than did the no PTSD group, and greater scores on the ASI and BAI than did the possible PTSD group. Further, when using a discriminant function analysis, self-report measures correctly classified 70% of the PTSD group and 80% of a composite group of possible PTSD and no PTSD participants. Implications of these results are discussed.

This case study describes the functional assessment and treatment of aggressive and destructive behaviors in a 14-year-old male child with a history of physical abuse. Evaluation was performed in a classroom within a residential school setting. Functional assessment in forms of indirect and descriptive methods was used to generate hypotheses regarding sources of behavioral control. A treatment plan that combined multi-level differential reinforcement of other behavior (DRO) and positive reinforcement for task completion was implemented based on the outcome of functional assessment. Treatment was associated with a gradual and steady reduction in challenging behaviors with near-zero rates achieved at follow-up. This case provides an example of clinical intervention for behavior disorders commonly observed in children who have been abused physically and a hypothesis-driven model of treatment formulation.

Individuals who report to have recovered memories of childhood sexual abuse (CSA) almost by definition believe that these memories were previously inaccessible for them. We examined whether poor autobiographical memory specificity for all kinds of events (i.e., events not necessarily related to CSA) may underlie such impressions of amnesia. Thus, we examined whether people who report recovered memories of CSA (n=44) would exhibit more difficulty retrieving specific autobiographical memories compared to people who never forgot their abuse experiences (continuous memory group; n=42) and people without a history of abuse (controls; n=26). The standard Autobiographical Memory Test (AMT) was administered to these 3 groups along with measures of depression and posttraumatic stress disorder symptomatology. Controls were significantly better at retrieving specific autobiographical memories relative to individuals with continuous and recovered CSA memories, who did not differ from each other. Thus, reduced autobiographical memory specificity was not particularly pronounced in people with recovered memories of CSA. Poor autobiographical memory specificity is unlikely to explain the impression of amnesia reported by this group.

While there have been studies of the use of contingency contracting with several populations of alcohol abusers, the application of alcohol-related contracting to non-psychiatric environments and patients without primary alcohol diagnoses has not been illustrated. A behavioral contract, which included the use of a time out detoxification room, scheduled communication sessions, and a drinking checklist was employed to reduce the inappropriate drinking, verbal and physical abuse of a spinal cord injured patient during a 12-month intervention/follow-up period. The contract's features and methods for improving its effectiveness are discussed.

Although sexual dysfunction of childhood sexual abuse survivors has received considerable attention, other sexual difficulties experienced by survivors of CSA, such as sexual fantasies to cues of sexual abuse, have received less attention. In this A-B design case study, a young adult female survivor of childhood sexual abuse presented for treatment at a Midwest rape crisis center. After successful treatment of post-traumatic stress disorder, she complained of unwanted sexual fantasies to sexual abuse cues and concomitant guilt and shame. Following baseline data collection, treatment consisted of self-applied aversion therapy to unwanted sexual arousal to sexual abuse cues. Decrease in sexual arousal to these cues was concurrent with the introduction of treatment. A concomitant decrease in guilt and shame occurred while self-ratings of control increased.

Cognitive restructuring and imagery modification (CRIM) to reduce the feeling of being contaminated (FBC) was tailored to adult survivors of childhood sexual abuse (CSA) suffering from this distressing feeling. A cognitive model of maladaptive appraisal and two factor learning theory can explain the development and maintenance of the FBC. CRIM combines cognitive interventions with imagery modification in a two-session treatment. To evaluate CRIMs feasibility and efficacy, we consecutively treated 9 women suffering from chronic CSA-related posttraumatic stress disorder (PTSD) plus the FBC. Ratings regarding intensity, vividness, and uncontrollability of this feeling, and related distress as well as the Posttraumatic Diagnostic Scale (PDS) were administered prior to (t0), post (t1), and six weeks after (t2) treatment. When comparing t0 and t2 Cohen's d was large for intensity of the FBC (d = 2.23; p < .01), its vividness (d = 1.83; p < .01), uncontrollability (d = 2.79; p < .01), and the related distress (d = 2.45; p < .01), as well as for PDS scores (d = .99; p < .05). Results are limited by the lack of a control group. Data suggest that CRIM has the potential to reduce the FBC as well as PTSD symptoms after CSA.

The objective of this study was to assess the prevalence of decreasing, consistent and increasing reports of sexual and physical abuse after 12 months of long-term psychological treatment of personality disorders, to investigate demographic and clinical characteristics predictive of inconsistency of reporting abuse, and to explore whether autobiographical memory may account for this inconsistency. In 229 clinical participants with an SCID II diagnosed personality disorder, 180 (78.6%) reported the same instances of invasive sexual and/or physical abuse on a trauma questionnaire (SPAQ) at baseline and follow-up, 25 (10.9%) decreased and 24 (10.4%) increased their abuse reports. Consistency of reporting abuse did not differ between schema-focused therapy, clarification-oriented psychotherapy and treatment-as-usual. Current depressive episode (SCID-I) and decreased capacity to produce specific negative memories on the Autobiographical Memory Test were characteristic of decreasing abuse reporters, while increasing abuse reporters showed higher levels of Cluster A personality pathology (in particular schizotypal traits) on the Assessment of DSM-IV Personality Disorders (ADP-IV). These results suggest that even in treatment procedures directed at exploring someone's personal past with abuse-related imagery consistency of reporting abuse is quite stable. However, certain clinical characteristics may make some persons more likely to change their trauma reports. Moreover, reduced negative memory specificity may represent an avoidant strategy associated with no longer reporting instances of abuse.