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Behavioral Interventions (behavioral + intervention)

Distribution by Scientific Domains

Medical Sciences	57%
Psychology	32%
3 Other Domains	11%

Selected Abstracts

Searching for Responders to Acamprosate and Naltrexone in Alcoholism Treatment: Rationale and Design of the Predict Study

ALCOHOLISM, Issue 4 2009
Karl Mann
Background:, Alcoholism represents a major public health issue and treating alcohol dependent patients remains an imminent challenge. Evidence based psychotherapies and pharmacotherapies are available. However, when administered to heterogeneous populations of patients effect sizes are only modest. We present the rationale and design of a double-blind randomized trial comparing acamprosate, naltrexone, and placebo. Additionally we subtype patients on the basis of biological and psychometric measures and explore their treatment response to both acamprosate and naltrexone. According to our initial hypothesis, the "relief drinker/craver" is an endophenotype associated with glutamatergic dysfunction who responds to acamprosate. The "reward drinker/craver" is mainly associated with alterations in the dopaminergic and opioidergic system and responds to naltrexone. Methods:, The study is planned for 430 patients (2:2:1 for both drugs and placebo) over 12 weeks of medication. All receive manualized counselling to improve compliance (Medical Management) which is extended to 6 months. Subtyping is primarily done using the acoustic startle reflex, functional magnetic resonance imaging, positron emission tomography (in a subset of patients), and the Inventory of Drinking Situations. Relapsers will be re-randomized into a second study where additional psychotherapy (Cognitive Behavioral Intervention) is used in a stepped care approach. Genotyping and additional analyses such as health economy are being done as well. The study follows the assessment methods, treatments, and medications used in the U.S. based COMBINE study, which will allow for a direct comparison between this U.S. study trial and a study performed in Europe. [source]

OPRM1 Asn40Asp Predicts Response to Naltrexone Treatment: A Haplotype-Based Approach

ALCOHOLISM, Issue 3 2009
Gabor Oroszi
Background:, Individualized pharmacotherapy requires identification of genetic variants predictive of treatment response. In OPRM1, Asn40Asp has been reported to be predictive of response to naltrexone treatment. Nevertheless, the in vitro function of the polymorphism remains elusive and over 300 OPRM1 sequence variants have been identified to date. Therefore we used a haplotype-based approach to capture information of other genetic variants that might predict treatment response to naltrexone in the COMBINE Study. Methods:, 5, nuclease genotyping assays (TaqMan®) were applied for 10 SNPs. Five-locus haplotypes in 2 OPRM1 haplotype blocks were assigned to Caucasian participants. The relationship of the haplotypes to medication reflected by "good clinical outcome" was analyzed in 306 Caucasians treated without Combined Behavioral Intervention and with either naltrexone or placebo. Results:, A significant haplotype by medication interaction (p = 0.03) was found in OPRM1 block 1. Naltrexone-treated alcoholics with haplotype AGCCC, the single haplotype carrying the Asp40 allele had the highest percent of good clinical outcome. When interaction of genotypes at each of the 5 loci comprising block 1 with medication was examined, only the Asn40/Asp40 and Asp40/Asp40 genotypes were found to significantly interact with naltrexone treatment. No haplotype by medication interaction was documented in OPRM1 block 2. Conclusions:, Our haplotype-based approach confirms that the single OPRM1 locus predictive of response to naltrexone treatment is Asn40Asp in exon 1. A substantial contribution of any other OPRM1 genetic variant to interindividual variations in response to naltrexone treatment (at least in terms of good clinical outcome) is not supported by our findings. [source]

Effects of Alcoholism Typology on Response to Naltrexone in the COMBINE Study

ALCOHOLISM, Issue 1 2009
Michael P. Bogenschutz
Background:, This study investigated whether subgroups of alcohol-dependent patients responded differently to naltrexone versus placebo in the NIAAA COMBINE study. In particular, the A versus B and the Early Onset versus Late Onset typologies were examined. Relative to Type A alcoholics, Type B alcoholics are characterized by greater severity, earlier onset, stronger family history, more childhood risk factors (e.g., conduct disorder), and greater frequency of comorbid psychiatric and substance use disorders. Methods:, COMBINE study participants were categorized as Type A or Type B using k-means cluster analysis and variables from 5 domains that have been shown to replicate the original Babor typology efficiently. Early Onset was defined as alcohol dependence beginning before age 25. For the planned analyses, the sample was reduced to the 618 participants receiving naltrexone alone or placebo, either with medical management (MM) alone or with MM plus the Combined Behavioral Intervention (CBI). The a priori primary outcome was percent heavy drinking days during treatment in the groups receiving MM without CBI. Results:, Among those receiving MM without CBI, Type A alcoholics had better drinking outcomes with naltrexone than placebo, whereas medication condition did not influence outcomes significantly in the Type Bs. Age of onset was not significantly related to outcome. For those receiving CBI, no significant effects were found for either typology. Conclusions:, In this sample, the beneficial effects of opioid antagonism were limited to Type A alcoholics receiving treatment in a MM model. Future studies should investigate the relationship between clinically relevant genotypes, phenotypes such as typologies, and treatment response. More work is also needed to develop practical algorithms for phenotypic assignment. [source]

Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT zones in defining levels of severity among out-patients with alcohol dependence in the COMBINE study

ADDICTION, Issue 12 2006
Dennis M. Donovan
ABSTRACT Aims To examine among alcohol-dependent out-patient clients the concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) total score and ,zones' suggested by the World Health Organization for defining levels of severity of alcohol use problems. Design Participants were classified into AUDIT zones (AUDIT total score = 8,15, 16,19, 20,40) and compared on measures of demographics, treatment goals, alcohol consumption, alcohol-related consequences, severity of dependence, physiological dependence, tolerance, withdrawal and biomarkers of alcohol use. Setting Eleven out-patient academic clinical research centers across the United States. Participants Alcohol dependent individuals (n = 1335) entering out-patient treatment in the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) study. Measurements The AUDIT was administered as part of an initial screening. Baseline measures used for concurrent validation included the Structured Clinical Interview for Diagnostic and Statistical Manual, 4th edition (DSM-IV) Disorders, the Alcohol Dependence Scale, the Drinker Inventory of Consequences, the Obsessive-Compulsive Drinking Scale, the University of Rhode Island Change Assessment, the Thoughts about Abstinence Scale, the Form-90, %carbohydrate-deficient transferrin and gamma-glutamyl transferase. Findings Indicators of severity of dependence and alcohol-related problems increased linearly with total score and differed significantly across AUDIT zones. The highest zone, with scores of 20 and above, was markedly different with respect to severity from the other two zones and members of this group endorsed an abstinence goal more strongly. Conclusions The AUDIT total score is a brief measure that appears to provide an index of severity of dependence in a sample of alcohol-dependent individuals seeking out-patient treatment, extending its potential utility beyond its more traditional role as a screening instrument in general populations. [source]

Blood Glucose Level, Alcohol Heavy Drinking, and Alcohol Craving During Treatment for Alcohol Dependence: Results From the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study

ALCOHOLISM, Issue 9 2009
Lorenzo Leggio
Background:, Heavy drinking may increase blood glucose levels. Moreover, in alcohol-dependent subjects, glucose may play a putative role in alcohol preference. Methods:, This study investigated the relationship between blood glucose levels and both alcohol heavy drinking and craving in alcohol-dependent subjects participating in the COMBINE Study. The primary objective was to evaluate the relationship between baseline (pretreatment) glucose levels and percentage of heavy drinking day (PHDD) during treatment. The secondary objective was to evaluate the relationship between glucose levels, baseline PHDD, and craving measured by the Obsessive Compulsive Drinking Scale (OCDS). Results:, This analysis consisted of 1,324 participants. Baseline glucose levels were significantly and positively associated with PHDD during treatment [F(1, 1225) = 5.21, p = 0.023], after controlling for baseline PHDD [F(1, 1225) = 36.25, p < 0.0001], gender [F (1, 1225) = 3.33, p = 0.07], and body mass index (BMI) [F(1, 1225) = 0.31, p = 0.58]. Higher glucose levels at baseline were associated with a higher percentage of PHDD at pretreatment [F(1, 1304) = 5.96, p = 0.015], after controlling for gender [F(1, 1304) = 0.29, p = 0.59] and BMI [F(1, 1304) = 0.90, p = 0.34]. Glucose was not significantly associated with the OCDS total score [F(1, 1304) = 0.12, p = 0.73], the OCDS Obsessive subscale [F(1, 1304) = 0.35, p = 0.56], or the OCDS Compulsive subscale [F(1, 1304) = 1.19, p = 0.28] scores, after controlling for gender and BMI. Discussion:, A link between pretreatment glucose levels and heavy drinking during treatment was found, suggesting a role of glucose in predicting heavy alcohol consumption. Although caution is needed in the interpretation of these results, elevated glucose and heavy drinking may be affected by a common mechanism and manipulations affecting glucose regulation may influence alcohol consumption. [source]

Use of office discipline referrals in school-wide decision making: A practical example

PSYCHOLOGY IN THE SCHOOLS, Issue 1 2007
Sheila M. Clonan
Problem-solving approaches incorporating interventions at multiple levels have gained in popularity in recent years. One such model, Positive Behavioral Interventions and Supports (PBIS), was developed to assist schools to more effectively promote positive student behavior through a systematic and recursive approach to developing and assessing school-wide behavioral interventions. The focus of this article is on how data such as office discipline referrals (ODRs) can be used to inform decisions made by school problem-solving teams. Following a brief overview of the PBIS model, specific recommendations are offered for school psychologists related to the collection and use of ODRs for intervention design, revision, and evaluation. In addition, preliminary data from a case-study implementation are reviewed, highlighting the use of a data-based decision-making model for promoting positive student behavior. © 2007 Wiley Periodicals, Inc. Psychol Schs 44: 19,27, 2007. [source]

Behavioral intervention to promote smoking cessation and prevent weight gain: a systematic review and meta-analysis

ADDICTION, Issue 9 2009
Bonnie Spring
ABSTRACT Aims The prospect of weight gain discourages many cigarette smokers from quitting. Practice guidelines offer varied advice about managing weight gain after quitting smoking, but no systematic review and meta-analysis have been available. We reviewed evidence to determine whether behavioral weight control intervention compromises smoking cessation attempts, and if it offers an effective way to reduce post-cessation weight gain. Methods We identified randomized controlled trials (RCTs) that compared combined smoking treatment and behavioral weight control to smoking treatment alone for adult smokers. English-language studies were identified through searches of PubMed, Ovid MEDLINE, CINAHL, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials. Of 779 articles identified and 35 potentially relevant RCTs screened, 10 met the criteria and were included in the meta-analysis. Results Patients who received both smoking treatment and weight treatment showed increased abstinence [odds ratio (OR) = 1.29, 95% confidence interval (CI) = 1.01, 1.64] and reduced weight gain (g = ,0.30, 95% CI = ,0.57, ,0.02) in the short term (<3 months) compared with patients who received smoking treatment alone. Differences in abstinence (OR = 1.23, 95% CI = 0.85, 1.79) and weight control (g = ,0.17, 95% CI = ,0.42, 0.07) were no longer significant in the long term (>6 months). Conclusions Findings provide no evidence that combining smoking treatment and behavioral weight control produces any harm and significant evidence of short-term benefit for both abstinence and weight control. However, the absence of long-term enhancement of either smoking cessation or weight control by the time-limited interventions studied to date provides insufficient basis to recommend societal expenditures on weight gain prevention treatment for patients who are quitting smoking. [source]

Effect of Evidence-Based Acute Pain Management Practices on Inpatient Costs

HEALTH SERVICES RESEARCH, Issue 1 2009
John M. Brooks
Objectives. To estimate hospital cost changes associated with a behavioral intervention designed to increase the use of evidence-based acute pain management practices in an inpatient setting and to estimate the direct effect that changes in evidence-based acute pain management practices have on inpatient cost. Data Sources/Study Setting. Data from a randomized "translating research into practice" (TRIP) behavioral intervention designed to increase the use of evidence-based acute pain management practices for patients hospitalized with hip fractures. Study Design. Experimental design and observational "as-treated" and instrumental variable (IV) methods. Data Collection/Extraction Methods. Abstraction from medical records and Uniform Billing 1992 (UB92) discharge abstracts. Principal Findings. The TRIP intervention cost on average $17,714 to implement within a hospital but led to cost savings per inpatient stay of more than $1,500. The intervention increased the cost of nursing services, special operating rooms, and therapy services per inpatient stay, but these costs were more than offset by cost reductions within other cost categories. "As-treated" estimates of the effect of changes in evidence-based acute pain management practices on inpatient cost appear significantly underestimated, whereas IV estimates are statistically significant and are distinct from, but consistent with, estimates associated with the intervention. Conclusions. A hospital treating more that 12 patients with acute hip fractures can expect to lower overall cost by implementing the TRIP intervention. We also demonstrated the advantages of using IV methods over "as-treated" methods to assess the direct effect of practice changes on cost. [source]

Pilot Test of an Attribution Retraining Intervention to Raise Walking Levels in Sedentary Older Adults

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007
Catherine A. Sarkisian MD
OBJECTIVES: To pilot test a new behavioral intervention to increase walking in sedentary older adults. DESIGN: Pre,post community-based pilot study. SETTING: Three senior centers in greater Los Angeles. PARTICIPANTS: Forty-six sedentary adults aged 65 and older. INTERVENTION: At four weekly 1-hour group sessions held at the senior centers, a trained health educator applied a theoretically grounded, standardized "attribution retraining" curriculum developed by a multidisciplinary team of investigators. Participants were taught that becoming sedentary is not inevitable with aging and that older adults should attribute being sedentary to modifiable attributes rather than to old age. A 1-hour exercise class including strength, endurance, and flexibility training followed each weekly attribution retraining session. MEASUREMENTS: Change from baseline in steps per week recorded using a digital pedometer was measured after 7 weeks. Age expectations (measured using the Expectations Regarding Aging-38 survey, a previously tested instrument on which higher scores indicate that the participant expects high functioning with aging and lower scores indicate that the participant expects physical and mental decline) and health-related quality of life were measured using in-person interviews. RESULTS: Mean steps per week increased from 24,749 to 30,707, a 24% increase,equivalent to 2.5 miles (2-sided t -test P=.002). Age expectation scores increased 30% (P<.001), and the changes in age expectations and steps per week correlated (correlation coefficient=0.39, P=.01). Participants experienced improved mental health,related quality of life (P=.049) and reported less difficulty with activities of daily living (P=.04). More than 50% of participants reported improvements in pain, energy level, and sleep quality. CONCLUSION: In this small pre,post community-based pilot study, a structured attribution retraining curriculum accompanied by a weekly exercise class was associated with increased walking levels and improved quality of life in sedentary older adults. Attribution retraining deserves further investigation as a potential means of increasing physical activity in sedentary older adults. [source]

An Intervention to Increase Fluid Intake in Nursing Home Residents: Prompting and Preference Compliance

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2001
Sandra F. Simmons PhD
OBJECTIVE: To evaluate a three-phase, behavioral intervention to improve fluid intake in nursing home (NH) residents. DESIGN: Controlled clinical intervention trial. SETTING: Two community NHs. PARTICIPANTS: Sixty-three incontinent NH residents. INTERVENTION: Participants were randomized into intervention and control groups. The intervention consisted of three phases for a total of 32 weeks: (1) 16 weeks of four verbal prompts to drink per day, in between meals; (2) 8 weeks of eight verbal prompts per day, in between meals; and (3) 8 weeks of eight verbal prompts per day, in between meals, plus compliance with participant beverage preferences. MEASUREMENTS: Between-meal fluid intake was measured in ounces by research staff during all three phases of the intervention. Percentage of fluids consumed during meals was also estimated by research staff for a total of nine meals per participant (3 consecutive days) at baseline and at 8 and 32 weeks into the intervention. Serum osmolality, blood urea nitrogen, and creatinine values were obtained for all participants in one of the two sites at the same three time points. RESULTS: The majority (78%) of participants increased their fluid intake between meals in response to the increase in verbal prompts (phase 1 to 2). A subset of residents (21%), however, only increased their fluid intake in response to beverage preference compliance (phase 3). There was a significant reduction in the proportion of intervention participants who had laboratory values indicative of dehydration compared with the control participants. Cognitive and nutritional status were predictive of residents' responsiveness to the intervention. CONCLUSIONS: A behavioral intervention that consists of verbal prompts and beverage preference compliance was effective in increasing fluid intake among most of a sample of incontinent NH residents. Verbal prompting alone was effective in improving fluid intake in the more cognitively impaired residents, whereas preference compliance was needed to increase fluid intake among less cognitively impaired NH residents. [source]

A Group-Mediated Cognitive-Behavioral intervention for Increasing Adherence to Physical Activity in Older Adults,

JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 1 2000
Lawrence R. Brawley
This study examined the efficacy of a group-mediated cognitive behavioral intervention (GMCB) on adherence rates to physically active lifestyles in older adults. Sixty older adults were randomized to I of 3 groups: waiting list control (WLC), a standard physical activity program (SPA), or GMCB. The SPA and GMCB involved 6 months of combined center- and home-based activity. Contact with participants was then terminated with a follow-up assessment at 9 months. Results revealed that, at the 9-month follow-up the GMCB group had a higher frequency of weekly physical activity than the SPA group. At 6 months, both groups were more active, had higher aerobic power, and improved HRQL when compared with the control group. [source]

Gender Differences in Alcohol Treatment: An Analysis of Outcome From the COMBINE Study

ALCOHOLISM, Issue 10 2010
Shelly F. Greenfield
Background:, Relatively few studies have examined gender differences in the effectiveness of specific behavioral or pharmacologic treatment of alcohol dependence. The aim of this study is to assess whether there were gender differences in treatment outcomes for specific behavioral and medication treatments singly or in combination by conducting a secondary analysis of public access data from the national, multisite NIAAA-sponsored COMBINE study. Methods:, The COMBINE study investigated alcohol treatment among 8 groups of patients (378 women, 848 men) who received medical management (MM) with 16 weeks of placebo, naltrexone (100 mg/day), acamprosate (3 g/day), or their combination with or without a specialist-delivered combined behavioral intervention. We examined efficacy measures separately for men and women, followed by an overall analysis that included gender and its interaction with treatment condition in the analyses. These analyses were performed to confirm whether the findings reported in the parent trial were also relevant to women, and to more closely examine secondary outcome variables that were not analyzed previously for gender effects. Results:, Compared to men, women reported a later age of onset of alcohol dependence by approximately 3 years, were significantly less likely to have had previous alcohol treatment, and drank fewer drinks per drinking day. Otherwise, there were no baseline gender differences in drinking measures. Outcome analyses of 2 primary (percent days abstinent and time to first heavy drinking day) and 2 secondary (good clinical response and percent heavy drinking days) drinking measures yielded the same overall pattern in each gender as that observed in the parent COMBINE study report. That is, only the naltrexone by behavioral intervention interaction reached or approached significance in women as well as in men. There was a naltrexone main effect that was significant in both men and women in reduction in alcohol craving scores with naltrexone-treated subjects reporting lower craving than placebo-treated subjects. Conclusions:, This gender-focused analysis found that alcohol-dependent women responded to naltrexone with COMBINE's Medical Management, similar to the alcohol-dependent men, on a wide range of outcome measures. These results suggest that clinicians can feel comfortable prescribing naltrexone for alcohol dependence in both men and women. In this study, it is also notable that fewer women than men reported receiving any alcohol treatment prior to entry into the COMBINE study. Of note, women tend to go to primary health care more frequently than to specialty substance abuse programs for treatment, and so the benefit we confirm for women of the naltrexone and MM combination has practical implications for treating alcohol-dependent women. [source]

Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients: Design and Implementation

ALCOHOLISM, Issue 2 2010
Shelly F. Greenfield
Background:, While the integration of alcohol screening, treatment, and referral in primary care and other medical settings in the U.S. and worldwide has been recognized as a key health care priority, it is not routinely done. In spite of the high co-occurrence and excess mortality associated with alcohol use disorders (AUDs) among individuals with tuberculosis (TB), there are no studies evaluating effectiveness of integrating alcohol care into routine treatment for this disorder. Methods:, We designed and implemented a randomized controlled trial (RCT) to determine the effectiveness of integrating pharmacotherapy and behavioral treatments for AUDs into routine medical care for TB in the Tomsk Oblast Tuberculosis Service (TOTBS) in Tomsk, Russia. Eligible patients are diagnosed with alcohol abuse or dependence, are newly diagnosed with TB, and initiating treatment in the TOTBS with Directly Observed Therapy-Short Course (DOTS) for TB. Utilizing a factorial design, the Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients (IMPACT) study randomizes eligible patients who sign informed consent into 1 of 4 study arms: (1) Oral Naltrexone + Brief Behavioral Compliance Enhancement Therapy (BBCET) + treatment as usual (TAU), (2) Brief Counseling Intervention (BCI) + TAU, (3) Naltrexone + BBCET + BCI + TAU, or (4) TAU alone. Results:, Utilizing an iterative, collaborative approach, a multi-disciplinary U.S. and Russian team has implemented a model of alcohol management that is culturally appropriate to the patient and TB physician community in Russia. Implementation to date has achieved the integration of routine alcohol screening into TB care in Tomsk; an ethnographic assessment of knowledge, attitudes, and practices of AUD management among TB physicians in Tomsk; translation and cultural adaptation of the BCI to Russia and the TB setting; and training and certification of TB physicians to deliver oral naltrexone and brief counseling interventions for alcohol abuse and dependence as part of routine TB care. The study is successfully enrolling eligible subjects in the RCT to evaluate the relationship of integrating effective pharmacotherapy and brief behavioral intervention on TB and alcohol outcomes, as well as reduction in HIV risk behaviors. Conclusions:, The IMPACT study utilizes an innovative approach to adapt 2 effective therapies for treatment of alcohol use disorders to the TB clinical services setting in the Tomsk Oblast, Siberia, Russia, and to train TB physicians to deliver state of the art alcohol pharmacotherapy and behavioral treatments as an integrated part of routine TB care. The proposed treatment strategy could be applied elsewhere in Russia and in other settings where TB control is jeopardized by AUDs. If demonstrated to be effective, this model of integrating alcohol interventions into routine TB care has the potential for expanded applicability to other chronic co-occurring infectious and other medical conditions seen in medical care settings. [source]

The Search for Mechanisms of Behavior Change in Evidence-Based Behavioral Treatments for Alcohol Use Disorders: Overview

ALCOHOLISM, Issue 2007
Robert B. Huebner
Background:, Over the past three decades, the main question of interest to alcohol treatment researchers has concerned the main effects of a particular behavioral intervention or what works. Increasingly, alcohol treatment researchers are turning their attention to the underlying psychological, social, and even neurophysiologic processes or "active ingredients" that are driving therapeutic change. Method:, The articles contained in this supplement to Alcoholism: Clinical and Experimental Research grew out of invited presentations given at a one-day satellite session immediately preceding the 28th Annual Meeting of the Research Society on Alcoholism (RSA). The conference was a collaborative effort of the Center on Alcoholism, Substance Abuse, and Addiction at the University of New Mexico, the Center on Addiction and Substance Abuse at Columbia University, Brown University, and the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health. Results:, The conference featured a mix of full-length presentations on conceptual and methodological issues, reports of original research findings, and lively discussion among speakers and conference participants. Understanding mechanisms of behavior change will benefit the field by identifying the key aspects of therapy that must be present for maximum effect, irrespective of the specific technique being applied; provide a new way to approach patient,treatment interactions; and lay the groundwork for understanding how change is affected by social and other extratreatment factors. Conclusions:, Although not a new topic to the field, understanding mechanisms of behavior change has begun to capture the interest of an increasing number of alcohol treatment researchers. Understanding behavior change is an exceedingly complex enterprise and innovative thinking and creative research designs will be required to advance the field. [source]

A 1.5-year follow-up of an internet-based intervention for complicated grief

JOURNAL OF TRAUMATIC STRESS, Issue 4 2007
Birgit Wagner
Only recently have psychotherapeutic interventions for complicated grief been developed and evaluated in randomized controlled trials. These trials have reported significant reductions in complicated grief and related symptoms in response to treatment relative to control groups. However, little is known about the long-term outcomes of these treatments. The authors present an evaluation of a 1.5-year follow-up of an Internet-based cognitive,behavioral intervention for complicated grief. Treatment group patients (n = 22) were administered various assessments of complicated grief indicators, including the Impact of Event Scale, the anxiety and depression subscales of the Brief Symptom Inventory, and the SF-12. Results indicate that the reduction in symptoms of complicated grief observed at posttreatment was maintained at 1.5-year follow-up. [source]

Effects of DRL and DRL combined with response cost on perseverative verbal behavior of an adult with mental retardation and obsessive compulsive disorder

BEHAVIORAL INTERVENTIONS, Issue 1 2001
George Kostinas
Although there has been increased interest in the identification and diagnosis of obsessive compulsive disorder (OCD) in people who have developmental disabilities, clinical research has been reported infrequently. The present single-case study evaluated the effects from systematic behavioral intervention with a 26-year-old man who had moderate mental retardation, OCD, and exhibited perseverative verbalizations. Verbalizations were reduced when the man gained access to preferred activities contingent upon a low response frequency (DRL: differential reinforcement of low-rate responding). The behavior was reduced further when a DRL contingency was implemented in the form of a response cost procedure. The implications of these findings for the treatment of OCD in people with developmental disabilities are discussed. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Dental fear in adults: a meta-analysis of behavioral interventions

COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 4 2004
Gerd Kvale
Abstract , Objectives:, The aim of this meta-analytic and systematic quantitative approach is to examine the effects of behavioral interventions for dental anxiety and dental phobia. Methods:, Eighty studies were identified where dental fear treatment with behavioral methods was evaluated. Thirty-eight of 80 met entry criteria and were included in a meta-analysis. Results:, The calculated effect sizes (ESs) for self-reported anxiety after intervention indicate positive changes in 36 of the 38 studies and no changes in two. The overall ES = 1.8 (95% CI: 1.6, 1.8). The percent of subjects with post-treatment dental visits in the first 6 months post-treatment varied between 50 and 100%. The overall ES for attendance at dental visits, weighted by sample size, is 1.4 (95% CI: 1.3, 1.6). The homogeneity analysis indicates that the studies cannot be adequately described in one ES. The reported percentage of subjects with a dental visit between 6 months and 4 years post-treatment varied from 48 to 100%. The overall weighted ES for visiting the dentist, adjusted for drop-outs in the studies, is 1.2 (95% CI: 0.99, 1.4). Conclusions:, Despite extensive heterogeneity, changes in self-reported anxiety represent medium to large ESs. Patients signing up for a behavioral intervention for dental fear can be expected to report a significant reduction in their fear, and this effect generally seems to be lasting. Mean long-term attendance (>4 years after treatment) is 77%. [source]

The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review

ADDICTION, Issue 12 2001
Chris Dunn
Aims. To examine the effectiveness of brief behavioral interventions adapting the principles and techniques of Motivational Interviewing (MI) to four behavioral domains: substance abuse, smoking, HIV risk and diet/exercise. Design. We conducted a systematic review of 29 randomized trials of MI interventions. Data on methodological quality were extracted and tabulated. Between-group behavior change effect sizes and confidence intervals were calculated for each study. Findings. Due to varying intervention time lengths, targeted problem behaviors, settings and interventionists' backgrounds and skill levels, outcomes were not combined meta-analytically. Sixty per cent of the 29 studies yielded at least one significant behavior change effect size. No significant association between length of follow-up time and magnitude of effect sizes was found across studies. There was substantial evidence that MI is an effective substance abuse intervention method when used by clinicians who are non-specialists in substance abuse treatment, particularly when enhancing entry to and engagement in more intensive substance abuse treatment treatment-as-usual. Data were inadequate to judge the effect of MI in the other domains. Client attribute-treatment interactions were understudied and the sparse and inconsistent findings revealed little about the mechanism by which MI works or for whom it works best. Conclusion. To determine more effectively how well MI works in domains other than substance abuse and for whom it works best in all domains, researchers should study MI with risk behaviors other than substance abuse, while examining both interactions and the theoretical components of MI. [source]

Behavioral Facilitation of Medical Treatment for Headache,Part II: Theoretical Models and Behavioral Strategies for Improving Adherence

HEADACHE, Issue 9 2006
Jeanetta C. Rains PhD
This is the second of 2 articles addressing the problem of noncompliance in medical practice and, more specifically, compliance with headache treatment. The companion paper describes the problem of noncompliance in medical practice and reviews literature addressing compliance in headache care (Behavioral Facilitation of Medical Treatment for Headache,Part I: Review of Headache Treatment Compliance). The present paper first summarizes relevant health behavior theory to help account for the myriad biopsychosocial determinants of adherence, as well as patient's shifting responsiveness or "readiness for change" over time. Appreciation of health behavior models may assist in optimally tailoring interventions to patient needs through instructional, motivational, and behavioral treatment strategies. A wide range of specific cognitive and behavioral compliance-enhancing interventions are described, which may facilitate treatment adherence among headache patients. Strategies address patient education, patient/provider interaction, dosing regimens, psychiatric comorbidities, self-efficacy enhancement, and other behavioral interventions. [source]

Preventive HIV Vaccine Acceptability and Behavioral Risk Compensation among a Random Sample of High-Risk Adults in Los Angeles (LA VOICES)

HEALTH SERVICES RESEARCH, Issue 6 2009
Peter A. Newman
Objective. To assess HIV vaccine acceptability among high-risk adults in Los Angeles. Study Setting. Sexually transmitted disease clinics, needle/syringe exchange programs, Latino community health/HIV prevention programs. Study Design. Cross-sectional survey using conjoint analysis. Participants were randomly selected using three-stage probability sampling. Data Collection. Sixty-minute structured interviews. Participants rated acceptability of eight hypothetical vaccines, each with seven dichotomous attributes, and reported post-vaccination risk behavior intentions. Principal Findings. Participants (n=1164; 55.7 percent male, 82.4 percent ethnic minority, mean age=37.4 years) rated HIV vaccine acceptability from 28.4 to 88.6; mean=54.5 (SD=18.8; 100-point scale). Efficacy had the greatest impact on acceptability, followed by side effects and out-of-pocket cost. Ten percent would decrease condom use after vaccination. Conclusions. Findings support development of social marketing interventions to increase acceptability of "partial efficacy" vaccines, behavioral interventions to mitigate risk compensation, and targeted cost subsidies. [source]

Meta-analysis of the effectiveness of psychological and pharmacological treatments for binge eating disorder

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 3 2010
Silja Vocks PhD
Abstract Objective: The aim of this study was to compute and compare mean effects of various treatments for binge eating disorder. Method: A total of 38 studies with 1973 participants fulfilled the defined inclusion criteria. Effect sizes, odds ratios, and simple rates were integrated in fixed and random (mixed) effects categorical models. Results: From randomized controlled trials, psychotherapy and structured self-help, both based on cognitive behavioral interventions, were found to have large effects on the reduction of binge eating. Regarding pharmacotherapy, mainly comprising antidepressants, randomized controlled trials revealed medium effects for the reduction of binge eating. Uncontrolled studies on weight-loss treatments demonstrated moderate reductions of binge eating. Combination treatments did not result in higher effects compared with single-treatment regimens. Except for weight-loss treatment, none of the interventions resulted in a considerable weight reduction. Discussion: Psychotherapy and structured self-help, both based on cognitive-behavioral interventions, should be recommended as the first-line treatments. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [source]

Anorexia nervosa treatment: A systematic review of randomized controlled trials,

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2007
Cynthia M. Bulik PhD
Abstract Objective: The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on efficacy of treatment for anorexia nervosa (AN), harms associated with treatments, factors associated with treatment efficacy, and differential outcome by sociodemographic characteristics. Method: We searched six major databases for studies on the treatment of AN from 1980 to September 2005, in all languages against a priori inclusion/exclusion criteria focusing on eating, psychiatric or psychological, or biomarker outcomes. Results: Thirty-two treatment studies involved only medications, only behavioral interventions, and medication plus behavioral interventions for adults or adolescents. The literature on medication treatments and behavioral treatments for adults with AN is sparse and inconclusive. Cognitive behavioral therapy may reduce relapse risk for adults with AN after weight restoration, although its efficacy in the underweight state remains unknown. Variants of family therapy are efficacious in adolescents, but not in adults. Conclusion: Evidence for AN treatment is weak; evidence for treatment-related harms and factors associated with efficacy of treatment are weak; and evidence for differential outcome by sociodemographic factors is nonexistent. Attention to sample size and statistical power, standardization of outcome measures, retention of patients in clinical trials, and developmental differences in treatment appropriateness and outcome is required. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source]

Cognitive,behavior therapy for PTSD in rape survivors

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2002
Lisa H. Jaycox
In recent years, new data have appeared, further suggesting the utility of cognitive,behavioral interventions for posttraumatic stress disorder (PTSD) subsequent to sexual assault. In this article, we present a model of cognitive,behavioral treatment (CBT) for PTSD in rape survivors. Emotional-processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A CBT-based therapy (Prolonged Exposure) is presented that entails education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring. Current research regarding the use of prolonged exposure is discussed. The case example of a young female rape survivor is described in detail, and her prior substance dependence and intense shame are highlighted. The therapy was successful in reducing the client's symptoms of PTSD, as well as her depressive symptoms, and these gains were maintained at a one-year follow-up assessment. © 2002 Wiley Periodicals, Inc. J Clin Psychol/In Session 58: 891,906, 2002. [source]

A Consumer-Driven Approach to Increase Suggestive Selling

PERFORMANCE IMPROVEMENT QUARTERLY, Issue 1 2003
Don Rohn
ABSTRACT Several research articles have been published demonstrating the effectiveness of behavioral interventions in improving suggestive selling behavior of sales staff (e.g., Johnson & Masotti, 1990; Martinko, White, & Hassell, 1989; Mirman, 1982; Ralis & O'Brien, 1986). Procedures employed in these studies made use of two classes of personnel to implement the intervention: (1) personnel internal to the organization or (2) external consultants. The current study examined the efficacy of a consumer-driven approach to improve suggestive selling behavior of three employees of a fast food franchise. Customers delivered either a verbal prompt or praise to an employee after they had placed their order. Delivery of a prompt or praise depended on whether or not the employee made a suggestion for an additional food purchase. This consumer-driven intervention increased suggestive selling behaviors of all three employees, and was associated with higher suggestive sales in each case. [source]

Use of Commercial Sex Workers Among Hispanic Migrants In North Carolina: Implications for the Spread of HIV

PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 4 2004
Emilio A. Parrado
CONTEXT: Rates of HIV and AIDS have risen among U.S. Hispanics and in migrant-sending regions of Mexico and Central America, pointing to a link between migration and HIV. However, little is known about male migrants' sexual risk behaviors, such as the use of commercial sex workers. METHODS: The prevalence and frequency of commercial sex worker use was examined among 442 randomly selected Hispanic migrants in Durham, North Carolina. Logistic and Poisson regression techniques were used to model predictors of commercial sex worker use, and descriptive data on condom use with commercial sex workers were examined. RESULTS: Twenty-eight percent of respondents reported using the services of a commercial sex worker during the previous year; rates reached 46% among single men and 40% among married men living apart from their wives. Men with spouses in Durham were less likely than other men to use commercial sex workers (odds ratio, 0.1). Among men who used commercial sex workers, the frequency of visits declined with greater education (incidence rate ratio, 0.9) and increased with hourly wage (1.1). Frequency and use declined with years of residence, although the results were of borderline significance. Reported rates of condom use with commercial sex workers were high, but were likely to fall if familiarity with a commercial sex worker increased. CONCLUSIONS: Commercial sex workers represent an important potential source of HIV infection. Educational and behavioral interventions that take into account social context and target the most vulnerable migrants are needed to help migrants and their partners avoid HIV infection. [source]

St John's Wort treating patients with autistic disorder

PHYTOTHERAPY RESEARCH, Issue 11 2009
Helmut Niederhofer
Abstract Problems of eye contact and expressive language limit the effectiveness of educational and behavioral interventions in patients suffering from pervasive developmental disorders. For that reason, additive psychopharmacological interventions are sometimes needed to improve symptomatology. In our preliminary open trial, three male patients with autistic disorder, diagnosed by ICD-10 criteria, completed an open trial of St John's Wort. Subjects were included in the study if their eye contact and expressive language was inadaequate for their developmental level and if they had not tolerated or responded to other psychopharmacologic treatments (methylphenidate, clonidine or desipramine). Parent and mentor ratings on the Aberrant Behavior Checklist, irritability, stereotypy, and inappropriate speech factors improved slightly during treatment with St John's Wort. Clinician ratings (Psychiatric Rating Scale Autism, Anger and Speech Deviance factors; Global Assessment Scale; Clinical Global Impressions efficacy) did not improve significantly. St John's Wort was only modestly effective in the short-term treatment of irritability in some patients with autistic disorder. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Recent advances in the neurobiology of anxiety disorders: Implications for novel therapeutics,

AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 2 2008
Sanjay J. Mathew
Abstract Anxiety disorders are a highly prevalent and disabling class of psychiatric disorders. This review focuses on new directions in neurobiological research and implications for the development of novel psychopharmacological treatments. Neuroanatomical and neuroimaging research in anxiety disorders has centered on the role of the amygdala, reciprocal connections between the amygdala and the prefrontal cortex, and, most recently, alterations in interoceptive processing by the anterior insula. Anxiety disorders are characterized by alterations in a diverse range of neurochemical systems, suggesting ample novel targets for drug therapies. Corticotropin-releasing factor (CRF) concentrations are elevated in a subset of anxiety disorders, which suggests the potential utility of CRF receptor antagonists. Pharmacological blockade of the memory-enhancing effects of stress hormones such as glucocorticoids and noradrenaline holds promise as a preventative approach for trauma-related anxiety. The glutamatergic system has been largely overlooked as a potential pharmacological target, although convergent preclinical, neuroimaging, and early clinical findings suggest that glutamate receptor antagonists may have potent anxiolytic effects. Glutamatergic receptor agonists (e.g., D -cycloserine) also have an emerging role in the treatment of anxiety as facilitators of fear extinction during concurrent behavioral interventions. The neuropeptides substance P, neuropeptide Y, oxytocin, orexin, and galanin are each implicated in anxiety pathways, and neuropeptide analogs or antagonists show early promise as anxiolytics in preclinical and/or clinical research. Each of these active areas of research holds promise for expanding and improving evidence-based treatment options for individuals suffering with clinical anxiety. © 2008 Wiley-Liss, Inc. [source]

Use of office discipline referrals in school-wide decision making: A practical example

Evidence-based cancer care and prevention: behavioral interventions.

PSYCHO-ONCOLOGY, Issue 7 2004
Springer Publishing Company.
No abstract is available for this article. [source]

High-Dose Naltrexone Therapy for Cocaine-Alcohol Dependence

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 5 2009
Joy M. Schmitz PhD
This randomized, double-blind, placebo-controlled study compared the effects of high-dose (100 mg/d) naltrexone versus placebo in a sample of 87 randomized subjects with both cocaine and alcohol dependence. Medication conditions were crossed with two behavioral therapy platforms that examined whether adding contingency management (CM) that targeted cocaine abstinence would enhance naltrexone effects compared to cognitive behavioral therapy (CBT) without CM. Primary outcome measures for cocaine (urine screens) and alcohol use (timeline followback) were collected thrice-weekly during 12 weeks of treatment. Retention in treatment and medication compliance rates were low. Rates of cocaine use and drinks per day did not differ between treatment groups; however naltrexone did reduce frequency of heavy drinking days, as did CBT without CM. Notably, adding CM to CBT did not enhance treatment outcomes. These weak findings suggest that pharmacological and behavioral interventions that have shown efficacy in the treatment of a single drug dependence disorder may not provide the coverage needed when targeting dual drug dependence. [source]