Showing papers on "Psychological intervention published in 1998"

The development of competence in favorable and unfavorable environments. Lessons from research on successful children

Abstract: The development of competence holds great interest for parents and society alike. This article considers implications from research on competence and resilience in children and adolescents for policy and interventions designed to foster better outcomes among children at risk. Foundations of competence in early development are discussed, focusing on the role of attachment relationships and self-regulation. Results from studies of competence in the domains of peer relations, conduct, school, work, and activities are highlighted. Lessons are drawn from studies of naturally occurring resilience among children at risk because of disadvantage or trauma and also from efforts to deliberately alter the course of competence through early childhood education and preventive interventions. Converging evidence suggests that the same powerful adaptive systems protect development in both favorable and unfavorable environments.

Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids

Abstract: Reviews psychosocial interventions for child and adolescent conduct problems, including oppositional defiant disorder and conduct disorder, to identify empirically supported treatments. Eighty-two controlled research studies were evaluated using the criteria developed by the Division 12 (Clinical Psychology) Task Force on Promotion and Dissemination of Psychological Procedures. The 82 studies were also examined for specific participant, treatment, and methodological characteristics to describe the treatment literature for child and adolescent conduct problems. Two interventions were identified that met the stringent criteria for well-established treatments: videotape modeling parent training program (Spaccarelli, Cotler, & Penman, 1992; Webster-Stratton, 1984, 1994) and parent-training programs based on Patterson and Gullion's (1968) manual Living With Children (Alexander & Parsons, 1973; Bernal, Klinnert, & Schultz, 1980; Wiltz & Patterson, 1974). Twenty of the 82 studies were identified as supporting the efficacy of probably efficacious treatments.

Translating Research Into Practice: The Schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations

Abstract: Beginning in 1992, the Agency for Health Care Policy and Research and the National Institute of Mental Health funded the Schizophrenia Patient Outcomes Research Team (PORT) to develop and disseminate recommendations for the treatment of schizophrenia based on existing scientific evidence. These Treatment Recommendations, presented here in final form for the first time, are based on exhaustive reviews of the treatment outcomes literature (previously published in Schizophrenia Bulletin, Vol. 21, No. 4, 1995) and focus on those treatments for which there is substantial evidence of efficacy. The recommendations address antipsychotic agents, adjunctive pharmacotherapies, electroconvulsive therapy, psychological interventions, family interventions, vocational rehabilitation, and assertive community treatment/intensive case management. Support for each recommendation is referenced to the previous PORT literature reviews, and the recommendations are rated according to the level of supporting evidence. The PORT Treatment Recommendations provide a basis for moving toward "evidence-based" practice for schizophrenia and identify both the strengths and limitations in our current knowledge base.

Investing in Our Children: What We Know and Don't Know About the Costs and Benefits of Early Childhood Interventions

Abstract: The authors find that well-targeted early intervention programs for at-risk children, such as nurse home visits to first-time mothers and high-quality pre-school education, can yield substantial advantages to participants in terms of emotional and cognitive development, education, economic well-being and health.

Antisocial Behavior and Mental Health Problems: Explanatory Factors in Childhood and Adolescence

Abstract: Epidemiological surveys have provided key information about the prevalence and degree of seriousness at different ages of a wide array of problem behaviors such as delinquency, substance use, early sexual involvement, and mental health disorders. Knowledge of the extent of these problems and changes in their course over time is important. In its absence, interventions and health planning in general can be difficult. Understanding which risk and protective factors are relevant to which problem behaviors is also essential for the formulation of theories that constitute the basis of intervention. This book draws on the results of the major Pittsburgh Youth Study complemented by follow-up tracking of juvenile court records for more than six years, to address the following questions: *What is the prevalence and age of onset of delinquency, substance use, and early sexual behavior for three samples of boys age 8, 11, and 14? What are the average mental health problems for these ages? How strong are the relationships among these problem behaviors in each of the samples? *Which variables best explain individual differences among the boys in their manifestations of delinquency, substance use, early sexual behavior, and mental health problems? To what extent do explanatory factors vary with age? How accurately can boys with different outcomes be identified by risk scores based on hierarchical multiple regressions? *To what extent are explanatory factors associated with one outcome that are also associated with other outcomes? Are explanatory factors that are especially characteristic of a multiproblem group of boys--who display many different problem behaviors--different from explanatory factors associated with boys with few problems? *Do the results fit a general theory of juvenile problem behaviors, or is a differentiated theory more applicable?

Abstinence and Safer Sex HIV Risk-Reduction Interventions for African American Adolescents A Randomized Controlled Trial

Abstract: Context.—African American adolescents are at high risk of contracting sexually transmitted infection with human immunodeficiency virus (HIV), but which behavioral interventions to reduce risk are most effective and who should conduct them is not known.Objective.—To evaluate the effects of abstinence and safer-sex HIV risk-reduction interventions on young inner-city African American adolescents' HIV sexual risk behaviors when implemented by adult facilitators as compared with peer cofacilitators.Design.—Randomized controlled trial with 3-, 6-, and 12-month follow-up.Setting.—Three middle schools serving low-income African American communities in Philadelphia, Pa.Participants.—A total of 659 African American adolescents recruited for a Saturday program.Interventions.—Based on cognitive-behavioral theories and elicitation research, interventions involved 8 1-hour modules implemented by adult facilitators or peer cofacilitators. Abstinence intervention stressed delaying sexual intercourse or reducing its frequency; safer-sex intervention stressed condom use; control intervention concerned health issues unrelated to sexual behavior.Main Outcome Measures.—Self-reported sexual intercourse, condom use, and unprotected sexual intercourse.Results.—Mean age of the enrollees was 11.8 years; 53% were female and 92.6% were still enrolled at 12 months. Abstinence intervention participants were less likely to report having sexual intercourse in the 3 months after intervention than were control group participants (12.5% vs 21.5%, P=.02), but not at 6- or 12-month follow-up (17.2% vs 22.7%, P=.14; 20.0% vs 23.1%, P=.42, respectively). Safer-sex intervention participants reported significantly more consistent condom use than did control group participants at 3 months (odds ratio [OR]=3.38; 95% confidence interval [CI], 1.25-9.16) and higher frequency of condom use at all follow-ups. Among adolescents who reported sexual experience at baseline, the safer-sex intervention group reported less sexual intercourse in the previous 3 months at 6- and 12-month follow-up than did control and abstinence intervention (adjusted mean days over prior 3 months, 1.34 vs 3.77 and 3.03, respectively; P≤.01 at 12-month follow-up) and less unprotected intercourse at all follow-ups than did control group (adjusted mean days, 0.04 vs 1.85, respectively, P<.001, at 12-month follow-up). There were no differences in intervention effects with adult facilitators as compared with peer cofacilitators.Conclusion.—Both abstinence and safer-sex interventions can reduce HIV sexual risk behaviors, but safer-sex interventions may be especially effective with sexually experienced adolescents and may have longer-lasting effects.

Effects of pediatric chronic physical disorders on child and family adjustment.

Abstract: Research conducted primarily over the past 5-8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement, and intervention are discussed.

Treatment of pediatric obesity.

Abstract: The primary goal of childhood obesity interventions is regulation of body weight and fat with adequate nutrition for growth and development. Ideally, these interventions are associated with positive changes in the physiologic and psychological sequelae of obesity. To contribute to long-term weight maintenance, interventions should modify eating and exercise behaviors such that new, healthier behaviors develop and replace unhealthy behaviors, thereby allowing healthier behaviors to persist throughout development and into adulthood. This overview of pediatric obesity treatment, using predominantly randomized, controlled studies, highlights important contributions and developments in primarily dietary, activity, and behavior change interventions, and identifies characteristics of successful treatment and maintenance interventions. Potential positive (eg, reduction in blood pressure, serum lipids, and insulin resistance) and negative (eg, development of disordered eating patterns) side effects of treatment also are described. Recommendations for improving implementation of childhood obesity treatments, including application of behavioral choice theory, improving knowledge of response extinction and recovery in regards to behavior relapse, individualization of treatment, and integration of basic science with clinical outcome research, are discussed.

Early intervention and early experience.

Abstract: For 4 decades, vigorous efforts have been based on the premise that early intervention for children of poverty and, more recently, for children with developmental disabilities can yield significant improvements in cognitive, academic, and social outcomes. The history of these efforts is briefly summarized and a conceptual framework presented to understand the design, research, and policy relevance of these early interventions. This framework, biosocial developmental contextualism, derives from social ecology, developmental systems theory, developmental epidemiology, and developmental neurobiology. This integrative perspective predicts that fragmented, weak efforts in early intervention are not likely to succeed, whereas intensive, high-quality, ecologically pervasive interventions can and do. Relevant evidence is summarized in 6 principles about efficacy of early intervention. The public policy challenge in early intervention is to contain costs by more precisely targeting early interventions to those who most need and benefit from these interventions. The empirical evidence on biobehavioral effects of early experience and early intervention has direct relevance to federal and state policy development and resource allocation.

Encyclopedia of mental health

Abstract: Encyclopedia of Mental Health, Second Edition, tackles the subject of mental health, arguably one of the biggest issues facing modern society. The book presents a comprehensive overview of the many genetic, neurological, social, and psychological factors that affect mental health, also describing the impact of mental health on the individual and society, and illustrating the factors that aid positive mental health. The book contains 245 peer-reviewed articles written by more than 250 expert authors and provides essential material on assessment, theories of personality, specific disorders, therapies, forensic issues, ethics, and cross-cultural and sociological aspects. Both professionals and libraries will find this timely work indispensable. * Provides fully up-to-date descriptions of the neurological, social, genetic, and psychological factors that affect the individual and society* Contains more than 240 articles written by domain experts in the field* Written in an accessible style using terms that an educated layperson can understand* Of interest to public as well as research libraries with coverage of many important topics, including marital health, divorce, couples therapy, fathers, child custody, day care and day care providers, extended families, and family therapy

Empirically Supported Couple and Family Interventions for Marital Distress and Adult Mental Health Problems

Abstract: This article evaluates the efficacy, effectiveness, and clinical significance of empirically supported couple and family interventions for treating marital distress and individual adult disorders, including anxiety disorders, depression, sexual dysfunctions, alcoholism and problem drinking, and schizophrenia. In addition to consideration of different theoretical approaches to treating these disorders, different ways of including a partner or family in treatment are highlighted: (a) partner-family-assisted interventions, (b) disorder-specific partner-family interventions, and (c) more general couple-family therapy. Findings across diagnostic groups and issues involved in applying efficacy criteria to these populations are discussed.

Implementing guidelines and innovations in general practice: which interventions are effective?

Abstract: BACKGROUND: It is crucial that research findings are implemented in general practice if high-quality care is to be achieved. Multifaceted interventions are usually assumed to be more effective than single interventions, but this hypothesis has yet to be tested for general practice care. This review evaluates the effectiveness of interventions in influencing the implementation of guidelines and adoption of innovations in general practice. A systematic literature study was carried out using MEDLINE searches for the period from January 1980 until June 1994, and 21 medical journals were searched manually. Randomized controlled trials and controlled before and after studies (with pre- and post-intervention measurements in all groups) were selected for the analysis. Clinical area, interventions used, methodological characteristics and effects on clinical behaviour were noted independently by two researchers using a standardized scoring form. Of 143 studies found, 61 were selected for the analysis, covering 86 intervention groups that could be compared with a control group without the intervention. Information transfer alone was effective in two out of 18 groups, whereas combinations of information transfer and learning through social influence or management support were effective in four out of eight and three out of seven groups respectively. Information linked to performance was effective in 10 out of 15 groups, but the combination of information transfer and information linked to performance was effective in only three out of 20 groups. Some, but not all, multifaceted interventions are effective in inducing change in general practice. Social influence and management support can improve the effectiveness of information transfer, but information linked to performance does not necessarily do so. The variation in the effectiveness of interventions needs further analysis.

Psychological distress: Linking impairment with disability in facial neuromotor disorders

Abstract: The relationship between facial neuromotor system impairment, disability, and psychological adjustment is not well understood. This study was designed to explore the relation between impairment and disability and the impact of psychological adjustment on the relation for individuals with disorders of the facial neuromotor system. We studied outpatients (n=48; mean age, 49.0; SD=16.3; range, 18 to 84 years) with a facial neuromotor disorder and acute or chronic facial paralysis. Measures of impairment (Facial Motion Assay, House-Brackmann scale, and Facial Grading System), disability (Facial Disability Index, physical and social well-being subscales), and psychological adjustment (Beck Anxiety Inventory, Beck Depression Inventory) were administered. Bivariate correlations between impairment and disability measures indicated impairment was positively correlated with physical and social disability (r=0.44, p < 0.01; r=0.39, p < 0.05, respectively). Stepwise regression analysis to predict disability indicated physical disability was predicted by impairment and the interaction of impairment and psychological distress (R2=0.425; F=12.57; df=2, 34; p=0.002). Psychological distress, and not impairment and the interaction of impairment and distress, was the single predictor of social disability (R2=0.274; F=13.23; df=1, 35; p=0.001). Psychological distress was a moderator of the relation between impairment and physical disability and a mediator of the relation between impairment and social disability for individuals with facial neuromotor disorders. Assessment and interventions targeted for psychological distress in addition to interventions targeted for impairments appear warranted to effectively reduce the disability associated with facial neuromotor disorders.

Psychosocial antecedents of sport injury: Review and critique of the stress and injury model'

Abstract: To counter the narrow scope and atheoretical nature of early research, Andersen and Williams (1988) developed a multi-component theoretical model of stress and injury. The model proposes that athletes with a history of many stressors, personality characteristics that exacerbate the stress response, and few coping resources will. when placed in a stressful situation, be more likely to appraise the situation as stressful and to exhibit greater physiological activation and attentional disruptions. The severity of the resulting stress response is the mechanism proposed to cause the injury risk. The model also proposes interventions for reducing injury risk. For the last decade. this stress-injury model has helped to provide the impetus and theoretical base for much of the psychosocial injury research. The present article examines research support for the different components of the model. The article concludes with suggestions for potential changes to the model and future research needs.

A Six‐Year Longitudinal Study of Undergraduate Women in Engineering and Science*

Abstract: In 1991, the Women in Engineering (WIE) Initiative at the University of Washington was funded by the Alfred P. Sloan Foundation to conduct a longitudinal study of undergraduate women pursuing degrees in science or engineering. Cohorts of approximately 100 students have been added to the study each year, for a current total of 672 participants. The objectives are: (a) to determine an accurate measure of retention by tracking individual students through their science and engineering academic careers; (b) to examine factors affecting retention of women in science and engineering; and (c) to evaluate the effectiveness of WIE’s programs targeted at increasing enrollment and retention of women in science and engineering. These programs include interventions primarily during the freshman and sophomore years, which are critical attrition points. The results of this study are reported annually to the Dean of Engineering and related departments for consideration in policy formulation. Annual results of the study have shown consistent patterns of persistence factors and barriers for these high-achieving women; most notably a significant drop in academic self-confidence during their freshman year in college. In addition, individual tracking of these women has shown a retention that is much higher than the estimated national average for engineering and science students.

Experimental Intervention Research on Students with Learning Disabilities: A Meta-Analysis of Treatment Outcomes:

Abstract: This article summarizes a comprehensive synthesis of experimental intervention studies that have included students with learning disabilities. Effect sizes for 180 intervention studies were analyzed across instructional domains, sample characteristics, intervention parameters, methodological procedures, and article characteristics. The overall mean effect size of instructional intervention was positive and of high magnitude (M = 0.79). Effect sizes were more positive for a combined model that included components of direct and strategy instruction than for competing models. Interventions that included instructional components related to controlling task difficulty, small interactive groups, and directed responses and questioning of students were significant predictors of effect size, and interventions that varied from control conditions in terms of setting, teacher, and number of instructional steps yielded larger effect sizes than studies that failed to control for such variations. The results are support...

Empirically supported psychosocial interventions for children: an overview.

Abstract: Discusses issues related to the identification of psychosocial interventions for children that have demonstrated efficacy. Recent debate concerning differences between clinical trials research and clinical practice is summarized, including the tradeoff between interpretability (internal validity) and generalizability (external validity) of outcome studies. This article serves as an introduction to the special issue containing articles that have as their focus the identification of empirically supported psychosocial interventions for children as part of a task force. The article provides an overview of the history, agenda, and methodology used by the task force to define and identify specific empirically supported interventions for children with specific disorders. Whereas a number of well-established or probably efficacious interventions are identified within the series, more work directed at closing the gap between research and practice is needed.

Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders

Abstract: Undertook an evaluation of a cognitive-behavioral group family-based intervention for childhood anxiety disorders in Brisbane, Australia. The treatment aimed to provide children and their families with skills in the management of anxiety and avoidance, problem solving, and mutual family support. Children (n = 60) ranging from 7 to 14 years old who fulfilled diagnostic criteria for separation anxiety, overanxious disorder, or social phobia were randomly allocated to 3 treatment conditions: group cognitive-behavioral therapy (GROUP-CBT), group cognitive-behavioral therapy plus family management (GROUP-FAM), and wait list (WL). The effectiveness of the interventions was evaluated at posttreatment and 12-month follow-up. Results indicated that across treatment conditions, 64.8% of children no longer fulfilled diagnostic criteria for an anxiety disorder in comparison with 25.2% of children on the wait list. At 12-month FU, 64.5% of children in the GROUP-CBT group and 84.8% of children in the GROUP-FAM group were diagnosis free. Comparisons of children receiving GROUP-CBT with those receiving GROUP-FAM on self-report measures and clinician ratings indicated marginal added benefits from GROUP-FAM treatment. Results show that CBT interventions for childhood anxiety disorders can be effectively administered in a group format.

Responsiveness in psychotherapy.

Abstract: Human interaction, including psychotherapy, is systematically responsive; therapists' and clients' behavior is influenced by emerging context, including perceptions of each other's characteristics and behavior. Feedback and mutual influence occur on a wide range of time scales, including treatment assignment, strategy, and tactics, -and even within the delivery of interventions. Consequently, research that assumes linear relations among psychotherapeutic variables may not be trustworthy. The concept of responsiveness helps show how client characteristics, therapist characteristics, and process components may be important in psychotherapy despite a lack of linear relations to outcomes. Research strategies that incorporate responsiveness include the use of evaluative measures, systems approaches, and qualitative and narrative approaches.

Harnessing peer networks as an instrument for AIDS prevention: results from a peer-driven intervention.

Abstract: OBJECTIVE: Since 1985, community outreach efforts to combat acquired immunodeficiency syndrome (AIDS) among injecting drug users (IDUs) in the United States have overwhelmingly depended on a provider-client model that relies on staffs of professional outreach workers. We report on a comparison of this traditional outreach model with an innovative social network model, termed "a peer-driven intervention" (PDI). The latter provides IDUs with guidance and structured incentives that permit them to play a much more active role in the outreach process, thereby harnessing peer pressure on behalf of human immunodeficiency virus (HIV) prevention efforts. METHODS: We compare the performance of a traditional outreach intervention (TOI) and a PDI that were implemented in medium-sized towns in eastern and central Connecticut. Comparisons are based on the number and representativeness of IDUs recruited at each site, the effectiveness of HIV prevention education, compliance rates with AIDS risk reduction recommendations, and relative cost. The analyses are based on 522 initial interviews and 190 six-month follow-up interviews conducted during the first two years of each intervention's operation. RESULTS: Both interventions produced significant reductions in HIV risk behaviors, as measured using self-reports. The PDI outperformed the traditional intervention with respect to the number of IDUs recruited, the ethnic and geographic representativeness of the recruits, and the effectiveness of HIV prevention education. In addition, the costs of recruiting IDUs into the intervention and educating them about HIV in the community was only one-thirtieth as much in the PDI as in the traditional intervention. CONCLUSIONS: The findings suggest that given guidance and nominal incentives, IDUs can play a more extensive role in community outreach efforts than the traditional model allows. The findings also suggest that both interventions reduce HIV-associated risk behaviors, but the PDI reaches a larger and more diverse set of IDUs, and does so at much less expense.

Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes

Abstract: Context.—Many computer software developers and vendors claim that their systems can directly improve clinical decisions. As for other health care interventions, such claims should be based on careful trials that assess their effects on clinical performance and, preferably, patient outcomes. Objective.—To systematically review controlled clinical trials assessing the effects of computer-based clinical decision support systems (CDSSs) on physician performance and patient outcomes. Data Sources.—We updated earlier reviews covering 1974 to 1992 by searching the MEDLINE, EMBASE, INSPEC, SCISEARCH, and the Cochrane Library bibliographic databases from 1992 to March 1998. Reference lists and conference proceedings were reviewed and evaluators of CDSSs were contacted. Study Selection.—Studies were included if they involved the use of a CDSS in a clinical setting by a health care practitioner and assessed the effects of the system prospectively with a concurrent control. Data Extraction.—The validity of each relevant study (scored from 0-10) was evaluated in duplicate. Data on setting, subjects, computer systems, and outcomes were abstracted and a power analysis was done on studies with negative findings. Data Synthesis.—A total of 68 controlled trials met our criteria, 40 of which were published since 1992. Quality scores ranged from 2 to10, with more recent trials rating higher (mean, 7.7) than earlier studies (mean, 6.4) (P,.001). Effects on physician performance were assessed in 65 studies and 43 found a benefit (66%). These included 9 of 15 studies on drug dosing systems, 1 of 5 studies on diagnostic aids, 14 of 19 preventive care systems, and 19 of 26 studies evaluating CDSSs for other medical care. Six of 14 studies assessing patient outcomes found a benefit. Of the remaining 8 studies, only 3 had a power of greater than 80% to detect a clinically important effect. Conclusions.—Published studies of CDSSs are increasing rapidly, and their quality is improving. The CDSSs can enhance clinical performance for drug dosing, preventive care, and other aspects of medical care, but not convincingly for diagnosis. The effects of CDSSs on patient outcomes have been insufficiently studied. JAMA. 1998;280:1339-1346

Achieving health and educational goals through schools—a study of the importance of the school climate and the students' satisfaction with school

Abstract: Over the past two decades many studies have examined the effectiveness of classroom teaching in influencing present and future health and health behaviours. Few of these studies have examined the importance of the students' satisfaction with school as a variable which explains effect, and in particular what determines their satisfaction with school. Based on data from the 'Health Behaviour in School-aged Children Survey', this paper presents a review of relevant literature and examines how the students' perception of school climate relates to their satisfaction with school. Data from 11-, 13- and 15year-old students in Finland, Latvia, Norway and Slovakia are used. In all countries, the older students tend to be significantly less satisfied with school than the younger ones. The students in Latvia and Norway seem to be more satisfied with school than students in the two other countries. The most important predictors of students' satisfaction with school are students' feeling that they are treated fairly, that they feel safe and that they believe that teachers are supportive. The findings suggest that, in school health promotion interventions, attention needs not only to be given to classroom teaching materials but also to the quality of a student's

Techniques to Improve Physicians' Use of Diagnostic Tests: A New Conceptual Framework

Abstract: Objectives.—To review the published literature on interventions aimed at improving physicians' testing practices and propose methodologic standards for these studies and to review selected studies using the PRECEDE framework, a behavioral model that helps categorize interventions based on which behavioral factors are being affected.Data Sources.—MEDLINE, EMBASE, and HEALTHStar databases were searched for the years 1966 to January 1, 1998, for English-language articles pertaining to diagnostic testing behavior; bibliographies were scanned to identify articles of potential interest; and researchers in health services, health behavior, and behavior modification were contacted for proprietary and other unpublished articles.Study Selection.—A total of 102 articles were identified that described the results of interventions aimed at changing physicians' testing practices. We included the 49 studies that compared diagnostic testing practices in intervention and control groups.Data Extraction.—Two investigators independently reviewed each article in a blinded fashion using a standard data collection form to obtain a methodologic score and to abstract the key elements of each intervention.Data Synthesis.—On a 38-point methodologic criteria scale, the mean±SD score was 13 ± 4.4. The desired behavior change was reported in the intervention group in 37 (76%) of 49 studies. Twenty-four (86%) of 28 interventions targeted at many behavioral factors were successful, while 13 (62%) of 21 studies aimed at a single behavioral factor were successful (P=.12).Conclusions.—A majority of interventions to improve physicians' testing practices reported in the literature claimed success, with interventions based on multiple behavioral factors trending toward being more successful. While methodologic flaws hamper drawing strong conclusions from this literature, application of a behavioral framework appears to be useful in explaining interventions that are successful and can facilitate interpretation of intervention results.

Empirically supported treatments for children with phobic and anxiety disorders: Current status

Abstract: Reviews the empirically supported status of behavioral and cognitive-behavioral interventions in the treatment of childhood phobias and anxiety disorders. For childhood phobias, it is concluded that imaginal desensitization, in vivo desensitization, filmed modeling, live modeling, and cognitive-behavioral interventions that use self-instruction training are probably efficacious and that participant modeling and reinforced practice are well established. For anxiety disorders, only cognitive-behavioral procedures with and without family anxiety management (FAM) were found to be probably efficacious. However, much of the support for these procedures comes from analogue studies conducted in research laboratory or school settings, delivered in small-group format and, not infrequently, with nonclinically referred children. Additional research that examines high-strength interventions with clinic-referred children is recommended. Furthermore, research that examines the pathological processes involved in the onset and maintenance of phobic and anxiety disorders as well as the change processes used to treat these disorders is called for.