Long-term Outcomes of Cognitive Behavioral Therapy for Social Phobia

Social phobia (SP) is a highly prevalent and chronic condition associated with a number of negative outcomes, including significant impairments in social, occupational, and educational functioning (Stein & Kean, 2000). Fortunately, there is substantial evidence to support the efficacy of cognitive behavioral and pharmacological interventions for SP immediately following treatment (McCabe & Antony, 2008). Less is known, however, about the extent to which treatment gains are maintained over the long-term. The current study examined long-term outcomes of two cognitive behavioral treatments for SP, Exposure Group Therapy (EGT) and Virtual Reality Exposure Therapy (VRE). Guided by theories of state dependent and extinction learning, we also sought to explore the extent to which concurrent use of psychotropic medication during treatment attenuated long-term responses to exposure therapy. Eligible participants (N = 75) were individuals had who previously completed either EGT or VRE as a part of two larger treatment studies. Thirty-four participants completed the long-term follow-up assessment which occurred several years (M = 5.7) after the completion of treatment and consisted of self-report measures, a structured clinical interview, and a behavioral avoidance test. We hypothesized that treatment completers would (1) exhibit fewer SP symptoms at long-term follow-up, relative to pre-treatment and would (2) maintain post-treatment gains over the long-term follow-up period. Lastly, we predicted that (3) concurrent medication use, during treatment, would be associated with diminished treatment gains at long term-follow-up for individuals who had discontinued medication during the follow-up period. Results revealed a significant effect of time on self-report and behavioral ratings of SP with clinically significant improvement observed from pre-treatment to long-term follow-up (p \u3c .05). No significant difference differences were observed from post-treatment to long-term follow-up (p \u3e.05) which suggests that that post-treatment gains were well maintained in the long-term. We were unable to test our hypothesis that psychotropic medication would attenuate long-term treatment gains due to the fact that only one participant had taken medication during treatment that was discontinued during follow-up. In sum, the current study suggests that EGT and VRE post-treatment gains are maintained in the long run up to seven years after the completion of treatmen

The Relation between Homework Compliance and Treatment Outcome for Individuals with Social Phobia

Homework compliance has been identified as a robust predictor of treatment outcome for depression and, to a lesser extent, anxiety disorders, including social phobia. The current study tested the following hypotheses: (1) homework compliance is positively related to ratings of global improvement, (2) homework compliance is negatively related to symptom reduction, (3) the relation between homework compliance and treatment outcome varies according to the nature of the homework exercise, and (4) expectancy is positively related to early homework compliance, in a clinical sample of individuals with social phobia. Results provided limited support for the relation between compliance and ratings of improvement, but did not support a negative relation between compliance and symptom reduction. Further, the results provided limited support for the hypothesis that compliance with exposure versus non-exposure homework would differ significantly in terms of their relation to treatment outcome, but did not support the relation between compliance and expectancy

Child Maltreatment and Disaster Prevention: Qualitative Study of Community Agency Perspectives

Introduction: Child maltreatment (CM) is a significant public health problem that increases following natural disasters. Ecological approaches have been used to study these complex phenomena, and the current research fits within this perspective by conducting qualitative interviews with disaster response and family-serving community agencies. The purpose of the study was to identify whether or not community agencies identified CM as an issue that is relevant for disaster planning and response and their perspectives on risk and protective factors for CM risk following disaster. Methods: Agencies (n=16) from 2 geographical areas participated - one that recently experienced a natural disaster (Louisiana (LA), n=7) and one that had not (Georgia (GA), n=9). Agency representatives completed semi-structured telephone interviews (n=16) and follow up in person focus groups (n=14). Theory-driven, thematic analyses were completed. Results: Results suggested that community agencies agree that post-disaster environments increase the risk for CM and that CM prevention has a role in disaster response planning. Risk and protective factors were identified according to Bronfenbrenner’ s ecological framework. Conclusion: Study results support the need to include CM prevention efforts within disaster planning and provide guidance for future research to inform such efforts. [West J Emerg Med. 2013;14(4):402–408

Developmental Outcomes in Duarte Galactosemia

: media-1vid110.1542/5849572227001PEDS-VA_2018-2516 OBJECTIVES: For decades, infants with Duarte galactosemia (DG) have been identified by newborn screening (NBS), but whether they should be treated with dietary restrictions of galactose has remained unknown. To clarify, we conducted a study of dietary and developmental outcomes in 206 children with DG (case patients) and 144 controls, all of whom were 6 to 12 years old. We recruited case patients from states where they were identified by NBS; unaffected siblings served as controls. Diet in infancy was ascertained by retrospective parent surveys; developmental outcomes were assessed in 5 domains, yielding 73 outcome measures for each child. We divided subjects randomly into independent discovery ( = 87) and validation ( = 263) sets. We tested the discovery set to order the 73 outcome measures by ascending values and tested the 10 outcomes with the lowest values for possible association with DG in the validation set. We also tested these same 10 outcomes for possible association with milk exposure in infancy among case patients in the validation set. None of the 73 outcomes tested in the discovery set revealed significant association with DG, and none of the 10 outcomes tested in the validation set revealed either significant association with DG or significant association with milk exposure among children with DG. Through our results, we demonstrated that there were no significant differences in outcomes tested between case patients and controls or among case patients as a function of milk exposure in infancy. In this study, we provide a long-needed foundation of knowledge for health care providers, families, and NBS professionals seeking to make evidence-based decisions about DG