Reviews 48 outcome studies that applied self-statement modification (SSM) to childhood behavior disorders. Selection criteria restricted the review to controlled experimental studies and to children with disorders of clinically relevant severity. Meta-analysis was used to provide summary information about the observed effects of SSM. Collectively, SSM outcomes surpassed no treatment and placebo treatment by roughly a half of a standard deviation, on the average. Efficacy varied considerably with length of follow-up, experience level of therapists, age of children, outcome content area, and a number of other clinical and methodological differences among the studies. These qualifiers of observed efficacy are summarized and discussed in terms of implications for further research and application of SSM in child psychotherapy.
Self-statement modification (SSM) has rapidly grown in popularity, and is commonly a principal technique of cognitive-behavioral therapies. Reviews to date, however, are inconclusive about its efficacy and less than exhaustive in their coverage. The present investigation attempted to locate all controlled studies in which therapy incorporated direct modification of covert self-statements. Meta-analysis was used as a statistical method of integrating the outcome data across studies. Aggregating across all types of clinical outcome measures, SSM evidenced considerable gains beyond no-treatment controls. This advantage was sufficient to place the average SSM-treated subject at a level of therapeutic outcome comparable to the 77th percentile of controls. As suspected, there were many salient qualifiers of outcome, and effects were generally smaller when therapy was contrasted to placebo treatment rather than no treatment at all. Implications for further clinical research are discussed, including the need for greater specificity in our terminology for cognitivebehavioral techniques.Behavioral psychotherapy has not been exempt from the recent "cognitive revolution" (Dember, 1974) within psychology. Smith, Glass, and Miller (1980) identified 475 controlled outcome studies of all types of psychotherapy. In our present effort, well over 100 controlled clinical outcome studies of merely one type of cognitive-behavior therapy were located even though more stringent selection criteria were used.Despite the popularity of cognitive approaches, Ledwidge (1978) has argued on theoretical grounds that the entire cognitivebehavior therapy movement is a "step in the wrong direction." A prudent response to this contention obviously involves a review of the empirical data generated to date. Unfortunately, findings from existing narrative reviews are selective and mixed, dismissing for the moment the considerable empirical support cited by the potentially biased authors of several cognitive behavior therapies (e.g.,
A controlled study of the impact of brief, transitional acute care in reducing psychiatric treatment costs for people in rural areas is presented. Treatment emphasized home-based counseling and support, 24-hour rapid response, rural outreach, and intensive support management. The objective was to avert hospitalizations when possible, expedite discharge, and reduce likelihood of readmission, while maintaining comparable or superior clinical outcome. One-hundred eighty-two participants were randomly assigned to the experimental group or a routine care control group. Clinical and utilization data tracked at initial contact, 2 weeks, 6 months, and 12 months suggest substantially lower hospital utilization for the experimental group. Clinical outcomes were comparable between groups.
Studies of disease outcomes have not produced an explanation or an intervention for the symptoms and complaints that some women have attributed to breast implants. Reviews of the literature have found no increased risk of specific systemic disease, and no treatment recommendations have emerged. However, similar symptoms in fibromyalgia, chronic fatigue, and other contexts have been considered to be stress or behaviourally mediated, and a number of promising behavioural interventions have been developed. Aetiological, research, and treatment implications may follow from the consideration of such symptoms within a behavioural medicine model that allows for the interaction of physical and psychological influences. In the case of implants, a mass somatisation model may also help to discern the potential eVects of litigation and other social influences.
While the study of placebo effects can be of aid in understanding and facilitating therapeutic change, the routine use of placebo control groups in outcome evaluations is of doubtful merit. Placebos are generally unstable, poorly specified, and of questionable ethical viability. Additionally, careful scrutiny of our analytical models suggests that placebo control groups fail to isolate specific treatment effects in the manner commonly assumed. Recommendations include (a) use of aggregate data from metaanalyses to provide normative estimates of expected minimal treatment effects, (b) empirical testing ofputative causal models, and (c) increased utilization of more precise experimental designs. It is suggested that aggregate estimates from existing literature of typical magnitudes of placebo effects provide potentially useful "benchmarks" against which to judge the performance of psychotherapy.
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