Group Therapy - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

GROUP THERAPY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Group Therapy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00497-6 1. Group Therapy-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on group therapy. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON GROUP THERAPY ...................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Group Therapy.............................................................................. 4 The National Library of Medicine: PubMed ................................................................................ 32 CHAPTER 2. ALTERNATIVE MEDICINE AND GROUP THERAPY ...................................................... 73 Overview...................................................................................................................................... 73 National Center for Complementary and Alternative Medicine.................................................. 73 Additional Web Resources ........................................................................................................... 76 General References ....................................................................................................................... 77 CHAPTER 3. DISSERTATIONS ON GROUP THERAPY ........................................................................ 79 Overview...................................................................................................................................... 79 Dissertations on Group Therapy.................................................................................................. 79 Keeping Current .......................................................................................................................... 84 CHAPTER 4. BOOKS ON GROUP THERAPY ...................................................................................... 85 Overview...................................................................................................................................... 85 Book Summaries: Federal Agencies.............................................................................................. 85 Book Summaries: Online Booksellers........................................................................................... 87 Chapters on Group Therapy......................................................................................................... 90 CHAPTER 5. MULTIMEDIA ON GROUP THERAPY............................................................................ 93 Overview...................................................................................................................................... 93 Audio Recordings......................................................................................................................... 93 CHAPTER 6. PERIODICALS AND NEWS ON GROUP THERAPY......................................................... 95 Overview...................................................................................................................................... 95 News Services and Press Releases................................................................................................ 95 Newsletter Articles ...................................................................................................................... 96 Academic Periodicals covering Group Therapy ........................................................................... 97 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 101 Overview.................................................................................................................................... 101 NIH Guidelines.......................................................................................................................... 101 NIH Databases........................................................................................................................... 103 Other Commercial Databases..................................................................................................... 105 APPENDIX B. PATIENT RESOURCES ............................................................................................... 107 Overview.................................................................................................................................... 107 Patient Guideline Sources.......................................................................................................... 107 Finding Associations.................................................................................................................. 110 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 113 Overview.................................................................................................................................... 113 Preparation................................................................................................................................. 113 Finding a Local Medical Library................................................................................................ 113 Medical Libraries in the U.S. and Canada ................................................................................. 113 ONLINE GLOSSARIES................................................................................................................ 119 Online Dictionary Directories ................................................................................................... 119 GROUP THERAPY DICTIONARY............................................................................................ 121 INDEX .............................................................................................................................................. 151

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with group therapy is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about group therapy, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to group therapy, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on group therapy. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to group therapy, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on group therapy. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON GROUP THERAPY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on group therapy.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and group therapy, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “group therapy” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Cognitive, Affective, and Behavioral Effects of Reminiscence Group Therapy on Demented Elderly Source: International Journal of Aging and Human Development. 25(3): 209-222. 1987. Summary: The study reported in this journal article examined the effects of reminiscence group therapy on cognitive, affective, and behavioral functioning in demented elderly. Twenty-seven demented elderly nursing home residents were given either reminiscence group therapy or supportive group therapy or were assigned to a no-treatment control group. The self reported level of depression in participants given reminiscence therapy was positively affected compared to participants in the supportive therapy and control groups, but no significant effects were found for cognitive or behavioral functioning. The results are discussed in terms of the issue of the applicability of reminiscence therapy for cognitively impaired persons, the appropriateness of the measures used in

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this study to assess depression, cognitive ability, and behavioral functioning, and in conjunction with clinical observations made during the process of therapy. 18 references. (AA-M).

Federally Funded Research on Group Therapy The U.S. Government supports a variety of research studies relating to group therapy. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to group therapy. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore group therapy. The following is typical of the type of information found when searching the CRISP database for group therapy: •

Project Title: A OUTPATIENTS

COGNITIVE

GROUP

TREATMENT

FOR

BORDERLINE

Principal Investigator & Institution: Black, Donald W.; Professor; Psychiatry; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 09-JUL-2002; Project End 30-JUN-2006 Summary: The goal of this project is to test the efficacy of a new cognitive-behavioral systems-based group treatment for persons with borderline personality disorder (BPD) and to compare it to "treatment as usual" (TAU). We elected to modify a program originally developed by Bartels and Crotty. This led us to develop STEPPS, an acronym that stands for Systems Training for Emotional Predictability and Problem Solving. Briefly, the program involves both cognitive-behavioral techniques and skills training combined with a systems component; the latter involves the patients with BPD and those in their system, including family members, friends, and health care professionals. STEPPS involves twenty 2-hour group meetings with two facilitators; the therapy is manual-based and each week specific goals are set. We propose to recruit approximately 160 adults with DSM-IV BPD during the first 2 1/2 years of the project. Subjects will be recruited through referral from area psychologists, psychiatrists, mental health clinics, and hospitals. Subjects will be screened using the Revised Diagnostic Interview for Borderlines (DIB-R) and relevant sections of the Structured Interview for DSM-IV Personality Disorders (SIDP-IV). Appropriate subjects meeting specified inclusion/exclusion criteria will be randomized to STEPPS or TAU. Subjects in both groups will be allowed to continue to see their psychiatrist, take psychotropic medication, and continue with other therapy. Baseline assessments will include the Structured Clinical Interview for DSM-IV, the SIDP- IV, the Hollingshead Scale, the 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Social Adjustment Scale, the Beck Depression Inventory, the Positive and Negative Affectivity Scale, the Symptom Checklist-90-R, the Barrett Impulsivity Scale, and the Medical Outcomes Study Short Form Health Survey. A new self-rated scale, the Borderline Evaluation of Severity Over Time (BEST), will also be used to rate BPD symptoms. Subjects will be assessed at baseline, and at weeks 4, 8, 12, 16, and 20. Lay and professional support system members (informants) will be asked to rate the subjects progress at specified intervals. Satisfaction with STEPPS and TAU will be assessed in informants and subjects at the conclusion of the trial. Therapy fidelity will be maintained through regular supervision, and blind ratings of videotaped sessions. Subjects randomized to STEPPS will be followed up at months 1, 3, 6, 9, and 12 poststudy completion. We hypothesize that subjects participating in STEPPS will have better symptomatic improvement than subjects receiving TAU; improvement will include greater mood stability, less deliberate self-harm, less anger/impulsivity, and lower rates of health care utilization. We hypothesize that the gains of STEPPS will be maintained over 1 year. These findings should add to our understanding of the appropriate clinical management of BPD. If the efficacy of STEPPS is confirmed, future studies will include larger samples to help test whether specific subgroups will preferentially respond, and comparisons of STEPPS to other programs, including Dialectical Behavior Therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: A COPING INTERVENTION FOR HIV-INFECTED OLDER ADULTS Principal Investigator & Institution: Heckman, Timothy G.; Associate Professor; Psychology; Ohio University Athens 105 Research & Technology Center Athens, Oh 457012979 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2007 Summary: This revised application is in response to PA-97-069 "AIDS and Aging: Behavioral Sciences Prevention Research" and requests support to evaluate a Coping Improvement Group Intervention for persons 50 years of age and older living with HIV disease. Through December 2001, more than 90,000 persons living with AIDS in the United States were 50 years of age or older at the time of their AIDS diagnosis (CDC, 2001). Unfortunately, because most AIDS mental health research has focused on younger individuals, geropractitioners know little about the mental health needs of HIV-infected older adults. Across a series of preliminary studies supported by NIH, our study team has characterized levels of psychological distress and coping difficulties in late middle-aged and older adults living with HIV/AIDS. These studies portend that many HIV-infected older adults experience elevated levels of depression and suicidal ideation, confront complex barriers to medical and mental health care services, and lack social support resources. These and other dilemmas not only reduce one's life quality but may also lead to health-compromising behaviors in this group, such as poor adherence to HIV treatment regimens and the continued practice of high HIVtransmission risk behaviors. The proposed three-year study will evaluate the impact of a face-toface Coping Improvement Group Intervention on the adjustment efforts of HIVinfected persons 50-plus years of age in relation to two comparison conditions. Three hundred (N=300) HIV-infected older adults will be randomly assigned to either: (1) a face-to-face, Coping Improvement Group Intervention based on Lazarus and Folkman's (1984) Transactional Model of Stress and Coping; (2) a face-to-face, Information-Support Group Intervention; or (3) a Standard of Care Comparison Condition. Pre- and postintervention measures, along with follow-up assessments collected 4- and 8-months post-intervention, will assess the relative efficacy of the three conditions. Participants will complete measures assessing comorbid health conditions, cognitive functioning,

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sources of life stress, ways of coping, psychological distress, social support, health services utilization, treatment adherence, and quality of life. At the current time, there are few--if any--age appropriate mental health interventions for HIV-infected older adults. However, the planned research may yield a culturally-contextualized coping improvement intervention for this vulnerable population, and this innovation would contribute significantly to the AIDS care and gerontological fields. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: A TRANSTHEORETICAL MODEL GROUP THERAPY FOR COCAINE Principal Investigator & Institution: Velasquez, Mary Marden.; Family Practice and Cmty Med; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2003; Project Start 10-AUG-2003; Project End 30-JUN-2006 Summary: (provided by applicant): Cocaine use in the general population is a significant and costly problem. Novel and innovative interventions targeting cocaine abuse are needed. The Transtheoretical Model of behavior change (TTM) offers a comprehensive framework for understanding, measuring, and intervening in behavior change and provides a strong theoretical foundation upon which effective treatments for substance abuse can be developed. The proposed Stage 1 research will pilot test a novel and innovative behavioral group therapy for cocaine users based on the TTM. In Phase 1, investigators will modify the newly developed Group Treatment for Substance Abuse: A Stages-of-Change Therapy Manual (Velasquez, Maurer, Crouch & DiClemente, 2001) to specifically target cocaine abuse resulting in a twelve-session, group intervention and accompanying therapy manual based on the TTM stages and processes of change: six "early stage" sessions targeting the experiential processes of change, and six "later stage" sessions targeting the behavioral processes of change. Phase 2 will consist of a pilot trial to evaluate the TTM group therapy with cocaine abusing patients. A randomized, controlled, between groups design will be used in which cocaine abusers (N=80) are assigned to one of two group treatment conditions: TTM therapy or Education/Advice. Participants will be recruited from Houston and surrounding communities through the Substance Abuse Research Center at the University of Texas Health Science Center Mental Sciences institute. We expect the delivery of the TTM therapy for cocaine users to be feasible and acceptable, and to produce significant patient improvement. Cocaine outcomes will be assessed via objective (urine and drug analysis) and self-report measures. This Stage I research will contribute important theoretical and empirical information concerning the promise of a new and innovative intervention for cocaine abusers, and will provide the basis for a larger efficacy trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ASSESSMENT OF EARLY RETENTION STRATEGIES Principal Investigator & Institution: Brown, Barry S.; Friends Research Institute, Inc. Box 10676, 505 Baltimore Ave Baltimore, Md 21285 Timing: Fiscal Year 2002; Project Start 20-AUG-1999; Project End 31-JUL-2004 Summary: (Applicant's Abstract) In response to NIDA's Health Services Research Program Announcement (PA-94- 047), study will be undertaken of "client and program factors that influence. retention, compliance, effectiveness and relapse." While length of time in treatment has been repeatedly found to be linked to positive outcome, outpatient drug free treatment programs have been found to retain less than half of their clients for three months and less than a quarter of their clients for six months - thereby providing subtherapeutic doses of treatment to the majority of clients seen. Consequently, two

Studies

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early intervention strategies for reducing dropout and increasing treatment effectiveness have been developed for comparison to standard treatment at one outpatient drug free treatment program. Clients admitted to treatment will be randomly assigned to one of three conditions: (a) standard treatment involving post- intake didactic group orientation to the treatment program together with counselor developed treatment plans agreed to by clients and updated at three month intervals; (b) role induction involving post-intake interactive individual orientation to the treatment program with counselor developed treatment plans updated at three month intervals; and (c) behavioral contracting involving role induction plus a negotiated treatment plan with jointly determined short-term goals, strategies and timetables updated frequently. Outcomes will be assessed through a repeated measures design exploring between and within group differences over a 18 month period and examining (a) retention, (b) program compliance, (c) motivation for behavior change and for use of treatment, (d) behavior change (drug and alcohol use, productive activity, illicit activity), (e) psychological functioning, (f) HIV risk taking behaviors, (g) optimism/pessimism, and (h) client and counselor satisfaction with treatment. Measurements will be taken at monthly intervals during the first three months of treatment and thereafter at 6, 12 and 18 months from time of intake. Treatment process variables and client demographic and background characteristics will be related to outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BEHAVIORAL COUPLES THERAPY FOR DRUG ABUSE Principal Investigator & Institution: Fals-Stewart, William S.; Senior Research Scientist; None; State University of New York at Buffalo Suite 211 Ub Commons Buffalo, Ny 14228 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2006 Summary: (provided by applicant): The results of multiple studies over the last 25 years indicate that, compared to traditional individual-based treatments, use of Behavioral Couples Therapy (BCT) for married or cohabiting alcoholic and drug-abusing patients results in superior outcomes across multiple domains of psychosocial functioning, including reduced substance use, increased relationship satisfaction, reduced levels of domestic violence, and improved family adjustment. However, despite its demonstrated efficacy, the results of a recent survey indicate BCT is rarely used in community-based substance abuse treatment programs. One of the barriers identified in the survey as interfering with the transfer of BCT from research settings into these programs was that BCT was perceived as costly to deliver, due largely to the staff resources required to provide BCT in the standard conjoint format (i.e., one or two therapists treating a patient and his or her partner for a clinical hour). The mandate for investigators is to develop a version of BCT that is less costly to deliver and yet retains the clinical effectiveness of standard BCT. A potential solution to the problem of the high treatment delivery costs for BCT is to develop a clinically effective version of BCT that can be conducted in a multi-couple group; such a format would allow for the more efficient use of limited staff resources. Thus, the proposed project has two primary aims which will be addressed in two sequential phases. In Phase I, we will develop and refine a 12-session treatment manual for conducting Behavioral Couples Therapy in a group therapy format (G-BCT) for married or cohabiting substance-abusing men and their nonsubstance-abusing intimate female partners. In Phase II of the project, we will conduct a small pilot study in which subjects participating in G-BCT plus Individual Drug Counseling (IDC) will be compared to subjects who participate in an equally intensive Standard BCT (S-BCT) plus IDC and those who receive treatment as usual [i.e., group-based drug abuse counseling

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(GDQ plus IDC] in terms of clinical outcomes (e.g., substance, dyadic adjustment, family functioning), as well as cost outcomes (e.g., cost-benefit and cost-effectiveness). If the objectives of the proposed study are met, an efficacious variant of BCT would be available that community-based treatment programs could provide using a comparatively efficient delivery format. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BRIEF BEHAVIORAL THERAPY TO ENHANCE TREATMENT ENGAGEMENT Principal Investigator & Institution: Schottenfeld, Richard S.; Professor; Psychiatry; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 20-SEP-1999; Project End 31-AUG-2004 Summary: Demoralization is highly prevalent among new entrants to methadone treatment, persists for months in about 30 percent of patients, and interferes with treatment retention and effectiveness. Based on research on message framing, modeling, cognitive biases, and self-efficacy, we are proposing a Stage I study for manual development and pilot testing of a leading, four-week individual therapy, Brief Engagement in Substance Treatment (BEST), targeting demoralization and drug use. BEST will incorporate principles of motivational interviewing used in Motivational Enhancement Therapy (MET). Sessions will address core issues including 1) fears about treatment; 2) cognitive biases and hopelessness; 3) self-efficacy; and 4) social isolation. Session format will be guided by health behavior psychology research suggesting that appropriate message framing and modeling increases treatment adherence and behavior change. We plan to develop motivational videotapes to be viewed within the sessions, with simulated patients serving as role models to counter patient hopelessness, illustrate therapy issues and stimulate discussion. In Phases 1 and 2 of the proposed study, we will develop a therapy manual and motivational videotapes, pre-pilot BEST in individual therapy, and develop materials for training therapists and for rating manual adherence and performance. Patient and therapist ratings of each session, data about patient response to treatment, reviews of session videotapes, and focus groups conducted with patients will be used to inform development and revisions of the treatment, therapy manual and motivational videotapes. Phase 3 is a randomized, pilot study (N=60) using a dismantling strategy to compare manual-guided BEST to manualguided MET. Patient outcomes will be assessed during the four-week lead in treatment and for 12 weeks following completion of the lead-in treatment, while patients are participating in standard, weekly group drug counseling. Primary outcome measures include retention in treatment, rates of illicit opioid and other drug use, and reductions of BDI scores. The pilot study will be used to estimate the potential effect size of the difference between the two treatments, evaluate the feasibility of comparing the two treatments in a larger, Stage II study, and to guide additional refinements of the treatment manuals and videotapes. In Phase 4, we plan to develop gender and ethnicity specific videotapes and to pilot BEST in group therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLINICAL PROCESSES IN DRUG ABUSE PREVENTION Principal Investigator & Institution: Coatsworth, J D.; Human Develmt & Family Studies; Pennsylvania State University-Univ Park 110 Technology Center University Park, Pa 16802 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2003

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Summary: This study, the Principal Investigators first NIH award, examines in-session behaviors in drug abuse preventive intervention groups. The primary goal of this study is to initiate a program of research that will increase the knowledge-base about how clinicians influence within-session participant behaviors and group processes which, in turn, influence proximal outcomes ('Attendance', 'Parental Involvement'). The research plan in this study borrows established theories, methods, and procedures from the psychotherapy research literature to examine in-session behaviors in preventive intervention groups. Findings from this study will provide a foundation for translating results from prevention trials into immediate improvements in the delivery of effective interventions. Videotapes of group sessions will be coded (statement by statement) and rated (molar level assessment of the extent to which a behavior was present in a segment) to identify distinct classes of in-session behaviors. Confirmatory factor analyses will be conducted to test for the presence of clinician intervention ('Supportive', 'Directive', and 'Facilitative'), participant behavior ('Bonding to Clinician' and 'Bonding to Group'), and group process ('Cohesion') constructs. Hierarchical linear modeling will be used to examine the hypothesized relationships between clinician interventions, participant behaviors, group process, and proximal outcomes ('Attendance' and 'Parental Involvement'). Microsequential analyses will be used to elucidate the immediate (speech act level) relationships between in-session clinician interventions and participant behaviors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COGNITIVE THERAPY VIA CD ROM FOR BINGE EATING DISORDER Principal Investigator & Institution: Bulik, Cynthia M.; Professor; Psychiatry; Virginia Commonwealth University Richmond, Va 232980568 Timing: Fiscal Year 2003; Project Start 01-APR-2001; Project End 30-JUN-2003 Summary: Although eating and weight-related disorders are treatable, most afflicted individuals never receive proper treatment. Despite the existence of excellent prototype cognitive-behavioral programs for the treatment of binge-eating disorder (BED) and other eating disorders, we face a crisis of dissemination. The goal of this project is to join cognitive-behavioral therapy (CBT) with novel information technology to develop an interactive CBT program that will allow individuals to experience the basics of CBT in the privacy of their own homes. This Exploratory/Development Grant for Mental Health Intervention (R21) proposes a four stage project to develop a CD-ROM-based program for the effective delivery of cognitive-behavioral therapy (CBT) to obese individuals with binge-eating disorder (OBED) and other unhealthy eating behaviors. In Phase 1 of the project, we will continue development of a CD-ROM program that we began in 1998. The program will be a rich, vivid, and interactive approach to CBT that provides helpful psychoeducation on unhealthy eating and weight-related practices; clearly introduces the basic concepts and techniques of CBT; provides rich and vivid examples of techniques; provides individualized and interactive exercises for practicing CBT principles; and enables users to contact the central web site and staff with questions. This program will be applicable to a broad range of adult women and men of all races and backgrounds. In Phase 2, we will implement a rigorous four-stage betatesting procedure that includes: group testing sessions followed by individual and focus group debriefing for feedback; peer review by experts in the field of CBT for eating disorders; and in-home beta testing prior to final production. Phase III of the project will be a small feasibility and pilot study comparing the efficacy of the CD-ROM-based delivery of CBT to traditional manual-based group therapy for individuals with OBED

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and a wait list control. Data from this pilot study will be used to support Phase IV, which will develop a proposal for a large-scale clinical trial comparing CD-ROM-based intervention with traditional group therapy. We anticipate that a CD-ROM-based program will be an efficacious and cost-effective intervention. For some, this program may suffice for treating their eating and weight-related problems. For others, it may be a useful adjunct to traditional psychotherapy or an introductory step to treatment which will familiarize them with the principles and techniques of CBT and increase their comfort and motivation to seek additional professional care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COMMUNITY-FRIENDLY MANUAL GUIDED DRUG COUNSELING Principal Investigator & Institution: Crits-Christoph, Paul F.; Associate Professor; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2005 Summary: (provided by applicant): We propose here treatment development work to create and test a "community-friendly" manual-based individual plus group drug counseling package. The NIDA Collaborative Cocaine Treatment Study (Crits-Christoph et at., 1999) recently reported that manual-based individual drug counseling (IDC) plus group drug counseling (GDC) has superior drug use outcomes compared to cognitivebehavior therapy plus GDC, psychodynamic therapy plus GDC, and GDC alone. Proposed changes to IDC and GDC to make them more "community-friendly" include changes to both the duration and content of the treatment models. The proposed treatment development work will include (1) obtaining feedback on the new treatment manuals by a sample of 15 community-based drug counselors, (2) evaluating whether a group of drug counselors can successfully learn to implement the new manuals, (3) evaluating counselors' experiences in learning and conducting the new treatments, (4) conducting a pilot randomized evaluation of the outcomes of the new package of individual plus group drug counseling compared to group drug counseling alone, (5) obtaining ratings of treatment fidelity to assess whether the new individual and group drug counseling approaches can be differentiated from the original therapies, (6) assessing patient reactions to the new treatment, and (7) conducting a preliminary investigation of potential mediators of change of the new treatments. The pilot randomized trial will involve assignment of 40 patients meeting DSM-IV criteria for cocaine dependence to either new versions of individual plus group drug counseling or group drug counseling alone. Assessments will be done at time of intake and weekly (for urines and self-report of cocaine use) or monthly (for other outcome measures) during a 3-month treatment phase. The primary efficacy measures will be the ASI Drug Use Composite scale and a composite cocaine use measure that incorporates urine data, Addiction Severity Index Interview data, and weekly self-report of cocaine use. Mediation of drug use change will be examined by assessing beliefs about substance use, endorsement of 12-step behaviors and beliefs, and attendance/ participation in 12step meetings at baseline, weekly for the first month and monthly thereafter. The data gathered from this treatment development project will inform the design of a subsequent larger study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COMPARISON OF DBT AND SUPPORTIVE THERAPY FOR BED Principal Investigator & Institution: Safer, Debra L.; Psychiatry and Behavioral Sci; Stanford University Stanford, Ca 94305

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Timing: Fiscal Year 2003; Project Start 11-APR-2003; Project End 29-FEB-2008 Summary: (provided by applicant): The overarching objective of the candidate's application for an individual Research Career Award (K23) is to train the candidate to become an independent clinical researcher in an academic setting in order to develop an expertise in the treatment of individuals with eating disorders. Binge Eating Disorder (BED), a proposed diagnostic category in DSM-IV, is associated with impairments in physical, psychological, and social functioning. Cognitive behavioral therapy (CBT), based on the restraint model, has been the most studied treatment for BED. Given that the average rate of abstinence from binge eating at the end of CBT treatment approximates 50% across multiple studies, potentially more effective treatment interventions merit consideration. Dialectical Behavior Therapy (DBT), based on the affect regulation model linking binge eating with emotional distress, is one such treatment approach. Preliminary studies indicate that abstinence rates at the end of 20 weeks of manualized DBT adapted for BED in a group format range from 82-89%. At the same time that new and more efficacious treatments for BED are being developed, current BED research has not as yet demonstrated consistently significant outcome differences among existing therapies. This suggests that nonspecific therapeutic factors (e.g. therapist-patient interactions) and/or baseline factors (e.g. patient expectations) may account for much if not all of BED treatment outcome. As no studies to date have compared the outcome of a specific psychotherapeutic treatment for BED with a therapy controlling for nonspecific factors, the candidate will conduct a randomized clinical trial comparing the outcome of manualized DBT to a manualized Supportive Group Therapy for adults. Assessed will be the short (post-treatment), medium (3 mo, 6 mo) and longer term (12 mo) outcomes of these treatments as well as mediators and moderators of abstinence. The candidate's specific aims for this K23 award are: 1) to obtain training in research design, statistical analysis, and the theory and process of research through an individualized program of coursework at the Stanford University School of Medicine, with a focus on health outcomes and emotion regulation research and theory; 2) to contribute meaningfully to the understanding of efficacious treatments for BED by conducting a randomized clinical trial and 3) to expand the candidate's skills so that she can develop into a successful and independent investigator capable of obtaining future support for patient-oriented research, such as an R01. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EARLY INTERVENTIONS FOR ANXIOUS CHILDREN Principal Investigator & Institution: Bernstein, Gail A.; Professor; Psychiatry; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2005 Summary: (provided by applicant): This R21 application is in response to Program Announcement #PA-99-134 Exploratory/Development Grants for Mental Health Intervention Research. This project focuses on early identification of anxious children and pilot testing of school-based group interventions for anxious youth. Anxiety disorders are among the most prevalent psychiatric disorders in children. These disorders are strongly associated with risk for later developing mood disorders and other psychiatric disorders, academic failure, substance abuse problems, and other significant health problems. Up to 10-15% of the general youth population has an anxiety disorder. Anxiety disorders are associated with functional impairment and substantial morbidity. Longitudinal studies have demonstrated that untreated anxiety disorders in children may continue for years. For all these reasons, early identification and intervention are critical for preventing anxiety disorders and returning anxious

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children to the normal developmental trajectory. This R21 will employ a multiple gating procedure to identify children (ages 7-11) with features or diagnoses of separation anxiety disorder, generalized anxiety disorder, or social phobia. Schools will be randomly assigned to one of three conditions: (1) group cognitive-behavioral therapy (CBT) for children, (2) group CBT for children plus parent training, or (3) treatment as usual. Treatment as usual will consist of whatever the school would normally recommend for a child identified as anxious. Active treatments will utilize the FRIENDS Manual and will be provided at school. The FRIENDS manual will be expanded to provide a more intensive parent training component (i.e., parental anxiety management, understanding the child's anxiety in the family context, contracting and contingency management). All children will be followed prospectively with assessments at 3 months and 6 months post-treatment. Outcome measures will evaluate symptom severity, level of functioning, remission of baseline anxiety disorders, and incidence of new anxiety disorders. Data from this study will guide a large-scale school-based investigation of group interventions for anxious youth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF WORK ACTIVITY AUGMENTED BY COGNITIVE TRAINING Principal Investigator & Institution: Bell, Morris D.; Career Research Scientist & Associate Pr; Psychiatry; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 15-MAY-2000; Project End 31-MAR-2005 Summary: (Adapted from the Applicant's Abstract): This study proposes to enroll 120 men and women with schizophrenia or schizoaffective disorder in a five-year investigation to compare work therapy alone with work therapy augmented by cognitive enhancement training. The cognitive enhancement condition has 4 elements: a) feedback to patients about their cognitive strengths and weaknesses from the baseline cognitive assessment; 2) 150 sessions of cognitive retraining employing computer-based hierarchically arranged exercises for memory, attention, and executive function; 3) a weekly group to improve verbal expression and social information processing; and 4) cognitively oriented work performance feedback in a weekly group with goal-setting and problem-solving. The work only condition will include 2 non-cognitive groups to control for non-specific effects. The work therapy program for both conditions will provide paid work activity ($6.00/hr.) for up to 20 hours per week in an accommodating setting with appropriate work service supports. Randomization into condition will be stratified by baseline cognitive functioning. Subjects will be provided with 12 months of work plus the procedures of their randomized condition. They will then be allowed to continue with work services for an additional 12 months. Clinical quality of life, neuropsychological, and rehabilitation effects will be assessed at 1- and 2-year followup. The two primary aims are 1) to determine whether cognitive enhancement training improves functional outcomes for this population and whether cognitive enhancement is especially needed to maintain work functioning for subjects with severe cognitive impairment; and 2) to determine whether paid work activity, which has demonstrated efficacy in veteran samples, is effective for a community sample of men and women. Two secondary aims are 1) to determine whether there are significant gender differences in the predictors, process and outcome of cognitive enhancement and work therapy; and 2) whether the provision of these services is cost effective from the point of view of the provider, the consumer and family, and society. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFICACY OF GROUP MOTIVATIONAL INTERVIEWING Principal Investigator & Institution: Santa Ana, Elizabeth J.; Psychology; State University of New York at Albany 1400 Washington Ave Albany, Ny 12222 Timing: Fiscal Year 2003; Project Start 20-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Poor compliance with aftercare treatment among dually diagnosed patients is a costly and pervasive health problem that limits the effectiveness of inpatient detoxification. Current strategies for improving compliance with aftercare treatment are minimally effective. The proposed project intends to improve current strategies by examining the impact of adding group motivational interviewing (GMI) to the standard treatment program of an inpatient psychiatric hospital for individuals with coexisting psychiatric and substance use disorders. The project aims to significantly improve compliance with aftercare treatment (e.g. AA/NA, outpatient therapy) and reduce substance use over standard inpatient treatment alone. The study specifically addresses Healthy People 2010 objectives to reduce the treatment gap for individuals with coexisting substance use and psychiatric problems and to reduce past-month use of alcohol and illicit substances by specifically targeting patientlevel barriers and motivation. Ample evidence shows that motivational interviewing (MI) significantly reduces substance abuse and increases treatment engagement. As such, MI holds great promise for use in the inpatient setting and may represent a significant upgrade in the treatment services provided. However, MI is traditionally delivered one-on-one. The project seeks to demonstrate the efficacy of GMI in a group format. Until this is accomplished, MI will remain underutilized in inpatient or substance abuse treatment settings that rely on group therapy. The consequence is that motivational interviewing continues to go undelivered in inpatient settings despite the fact that this intervention may result in substantial benefits for patients, their families, and the community at large. Inpatients meeting eligibility criteria will be allocated to GMI + Standard Treatment (ST) or to ST alone using block randomization. Following admission, screening, and informed consent procedures, a group containing 5-6 participants will be invited to complete pretreatment questionnaires. Patients assigned to receive GMI + ST will be invited to return the following two days to attend two 90minute group sessions delivered in the style of motivational interviewing. Patients receiving ST alone will be invited to return the following two days for a nonexperimental group activity to control for therapist attention effects. All participants and collaterals will be contacted at a one and three month follow-up period after discharge to evaluate compliance with aftercare treatment and rate of alcohol and other drug consumption. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFICACY OF PSYCHOSOCIAL THERAPIES FOR DRUG ABUSE Principal Investigator & Institution: Najavits, Lisa M.; Associate Professor and Director, Trauma; Mc Lean Hospital (Belmont, Ma) Belmont, Ma 02478 Timing: Fiscal Year 2002; Project Start 10-MAR-1999; Project End 29-FEB-2004 Summary: The primary aim of this K02 application is to further the applicant's career in improving the efficacy of psychosocial treatments for patients with substance use disorder, comprising three subsidiary aims: (1) an emphasis on psychosocial treatments for "poor prognosis" substance use disorder (SUD) populations (e.g., patients who have co-occurring posttraumatic stress disorder or bipolar disorder, low motivation for treatment, or HIV; are poor and/or homeless; and inner-city women); (2) improving the quality of treatment of treatment delivery by psychosocial clinicians; and (3) developing

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new assessment measures to assist the above goals, for both research and clinical use. The K02 award would be useful to strengthen the applicant's involvement in the following eight studies, six of which are NIDA-funded: (1) Group Cognitive-Behavioral Therapy for Dual Diagnosis Women (and HIV supplement), a controlled randomized trial comparing a new cognitive-behavioral group psychotherapy developed by the applicant for women with posttraumatic stress disorder (PTSD) and SUD versus a "treatment-as-usual" control; a supplement to the grant focuses on reducing HIV risk behaviors in the sample; (2) A Relapse Prevention Group for Bipolar Substance Abusers to develop and pilot-test an integrated group therapy manual for patients with bipolar disorder and SUD; (3) Collaborative Cocaine Treatment Study, a multi-site randomized controlled trial comparing four psychosocial treatments for cocaine-dependent outpatients; (4) PTSD treatment outcomes for cocaine dependent women, a controlled randomized trial comparing the new cognitive-behavioral psychotherapy developed by the applicant versus standard relapse prevention for inner-city cocaine- dependent women with PTSD; (5) Validity of the ASAM Criteria for Drug Abuse Treatment, to test the validity of a widely used treatment- matching protocol and its applicability to a publicly funded population; (6) Research Diagnostic Project, to analyze the relationship between PTSD and SUD among 375 adult treatment-seeking patients; (7) Behavioral and Pharmacologic Treatment of Alcoholism, a multi-site controlled randomized trial comparing two psychosocial and two pharmacologic interventions for 720 outpatients with alcohol dependence; (8) PTSD and substance abuse among poor and homeless women (Smith-Richardson Foundation), a controlled randomized trial comparing the new cognitive- behavioral psychotherapy developed by the applicant versus "treatmentas-usual" for poor and/or homeless women with PTSD and SUD. The award would also enhance the applicant's potential to expand into related areas of research and to mentor new researchers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EVALUATION OF DIALECTICAL BEHAVIOR THERAPY (DBT) Principal Investigator & Institution: Linehan, Marsha M.; Professor and Director; Psychology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 20-JUL-2003; Project End 30-APR-2008 Summary: (provided by applicant): The purpose of this proposal is to conduct an efficacy trial to determine whether Dialectical Behavior Therapy (DBT) added to suboxone (an opiate drug replacement) is an efficacious treatment for suicidal opiate addicts with Borderline Personality Disorder (BPD) characteristics and to analyze factors that influence efficacy in this population in order to improve the treatment. The combination of suicidality with substance abuse, particularly when other Axis I or II disorders are present, significantly compromises treatment outcome, and the purpose of this study is to investigate the efficacy of DBT added to suboxone as an effective treatment for this population. DBT, originally developed for chronically suicidal women with borderline personality disorder (BPD), is a synthesis of behavior therapy strategies aimed at change, and validation strategies aimed at acceptance, both held together by a set of dialectical strategies and underlying assumptions. DBT has been adapted for BPD substance abusers by the addition of 1) specific targets relevant to drug use, 2) a set of attachment strategies, 3) greater reliance on arbitrary reinforcers at treatment start, 4) weekly urinalysis, and 5) an opiate drug-replacement program (suboxone, i.e., buprenorphine in combination with naloxone) plus DBT clinical management. The research proposed here is a two arm, randomized clinical trial comparing a one year treatment program of DBT + suboxone for heroin addicted individuals to a one year

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program of Treatment-as-Usual (TAU) + suboxone. Treatment-as-usual will consist of the standard drug counseling and group therapies offered at area methadone clinics plus suboxone. Participants in both conditions will be prescribed psychotropic medications as needed. One hundred and thirty-six individuals (68 per condition) with opiate dependence, high suicidality and meeting a minimum of four BPD criterion will be enrolled in a one-year treatment and a one-year follow-up assessment. Assessments measuring drug use, suicidal behaviors, retention and other treatment-related behaviors, general psychopathology, and increases in behavioral skills will be given at four month intervals for the entire two years. Results will be analyzed using HLM and other regression-based procedures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FAMILY AND GROUP THERAPIES FOR ADOLESCENT ALCOHOL ABUSE Principal Investigator & Institution: Stanton, Morris D.; Morton Center 1028 Barret Ave Louisville, Ky 40204 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-AUG-2005 Summary: APPLICANT'S ABSTRACT: Despite well-founded societal concerns over use of illicit drugs by youth, alcohol use has persisted for decades as the number one adolescent substance abuse problem in the U.S. Further, research has shown that the earlier the onset of alcohol use, the more likely a person is to develop alcohol dependence later during the life course. Consequently, the need is clear for interventions that will arrest this process at the earliest point possible. Hence, interventions that mobilize a youth's social systems to help that young person deal with the problem, i.e., the family and peer systems, would make sense from a number of standpoints. The first objective of the research proposed here is to compare the effectiveness of two different modalities. One of these is a state-of-the-art family therapy approach, Transitional Family Therapy (TFT), which integrates nuclear family, here-and-now interventions, with multigenerational issues. The other is a standardized version of the established modality of Adolescent Group Therapy (AGT), which includes both psycoeducational and therapeutic components. Both approaches have been developed expressly to target adolescent alcohol problems. Participants will be 140 males and females, ages 13-17, with diagnoses of alcohol abuse or dependence. Following random assignment to conditions, treatment in either condition will take four months in addition to two months of aftercare (six months total). Outcomes will be compared at treatment termination, one year post-treatment, and two years post-treatment. The second objective is to establish a standard as to the outcomes that can be achieved with AGT for this population. Even though group therapy is probably the most widely used treatment modality for such problems, there presently appear to be no clinical trails defining its parameters and expectation with adolescent alcohol abusers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GROUP MOTIVATIONAL INTERVENTION IN DRUG ABUSE TREATMENT Principal Investigator & Institution: Magura, Stephen; Acting Executive Director; National Development & Res Institutes Research Institutes, Inc. New York, Ny 100103509 Timing: Fiscal Year 2002; Project Start 20-DEC-1999; Project End 31-MAY-2004

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Summary: High rates of early dropout from out patient drug free (ODF) programs and subsequent relapse are critical issues for substance abuse treatment. Motivational interventions to address this have shown effectiveness in alcoholism treatment. This study would extend development of such interventions in three ways: by demonstrating a new group Motivational Interventional (GMI) as an option to existing individual motivational therapy; by testing the efficacy of this group model as an induction to standard ODF treatment rather than as a free-standing treatment; and by extending such motivational interventions from primary alcoholics to drug users (cocaine, opiates, cannabis). The specific aims and methods of the study are: 1) To implement a new Group Motivational Intervention as an induction to standard outpatient treatment. The intervention will employ the motivational elements of effective brief therapies (FRAMES) in a group setting. GMI consists of a total of four twice-weekly, manualdriven, small group sessions with the objectives of helping patients identify and understand their ambivalence about substance use, treatment and recovery. 2) To conduct an efficacy trial of GMI, by contrasting drug-abusing patients voluntarily randomly assigned to two conditions: (a) GMI followed by outpatient treatment "as usual" (N=120), and (b) outpatient treatment "as usual" (i.e., direct admission to clinicbased outpatient treatment) (N=135). The primary outcome variables are length of retention in treatment and substance use at 3 and 6 month follow-ups. 3) To determine the patient characteristics and treatment process variables which may predict drop-out and other differences in treatment outcomes. Key variables to be examined will include: sociodemographics, criminal involvement, treatment history, substance abuse severity, psychiatric severity, consequences of substance abuse, motivation for change, selfefficacy, therapeutic alliance, group treatment climate, "autonomy supportiveness" of treatment, types and amounts of services, received, 12- step involvement, and social support. 4) To conduct a cost-effectiveness analysis of GMI. Because even a brief group therapy may add to treatment costs, it is important6 to determine the cost per patient for each additional unit of positive outcome achieved (assuming outcomes improve). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GROUP TREATMENT FOR DEPRESSION IN HEART FAILURE Principal Investigator & Institution: Friedman, Michael A.; Psychology; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, Nj 08901 Timing: Fiscal Year 2003; Project Start 14-FEB-2003; Project End 31-JAN-2006 Summary: (provided by applicant): The overall aim of this research is to develop an efficacious group psychotherapy for the treatment of major depression among individuals with congestive heart failure. Both major depression and heart failure are associated with severe loss of functioning and increased mortality, and this co-morbid condition is particularly debilitating. While treating depression among heart failure patients has the potential to improve functioning and prolong life in this population, there are currently no empirically-supported treatments for depression among heart failure patients. Among the several well-validated psychosocial treatments, group cognitive-behavioral therapy (CBT) has been proposed as efficacious, and has established feasibility among heart failure patients. Group CBT may be particularly efficacious among CHF patients with depression due to the potential for increasing patient social support. Initial research suggests that there are several ways in which current group CBT could be improved to treat major depression among CHF patients, including: (1) the use of an "open" group format that allows for immediate patient care, (2) integration of individual interventions to individually tailor treatment goals and improve adherence to treatment, and (3) family-based interventions within the group

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CBT format to mobilize patient social support. The proposed integrated cognitivebehavioral therapy program includes group, individual, and family treatment (GIFT) for depression among individuals with CHF (GIFT-CHF). The current proposal is designed to develop the GIFT-CHF program. The proposal consists of three phases: a Development, Pilot, and Revision Phase. During the Development phase of the GIFTCHF, the goal of the research will be to: (a) develop an integrative group therapy program for depressed patients with heart failure (GIFT-CHF); (b) develop a therapist training program; and (c) develop and test the reliability and validity of competence and adherence rating scales. During the Pilot phase of the GIFT-CHF program, the goal will be to conduct a small pilot trial investigating the short-term efficacy of the GIFT-CHF program in comparison to a Standard Medical Care/Wait-List control group, and determine effect size. Finally, during the Revision phase of the GIFT-CHF program, the goal of the research will be based on the results of the Development and Pilot phases, to revise the GIFT-CHF program and treatment manual. This treatment development grant will lay the groundwork for a large-scale treatment outcome study of the GIFT-CHF program for depressed individuals with congestive heart failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LIFESTYLE CHANGE TO INCREASE BONE DENSITY IN TEEN GIRLS Principal Investigator & Institution: Debar, Lynn L.; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 946123433 Timing: Fiscal Year 2003; Project Start 01-JUL-1999; Project End 30-JUN-2005 Summary: The annual cost of osteoporosis-related fractures in the US is $8 billion, most of which is borne by women in spite of an abundance of research on factors that might ameliorate the postmenopausal drop in bone mineral density (BMD). An important component of a lifelong prevention strategy would be to create methods for young women in the years 14-20 to maximize their bone mineral content and maintain it until menopause. This proposal will rigorously test two comprehensive lifestyle interventions, both oriented toward healthy diet and sustainable exercise, one based on individual counseling and the other on group intervention, against an attention control. The aim is to build bone and prevent bone loss among young women 14 to