Biomedical subjects

N S Jacobson

Publications and source records attributed to N S Jacobson.

At least 19 recordsLinked to original sources

PubMed2001

Understanding infidelity: correlates in a national random sample.

Infidelity is a common phenomenon in marriages but is poorly understood. The current study examined variables related to extramarital sex using data from the 1991-1996 General Social Surveys. Predictor variables were entered into a logistic regression with presence of extramarital sex as the dependent variable. Results demonstrated that divorce, education, age when first married, and 2 "opportunity" variables--respondent's income and work status--significantly affected the likelihood of having engaged in infidelity. Also, there were 3 significant interactions related to infidelity: (a) between age and gender, (b) between marital satisfaction and religious behavior, and (c) between past divorce and educational level. Implications of these findings and directions for future research are discussed.

Adult↗

PubMed2000

Can depression be de-medicalized in the 21st century: scientific revolutions, counter-revolutions and the magnetic field of normal science.

This article is about our scientific investigations of the change mechanisms in cognitive therapy (CT) for depression. In a previous clinical trial, we found that so-called 'cognitive' interventions were not necessary for the success of CT: the behavioral activation (BA) component, a treatment precluding attempts to change thinking, worked as well as the entire CT package, both in maximizing acute treatment response and in relapse prevention over a two year period. We tentatively suggested at the time of publication [Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E. T., & Prince, S. E. (1996). A component analysis of cognitive-behavioral treament for depression. Journal of Consulting and Clinical Psychology, 64, 295-304; Gortner, E. T., Gollan, J. K., Dobson, K. S., & Jacobson, N. S. (1998). Cognitive-behavioral treatment for depression: relapse prevention. Journal of Consulting and Clinical Psychology, 66, 377-384.] that the 'cognitive' components of CT may not only be unnecessary but potentially a liability, since they result in a less parsimonious treatment package that may be not be cost effective. In this article, we not only defend this contention, but counteract the skepticism expressed by some CT advocates that the quality of our CT was deficient. Finally, we describe a study designed to confirm our conclusions from the earlier trial and, in the process, reintroduce a contextual perspective on depression, one which counters the currently dominant defect models reflected in both Beck's cognitive model and in theories that emphasize biological causation.

Cognitive Behavioral Therapy↗

PubMed2000

Integrative behavioral couple therapy: an acceptance-based, promising new treatment for couple discord.

Although traditional behavioral couple therapy (TBCT) has garnered the most empirical support of any marital treatment, concerns have been raised about both its durability and clinical significance. Integrative behavioral couple therapy (IBCT) was designed to address some of these limitations by combining strategies for fostering emotional acceptance with the change-oriented strategies of TBCT. Results of a preliminary clinical trial, in which 21 couples were randomly assigned to TBCT or IBCT, indicated that therapists could keep the 2 treatments distinct, that both husbands and wives receiving IBCT evidenced greater increases in marital satisfaction than couples receiving TBCT, and that IBCT resulted in a greater percentage of couples who either improved or recovered on the basis of clinical significance data. Although preliminary, these findings suggest that IBCT is a promising new treatment for couple discord.

Adaptation, Psychological↗

PubMed2000

Testing a typology of batterers.

A. Holtzworth-Munroe and G. L. Stuart (1994) proposed a tripartite typology of men who batter their female partners based on the severity of violence, extent of violence, and personality disorder characteristics. The current study attempts to empirically validate this typology using data from 75 domestically violent (DV) men and their partners, and 32 maritally distressed, nonviolent (DNV) comparison couples. Mixture analysis results generally supported the model, although 2 types were not distinguishable on personality disorder characteristics as predicted. Generally violent batterers were significantly more violent within and outside the relationship. The pathological group was moderately violent within and outside the relationship and endorsed numerous psychological symptoms. Family-only batterers endorsed fewer symptoms and were less violent. Violence in the family of origin, attachment, and communication skills also differentiated the 3 types and DNV men.

Adult↗

PubMed1999

Clinically significant but impractical? A response to Hageman and Arrindell.

UNLABELLED: Hageman, and Arrindell [Hageman, W.J., & Arrindell, W.A. (in press). Establishing clinically significant change: increment of precision and the distinction between individual and group level of analysis. Behavior Research and Therapy.] suggest adaptations to the traditional clinical significance model originally developed by Jacobson, Follette, and Revenstorf [Jacobson, N.S., Follette, W.C., & Revenstorf, D. (1984). Toward a standard definition of clinically significant change. Behavior Therapy, 17, 308-311.]. They observe that one must distinguish between analysis at the individual and group level and based upon an alternative decision-making strategy have formulated different procedures for assessing clinically significant change that incorporate the unreliability inherent in testing measures. A comparison of the traditional method with Hageman and Arrindell's suggested approach is conducted utilizing data originally presented by Jacobson and Truax [Jacobson, N.S., & Truax, P., CLINICAL SIGNIFICANCE: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.] and implications of this comparison for the method developed by Hageman and Arrindell's method are discussed. Although this revised method has much to recommend it, it seems to yield results at the individual level that are quite similar to those derived from the traditional method. Given the complexity of the revised method, the traditional model developed by Jacobson, Follette, and Revenstorf (1984) still seems to be preferable.

Humans↗

PubMed1999

Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives.

This article summarizes and scrutinizes the growth of the development of clinically relevant and psychometrically sound approaches for determining the clinical significance of treatment effects in mental health research by tracing its evolution, by examining modifications in the method, and by discussing representative applications. Future directions for this methodology are proposed.

Clinical Trials as Topic↗

PubMed1999

Demand-withdraw interaction in couples with a violent husband.

This study examined the relationship between demand-withdraw interaction and battering in couples with a violent husband. The authors compared the interaction patterns of 47 couples with a violent husband with the interaction patterns of 28 distressed but nonviolent couples and 16 happily married nonviolent couples. All couples engaged in videotaped discussions of problem areas in their marriage. Both batterers and battered women showed less positive communication and more negative communication than did their nonviolent counterparts. Additionally, batterers showed significantly higher levels of both demanding and withdrawing than did other men. Battered women demanded more change than did women in nonviolent marriages but were significantly less inclined to withdraw than were their husbands. The discussion of these findings focuses on the interactional dynamics between batterers and battered women and how these interactions might be understood.

Adult↗

PubMed1999

Demand/withdraw interaction patterns between different types of batterers and their spouses.

The investigation of subtypes of violent men could provide invaluable information to researchers and clinicians. In earlier studies, investigators examined whether subtypes of male batterers could be identified based on physiological markers in combination with observational and self-report perspectives. In a sample of batterers and their wives, they found a physiological marker that discriminated between two groups of violent men on several interesting dimensions. To highlight the importance of studying batterer typologies, the present study examined differences in marital interaction patterns across the two groups of batterers. Analyses revealed clinically relevant patterns of interaction in the two groups, and effect sizes indicating the possibility of differences between the two types of batterers. Implications for future research as well as therapy are discussed.

Adult↗

PubMed1998

Cognitive-behavioral treatment for depression: relapse prevention.

This study presents 2-year follow-up data of a comparison between complete cognitive-behavioral therapy for depression (CT) and its 2 major components: behavioral activation and behavioral activation with automatic thought modification. Data are reported on 137 participants who were randomly assigned to 1 of these 3 treatments for up to 20 sessions with experienced cognitive-behavioral therapists. Long-term effects of the therapy were evaluated through relapse rates, number of asymptomatic or minimally symptomatic weeks, and survival times at 6-, 12-, 18-, and 24-month follow-ups. CT was no more effective than its components in preventing relapse. Both clinical and theoretical implications of these findings are discussed.

Adult↗

PubMed1998

Acceptance versus change interventions in behavioral couple therapy: impact on couples' in-session communication.

Integrative Behavioral Couple Therapy (IBCT) attempts to improve Traditional Behavioral Couple Therapy (TBCT) by incorporating an emphasis on promoting acceptance into TBCT's emphasis on behavioral change. This study examined changes in couples' communication over the course of IBCT and TBCT. Early, middle, and late sessions were coded to measure couples' communication of acceptance. Results showed that IBCT couples expressed more nonblaming descriptions of problems and more soft emotions than TBCT couples during late stages of therapy. IBCT couples significantly increased their nonblaming description of problems and significantly decreased their expressions of hard emotions and their problematic communication over time. Results support the hypothesis that structural differences between the therapies affect initial levels of emotional expression in session. Increases in nonblaming descriptions of problems were significantly correlated with increases in marital satisfaction.

Adult↗

PubMed1997

Psychological aspects of perpetrators of domestic violence and their relationships with the victims.

Domestic violence is a serious public health concern in the United States. Despite the serious and often tragically fatal consequences of spousal abuse, we have very little understanding about the root causes of domestic violence. We know even less about providing effective treatments and prevention. In this article, we have discussed some of the more promising individual difference variables that discriminate between violent and nonviolent men. We also have addressed some of the growing research on how violent couples are different from nonviolent ones. Unfortunately, methodologic limitations hamper us from being able to discuss definitive risk factors or predictive variables, but we can speak of factors associated with domestic violence. We also have discussed the importance of attending to important differences among violent men and violent couples. The complexity of battering behavior and battering relationships necessarily points researchers and clinicians toward multifaceted research designs and treatment models. The tragedy of domestic violence demands that science continues to address these crucial unanswered questions.

Affect↗

PubMed1996

Studying the effectiveness of psychotherapy. How well can clinical trials do the job?

Although there has been much discussion of the recent Consumer Reports (CR) study (1995) on the effectiveness of psychotherapy, there is little new information reported either in the CR article or in M. E. P. Seligman's (1995) discussion of the findings. The findings that are new are hard to interpret because of serious methodological problems. In fact, the CR study is similar in many ways to H. J. Eysenck's (1952) controversial report on the effectiveness of psychotherapy, a study that has been rejected by the field despite the fact that it avoided some of the methodological shortcomings of the CR study. It would be a mistake to put forth a design rejected in the 1950s as an exemplar of good effectiveness research, especially when better alternatives exist. Clinical trials, despite many limitations, can answer all of the questions regarding the effectiveness of psychotherapy posed by M. E. P. Seligman, without the interpretive ambiguities and other methodological problems inherent in surveys such as the one published in CR.

Clinical Trials as Topic↗

PubMed1996

Prospects for future comparisons between drugs and psychotherapy: lessons from the CBT-versus-pharmacotherapy exchange.

In these concluding comments to the exchange among N. S. Jacobson and S. D. Hollon (1996), D. F. Klein (1996), I. Elkin, R. D. Gibbons, M. T. Shea, and B. F. Shaw (1996), and R. J. McNally (1996) issues of continuing controversy are highlighted: the best ways to control for the allegiance effect, the complexities of assessing competence, and the role of pill placebos in comparisons between cognitive-behavior therapy (CBT) and pharmacotherapy. It is concluded that controlling for allegiance within site is the optimal strategy, that measures of competence must take context into account, and that pill placebo controls are optimal but not essential to comparisons between CBT and pharmacotherapy.

Bias↗

PubMed1996

Cognitive-behavior therapy versus pharmacotherapy: Now that the jury's returned its verdict, it's time to present the rest of the evidence.

Recent reanalyses suggest that pharmacotherapy was superior to cognitive-behavior therapy in the acute treatment of more severely depressed outpatients in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). At the same time, this finding was neither robust across sites within the TDCRP nor consistent with findings from other studies. D.F. Klein has argued that those other studies were inherently flawed because they did not include pill-placebo controls, an argument that he extended to drug-psychotherapy comparisons in the treatment of panic as well. It is agreed that the inclusion of such controls would have facilitated the interpretation of the findings, but it is not agreed that their omission rendered those studies uninterpretable. Cognitive-behavior therapy remains a viable alternative to pharmacotherapy in the treatment of depression and a particularly promising intervention in the treatment of panic disorder.

Antidepressive Agents, Tricyclic↗

PubMed1996

A component analysis of cognitive-behavioral treatment for depression.

The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.

Adult↗

PubMed1996

Reasons for depression and the process and outcome of cognitive-behavioral psychotherapies.

This study examined the relationships between clients' reasons for depression and the process and outcome of a cognitive therapy (CT) and a behavioral activation (BA) treatment for major depression. Reason giving was conceptualized as the tendency to offer multiple explanations for a problem. Different reasons for depression were also thought to match or mismatch the theoretical model underlying each treatment. Reasons for depression were assessed pretreatment with a previously developed questionnaire. Process variables including homework compliance and perceived treatment helpfulness were measured early in treatment. Results demonstrated that perceived helpfulness of the treatment was associated with positive outcomes in BA. Reason giving was associated with worse outcomes in BA. Specific reasons also predicted differential outcome in the 2 treatments. Clients who endorsed existential reasons for depression had better outcomes in CT and worse outcomes in BA. Relationship-oriented reasons were consistently associated with negative process and outcome in CT. Results are discussed in terms of the function of reason giving and the role of specific explanations for depression in treatment process and outcome.

Adult↗

PubMed1996

Psychological factors in the longitudinal course of battering: when do the couples split up? When does the abuse decrease?

The longitudinal course of battering was investigated over a 2-year time span. Forty-five batterers and their spouses were assessed with self-report, psychophysiological, and marital interaction measures. Both the stability of the relationship and of the battering were assessed. At the two-year follow-up, 62% of the couples were still married and living together, while 38% had separated or divorced. A combination of six variables, reflecting severity of husband emotional abuse, wife dissatisfaction, husband physiological arousal, and wife defending herself assertively, was 90.2% accurate in predicting separation or divorce 2 years later. Of the couples still living together at follow-up, 46% of the batterers did not reduce their levels of severe violence, while 54% did significantly decrease levels of violence. Husbands who continued to be severely violent at 2-year follow-up were more domineering, globally negative and emotionally abusive toward their wives at Time 1 than husbands who reduced their levels of violence. Even though 54% of the batterers decreased the frequency of violent acts over the 2-year period, only 7% achieved complete desistance. Moreover, husband emotional abuse did not decrease over the 2-year period, even when physical abuse did.

Adult↗

PubMed1994

Affect, verbal content, and psychophysiology in the arguments of couples with a violent husband.

The purpose of this investigation was to study the affect, psychophysiology, and violent content of arguments in couples with a violent husband. On the basis of self-reports of violent arguments, there were no wife behaviors that successfully suppressed husband violence once it began; moreover, husband violence escalated in response to nonviolent as well as violent wife behaviors, whereas wife violence escalated only in reaction to husband violence or emotional abuse. Only wives were fearful during violent and nonviolent arguments. The observational coding of nonviolent arguments in the laboratory revealed that both battering husbands and their wives (DV) were angrier than their maritally distressed but nonviolent (DNV) counterparts. As predicted, on the more provocative anger codes, only DV men differed from their DNV counterparts. However, DV wives were as verbally aggressive toward their husbands as DV husbands were toward their wives.

Adult↗