Biomedical subjects

D L Chambless

Publications and source records attributed to D L Chambless.

At least 19 recordsLinked to original sources

PubMed1998

Behavioral treatment of obsessive-compulsive disorder in African Americans: clinical issues.

African Americans with obessive-compulsive disorder are underrepresented in behavioral treatment outcome studies. This paper consists of a clinical discussion of issues arising during the treatment with exposure plus response prevention of two African-American women with obessive-compulsive disorder. Clinical issues, such as excessive shame, insanity fears, and a sense of uniqueness, complicated the treatment process. However, both clients made significant improvement as assessed by behavioral testing, target ratings and the Yale-Brown Obsessive-Compulsive Scale.

Adult↗

PubMed1998

Are emotions frightening? II: An analogue study of fear of emotion, interpersonal conflict, and panic onset.

Two studies with college students were conducted to further explore the reliability and construct validity of fear of emotion, as assessed by the Affective Control Scale (ACS), a measure of fear of anxiety, depressed mood, anger, and strong positive emotion. The ACS fared well in tests of internal consistency and of convergent and divergent validity. In an analogue study of panic onset with college students with no history of panic, the predictive and incremental validity of the ACS was demonstrated: the ACS predicted students' fear of induced panic-like bodily sensations even once trait and state anxiety were statistically controlled. A second aspect of the investigation was an analogue test of the hypothesis that stress from interpersonal conflict (induced via remembrance of conflictual interactions with an important person) would moderate the ACS's effects on anxiety and fear of induced bodily sensations. This hypothesis was not confirmed.

Adolescent↗

PubMed1998

Behavioral assessment of social performance: a rating system for social phobia.

The Social Performance Rating Scale (SPRS) is a modification of the rating system for behavioral assessment of social skills, originally developed by Trower, P., Bryant, B., & Argyle, M. (1978). Social skills and mental health. Pittsburgh: University of Pittsburgh Press) and subsequently adapted by Turner and colleagues (e.g., Turner, S.M., Beidel, D.C., Dancu, C.V., & Keys, D.J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology, 95, 389-394). Designed to yield ratings of social performance appropriate for use in a socially phobic population and based on videotaped role plays, the five SPRS ratings are gaze, vocal quality, speech length, discomfort, and conversation flow. The sum of these ratings provides an internally consistent total score. In an initial study of the psychometric properties of the SPRS, three groups were assessed: individuals with social phobia, another anxiety disorder, or no psychological disorder. Inter-rater reliability for individual items and the total score proved excellent, and positive evidence for convergent, divergent, and criterion-related validity was obtained.

Adult↗

PubMed1998

Defining empirically supported therapies.

A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious. The importance of independent replication before a treatment is established in efficacy is emphasized, and a number of factors are elaborated that should be weighed in evaluating whether studies supporting a treatment's efficacy are sound. It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research.

Cost-Benefit Analysis↗

PubMed1998

Validity of the Perceived Criticism Measure in an undergraduate sample.

The concurrent and predictive validity of the Perceived Criticism Measure's Criticism and Upset subscales was assessed for undergraduates, 21 men and 98 women. Participants were asked to identify five people important to them at present (typically these were parents as well as peers) and, for each, to rate how critical that person was as well as how upsetting they found that criticism to be. Scores on Upset exhibited convergent validity with another self-report measure of general sensitivity to criticism, whereas those on Criticism did not. Neither measure predicted higher ratings of criticism in a specific interaction with a mildly critical peer. Divergent validity with scores on a measure of depression was supported for Upset but was less clear for Criticism. Strong evidence of predictive validity for Criticism and Upset was obtained. Ratings for both Peer scales predicted increased negative affect after mild criticism from a peer, although this interaction took place 4 to 10 weeks after administration of the Perceived Criticism Measure.

Adolescent↗

PubMed1997

Measurement of panic disorder by a modified panic diary.

The psychometric characteristics of panic diary measures were investigated in a sample of 37 patients suffering from panic disorder with agoraphobia. Following recommendations made in the recent consensus development conference on the assessment of panic disorder, daily ratings included not only the occurrence of panic attacks but also fear of panic, expectancy of panic, and expected aversiveness of panic. These new measures were reliable and, on the whole, demonstrated good divergent and convergent validity. Further, adding such measures increased the incremental validity of panic disorder assessment.

Adult↗

PubMed1997

Convergent and divergent validity of the Beck Anxiety Inventory for patients with panic disorder and agoraphobia.

Psychometric properties of the Beck Anxiety Inventory (BAI) (Beck and Steer, 1990) were investigated in a sample of 82 patients suffering from panic disorder with agoraphobia. Before and after brief treatment, patients completed a battery of questionnaires and, for 2-week periods, kept a daily panic diary in which they recorded panic attacks, fear of panic, and average anxiety. The BAI demonstrated excellent internal consistency and good test-retest reliability over a 5-week interval. A partial multitrait, multimethod correlation matrix provided evidence of convergent validity with other measures of anxiety and of divergent validity vis á vis measures of depression. Factor analyses of pretest scores and residual gain scores used to address criticism that the BAI is excessively panic-centric yielded mixed results. In one analysis, the BAI was loaded with multimethod measures of panic and anxiety and, in the other, with questionnaire methods of assessing anxiety and depression. However, the BAI was clearly distinguished from measures of fear of fear, a central construct in panic disorder, and agoraphobic avoidance. Finally, the BAI proved sensitive to change with treatment, yielding effect sizes for improvement comparable to those of other anxiety measures.

Adult↗

PubMed1997

Self-focused attention in the treatment of social phobia.

For those with social phobia self-focused attention has been linked with impairment in social performance increased social anxiety, and a higher frequency of self-critical thoughts during social situations. The purpose of this investigation was to assess correlates of changes in situational self-focus over the course of cognitive-behavioral treatment (CBT). Focus of attention was assessed after in-session role-plays and after in vivo homework assignments during group CBT for social phobia. Analyses revealed a significant decrease in self-focused attention over time; focus on events and stimuli outside of the self remained unchanged. Treatment gains on anxiety during dyadic interactions, on negative self-judgments, and on personalized social fears were related to reduction in self-focused attention. Those with public speaking phobias showed a strong relationship between decreased self-focus and speech anxiety. These findings suggest that changes in self-focused attention during the course of CBT are related to important therapeutic gains Specific interventions aimed at decreasing self-focus may be a useful treatment strategy.

Adult↗

PubMed1997

Are emotions frightening? An extension of the fear of fear construct.

Proposed in this paper is an expansion of the concept of fear of fear to include fear of other emotions (anger, depression, and positive emotions). In Study 1, initial evidence of the reliability and validity of a questionnaire designed to measure this construct, the Affective Control Scale, is provided. In Study 2, an analogue experiment of susceptibility to panic disorder was conducted. The ability of fear of anger, depression, and positive emotions to predict fear of laboratory-induced bodily sensations in a population with no history of panic attacks was demonstrated.

Adult↗

PubMed1996

Behavioral avoidance test for obsessive compulsive disorder.

Few treatment outcome studies of Obsessive Compulsive Disorder (OCD) have employed Behavioral Avoidance Tests (BATs) to assess changes in symptomatology, probably because of the difficulty of constructing such tests for a disorder which has widely varying symptoms. The few studies that have examined the psychometric properties of BATs for OCD have found mixed evidence for validity but good treatment sensitivity. The present study presents psychometric findings for a multi-step/multi-task BAT that assessed percentage of steps completed, subjective anxiety, global avoidance, and rituals. This measure was used with 50 clients diagnosed with OCD whose symptoms varied widely. The BAT demonstrated good convergent and divergent validity, as well as treatment sensitivity according to effect size calculations. A composite score combining steps, anxiety level, avoidance and rituals also performed well in psychometric tests. Strategies to reduce the complexity of scoring are presented, along with examples of several BAT tasks to enable researchers to employ this behavioral measure.

Adolescent↗

PubMed1995

Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia.

The relationship between adherence to group cognitive-behavioral treatment instructions and outcome was examined for 52 social phobic clients. Less symptomatic clients were no more likely to adhere to treatment instructions than more highly symptomatic clients. Clients were less likely to participate during group treatment sessions if they were higher on avoidant personality traits, and were less likely to complete self-directed exposures if they were more paranoid. Dependent clients tended to complete homework assignments more than less dependant clients. With one exception, adherence to treatment instructions for between session homework was not related to any of the outcome measures at the completion of treatment. However, at the 6-month follow-up, clients who adhered more to homework instructions reported less anxiety during the speech, and also tended to report greater decrements in anxiety and larger changes in their avoidant behavior. These data suggest that homework may be more important in the long-run, when the therapist is no longer present to prompt exposure.

Adult↗

PubMed1995

Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale.

The reliability and validity of the Yale-Brown Obsessive-Compulsive Scale were examined according to a multi-trait multi-method approach in a sample of 54 outpatients with obsessive-compulsive disorder (OCD). Internal consistency was acceptable but was improved by deletion of items concerning resistance to obsessions and compulsions. Inter-rater reliability was excellent, but test-retest reliability over an average interval of 48.5 days was lower than desirable. The YBOCS demonstrated good convergent validity with most other measures of OCD, but divergent validity vis à vis depression was poor. Analyses of new items assessing avoidance and the duration of obsession-free and compulsion-free intervals indicated that only the avoidance rating added meaningfully to the full scale score. In future research the authors recommend deletion of the resistance items and inclusion of the avoidance item to yield a revised 9-item YBOCS total score.

Adult↗

PubMed1995

The usefulness of the Obsessive Compulsive Scale of the Symptom Checklist-90-Revised.

The reliability and validity of the SCL-90-R Obsessive Compulsive Scale were examined using a multi-trait multi-method approach in a sample of 54 outpatients with obsessive-compulsive disorder (OCD). The OC scale proved to be internally consistent. Evidence for convergent validity was mixed, and the results suggest poor divergent and criterion-related validities. The scale demonstrated sensitivity to changes with behavioral treatment. Overall, the SCL-90-R proved to be a poor measure of OCD symptoms.

Adult↗

PubMed1993

Memory in sub-clinical obsessive-compulsive checkers.

In a series of experiments we extended the research on possible memory deficits in subclinical obsessive-compulsive Ss who reported excessive checking. Using a variety of memory tests we compared 20 subclinical checkers to 20 Ss without obsessive-compulsive symptomatology. Contrary to hypothesis, checkers remembered self-generated words better than read words just as much as did normals, but they were more likely than normals to report thinking they had studied words that, in fact, had not been on the study list. Further, they more often confused whether they read or generated the words at study. Checkers did not appear to perseverate on already-recalled words on repeated free recall tests any more than did normals. However, checkers remembered fewer actions overall and more often misremembered whether they had performed, observed, or written these actions. Such memory deficits may contribute to the development of excessive checking.

Adult↗

PubMed1993

Compliance during sessions and homework in exposure-based treatment of agoraphobia.

The relationship between compliance with cognitive-behavioral treatment instructions and outcome was examined for 56 agoraphobic clients treated with in vivo exposure and training in anxiety management strategies. Clients who complied more often with anxiety management instructions during treatment sessions tended to improve more on a behavioral avoidance test than those who were less compliant, but did not differ on three other outcome variables. Compliance with instructions for self-directed exposure between sessions was examined in a subset of 28 of these Ss. Clients who spent more time doing homework reported significantly greater decrements in fear of fear than less compliant clients and also tended to report larger changes on avoidance behavior. However, a quasi-experimental comparison of homework vs no-homework treatment protocols yielded no difference in outcome. Less compliant clients were more symptomatic pretreatment and rated their therapists as less caring and less self-confident.

Adult↗

PubMed1993

Cognitive therapy of anxiety disorders.

A review of studies of cognitive-behavioral therapy (CBT) for generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia indicates that CBT is consistently more effective than waiting-list and placebo control groups. In general, CBT has proved more beneficial than supportive therapy as well. Comparisons with active behavioral treatments provide more variable results. Converging evidence suggests that cognitive change may be a strong predictor of treatment outcome, but that such change may be produced by a number of therapeutic approaches. Pretest-posttest change with CBT is depicted in meta-analytic summary form for each disorder.

Agoraphobia↗

PubMed1990

Is agoraphobia harder to treat? A comparison of agoraphobics' and simple phobics' response to treatment.

Agoraphobia is reputed to be more difficult to treat than simple phobia. In a test of this supposition, 38 agoraphobics and 19 simple phobics were each given 10 sessions of graduated in vivo exposure. They were assessed before and after therapy using a behavioral avoidance test, behavioral diaries, and self-report measures. Analysis of covariance revealed unequivocal posttest differences only on self-assessed disability level; agoraphobics had changed less in their report of global disability immediately following treatment but not at follow-up. Sixty-eight percent of the simple phobics showed clinically significant improvement on avoidance of the Main Phobia, compared with 34% of the agoraphobics. On three other outcome measures, including more precise behavioral measures of phobia, agoraphobics and simple phobics responded equivalently to treatment. Given clinicians' impression about the comparative difficulty in treating agoraphobic clients, fewer differences in treatment response were obtained than were expected. Several possible explanations for this discrepancy are discussed.

Adult↗

PubMed1988

Widowhood, sexuality and aging: a life span analysis.

In an attempt to evaluate how widows of various ages adapt sexually to loss of a marital partner, 100 relatively healthy, community-dwelling widows between the ages of 40 and 89 completed a reliable 101-item questionnaire which evaluated three major areas: 1) barriers to sexual expression posed by age-related changes in body image, mood state and environmental context; 2) degree of unhappiness associated with loss of various marriage-oriented activities; and 3) perceived utility of various activities which indirectly might satisfy sexual and affectional needs. Controlling for income, education, heterosocial involvement, and family contact, and using level of morale and depression as corroborative measures, results showed specific age differences across variables assessed. In particular, younger widows, when compared with their older counterparts, viewed changes in body image, the dearth of unattached men, and limited financial resources for social activities as representing significant sexual barriers. Increasing age of the widow was associated with lower unhappiness ratings with loss of marriage-related activities. For the sample as a whole, greater unhappiness was expressed with the loss of nonsexual, heterosocial activity (e.g., conversation with a man, going places with a man). Results also indicated that, regardless of the widow's age, activities pertaining to her children and grandchildren, wearing attractive clothing, and expressing her spirituality are all effective in meeting affectional and sexual needs. Results are discussed within the context of older female sexuality, affectional adaptation to widowhood, and therapeutic implications directed at this neglected group.

Adaptation, Psychological↗