Correlation between histone lysine methylation and developmental changes at the chicken beta-globin locus

Methylation of histones at specific residues plays an important role in transcriptional regulation. Chromatin immunoprecipitation of dimethylated lysine 9 on histone H3 across 53 kilobases of the chicken beta-globin locus during erythropoiesis shows an almost complete anticorrelation between regions of elevated lysine 9 methylation and acetylation. Lysine 9 is methylated most over constitutive condensed chromatin and developmentally inactive globin genes. In contrast, lysine 4 methylation of histone H3 correlates with H3 acetylation. These results lead us to propose a mechanism by which the insulator in the beta-globin locus can protect the globin genes from being silenced by adjacent condensed chromatin.

Prospective matching of alcoholic clients to cognitive-behavioral or interactional group therapy

OBJECTIVE

In earlier work, client sociopathy and global psychopathology were effective variables for treatment matching: clients low on both sociopathy and severity of psychopathology were likely to benefit from interactional group therapy, whereas those scoring high on either of these dimensions benefited more from a coping skills intervention. The present study assessed whether outcomes improve further when clients are assigned to group treatments prospectively based on a matching strategy derived from the previous findings.

METHOD

All participants (N = 250, 66% men) met criteria for alcohol dependence or abuse. About half were prospectively assigned to either cognitive-behavioral (CB) coping skills training or interactional therapy, those with higher levels of psychiatric severity or sociopathy were given CB and those who were low on both dimensions were given interactional therapy. The other half were randomly assigned to those treatments, replicating the procedure of the earlier study. Outcome data were collected at the conclusion of treatment and at 3-month intervals for 1 year following.

RESULTS

Prospective matching of clients to treatment did not produce superior drinking outcomes compared to random treatment assignment. Randomly assigned clients were more likely to be abstinent at the end of treatment, but this effect disappeared at later follow-ups. Prospectively matched clients had fewer negative consequences of drinking than did those assigned randomly (unmatched). Neither sociopathy nor psychiatric severity was particularly effective for matching.

CONCLUSIONS

The matching effects from our previous study were not replicated. Nevertheless, prospective matching did reduce the negative consequences of drinking, consistent with our previous results.

Reactivity to alcohol-related stimuli in the laboratory and in the field: predictors of craving in treated alcoholics

AIMS

(1) To search for predictors of alcohol craving in treated alcoholics; (2) to evaluate the relationship between craving and drinking immediately after treatment.

DESIGN

Alcoholic patients in treatment underwent cue-reactivity trails in the laboratory and then recorded craving in the field using hand-held computers. Laboratory craving was correlated with craving in the field, and moods and situations recorded in the field were correlated with contemporaneous craving ratings using a multi-level correlational design.

SETTING

A VA Medical Center substance abuse treatment program provided the treatment and laboratory settings. The patients' home environment was the field setting.

PARTICIPANTS

Male alcohol-dependent veterans (N = 26) treated in a VA inpatient or intensive outpatient program.

INTERVENTION

Participants underwent two cue-reactivity laboratory sessions prior to discharge to measure craving. Following discharge, participants recorded drinking and cravings eight times per day for 21 consecutive days.

MEASUREMENTS

Craving ratings in the laboratory and multiple recordings per day of surroundings, craving and mood state in the field.

FINDINGS

Desire to drink in the laboratory accounted for 8-10% of the variance in later drinking and urges to drink recorded in the field--a modest correlation. Frequency of positive urges in the field was significantly correlated with drinking frequency. Those who reported urges in the field had greater alcohol dependence and higher trait anger and anxiety scores than non-reporters.

CONCLUSIONS

Craving is related to drinking immediately following treatment, and is most likely in those who have more severe dependence and greater mood disturbance. These individuals may benefit most from interventions for coping with cravings after treatment.

A dental fears typology of oral surgery patients: matching patients to anxiety interventions

Two studies are described in which dental patients were administered the Dental Fear Survey (DFS) and then received 1 of 5 anxiety reduction interventions to prepare them for extraction of 3rd-molar teeth. Interventions included standard clinic treatment, oral premedication, and several relaxation-based procedures. Dependent variables were self-reported and observer-rated distress. In the 1st study (N = 231), cluster analyses of the DFS subscales revealed that patients could be subtyped as low-fear, high-fear, or cue-anxious patients who admitted fear only in response to specific stimuli. Dental fear subtypes were distinguishable by situational cognitions reported, and fear subtype interacted with anxiety intervention to predict distress. These results were replicated in the 2nd study (N = 150). The results are seen as supportive of a multidimensional view of dental anxiety.

A dental fears typology of oral surgery patients: matching patients to anxiety interventions

Two studies are described in which dental patients were administered the Dental Fear Survey (DFS) and then received 1 of 5 anxiety reduction interventions to prepare them for extraction of 3rd-molar teeth. Interventions included standard clinic treatment, oral premedication, and several relaxation-based procedures. Dependent variables were self-reported and observer-rated distress. In the 1st study (N = 231), cluster analyses of the DFS subscales revealed that patients could be subtyped as low-fear, high-fear, or cue-anxious patients who admitted fear only in response to specific stimuli. Dental fear subtypes were distinguishable by situational cognitions reported, and fear subtype interacted with anxiety intervention to predict distress. These results were replicated in the 2nd study (N = 150). The results are seen as supportive of a multidimensional view of dental anxiety.

Inducing craving for alcohol in the laboratory

Research on the mechanisms of craving often involves inducing craving in subjects in controlled settings. This article describes techniques that have been used to induce craving for alcohol, including (1) exposing subjects to actual alcoholic beverages, (2) exposing subjects to visual representations of alcoholic beverages, (3) manipulating the subjects' mood states, and (4) controlling environmental settings. The intensity of craving can be rated by the subjects themselves or can be assessed by clinicians through behavioral observations or the measurement of certain physiological responses. Success in inducing craving in the laboratory, however, has been inconsistent. Ultimately, researchers may need to monitor subjects' craving responses in actual environmental settings.

Ecological momentary assessment (EMA) with treated alcoholics: methodological problems and potential solutions

Ecological Momentary Assessment, a methodology by which information can be obtained about phenomena as they occur in a person's natural environment, was used to assess the antecedents to relapse in treated alcohol abusers. Alcoholic participants (N = 27) were asked to record their urge to drink alcohol and their mood state, situation, and alcohol use on 5- x 7-in. record cards in response to 8 random prompts per day for 21 consecutive days after discharge from a Veterans Affairs inpatient treatment center. The purpose of the research was to determine the extent to which drinking urges occurred in the patient's home environment after treatment and to identify the mood states and alcohol-related stimuli associated with urges. Field recordings were prompted by a programmable wrist watch. Results suggested that compliance with procedures was excellent and that the occurrence of drinking and of drinking urges was relatively rare. However, significant methodological problems were brought to light that may have compromised the results. These problems are presented and potential solutions are proposed.

Ecological momentary assessment (EMA) with treated alcoholics: methodological problems and potential solutions

Ecological Momentary Assessment, a methodology by which information can be obtained about phenomena as they occur in a person's natural environment, was used to assess the antecedents to relapse in treated alcohol abusers. Alcoholic participants (N = 27) were asked to record their urge to drink alcohol and their mood state, situation, and alcohol use on 5- x 7-in. record cards in response to 8 random prompts per day for 21 consecutive days after discharge from a Veterans Affairs inpatient treatment center. The purpose of the research was to determine the extent to which drinking urges occurred in the patient's home environment after treatment and to identify the mood states and alcohol-related stimuli associated with urges. Field recordings were prompted by a programmable wrist watch. Results suggested that compliance with procedures was excellent and that the occurrence of drinking and of drinking urges was relatively rare. However, significant methodological problems were brought to light that may have compromised the results. These problems are presented and potential solutions are proposed.

Alcohol cue reactivity, negative-mood reactivity, and relapse in treated alcoholic men

Relapsed alcoholic individuals frequently report that negative emotional states trigger their return to drinking. A parametric laboratory study was conducted to assess the separate and combined effects of exposure to alcohol-related stimuli and induced negative moods in abstinent alcoholic persons. The authors also sought to determine if reactivity to alcohol cues or reactivity to negative mood induction predicted relapse soon after treatment. Men with alcoholism (N = 50) undergoing inpatient treatment participated in a guided imagery procedure designed to induce negative moods and were then exposed to either their favorite alcoholic beverage or to spring water. Results indicated that both alcoholic beverage presentation and negative affect imagery led to increased subjective reporting of desire to drink. These effects were additive but not multiplicative (i.e., the interaction of mood state with beverage type was not significant). Reported urge to drink during the trial that combined negative mood imagery with alcoholic beverage exposure predicted time to relapse after inpatient discharge.

5-Azadeoxycytidine-induced chromatin remodeling of the inactive X-linked HPRT gene promoter occurs prior to transcription factor binding and gene reactivation

During the process of 5-aza-2'-deoxycytidine (5aCdr)-induced reactivation of the X-linked human hypoxanthine phosphoribosyltransferase (HPRT) gene on the inactive X chromosome, acquisition of a nuclease-sensitive chromatin conformation in the 5' region occurs before the appearance of HPRT mRNA. In vivo footprinting experiments reported here show that the 5aCdr-induced change in HPRT chromatin structure precedes the appearance of three footprints in the immediate 5' flanking region that are characteristic of the active HPRT allele. These and other data suggest the following sequence of events that lead to the reactivation of the HPRT gene after 5aCdr treatment: (a) hemi-demethylation of the promoter, (b) an "opening" of chromatin structure detectable as increased nuclease sensitivity, (c) transcription factor binding to the promoter, (d) assembly of the transcription complex, and (e) synthesis of HPRT RNA. This sequence of events supports the view that inactive X-linked genes are silenced by a repressive chromatin structure that prevents the binding of transcriptional activators to the promoter.

Alcohol cue reactivity, negative-mood reactivity, and relapse in treated alcoholic men

Relapsed alcoholic individuals frequently report that negative emotional states trigger their return to drinking. A parametric laboratory study was conducted to assess the separate and combined effects of exposure to alcohol-related stimuli and induced negative moods in abstinent alcoholic persons. The authors also sought to determine if reactivity to alcohol cues or reactivity to negative mood induction predicted relapse soon after treatment. Men with alcoholism (N = 50) undergoing inpatient treatment participated in a guided imagery procedure designed to induce negative moods and were then exposed to either their favorite alcoholic beverage or to spring water. Results indicated that both alcoholic beverage presentation and negative affect imagery led to increased subjective reporting of desire to drink. These effects were additive but not multiplicative (i.e., the interaction of mood state with beverage type was not significant). Reported urge to drink during the trial that combined negative mood imagery with alcoholic beverage exposure predicted time to relapse after inpatient discharge.

In vivo footprinting and high-resolution methylation analysis of the mouse hypoxanthine phosphoribosyltransferase gene 5' region on the active and inactive X chromosomes

To investigate potential mechanisms regulating the hypoxanthine phosphoribosyltransferase (HPRT) gene by X-chromosome inactivation, we performed in vivo footprinting and high-resolution DNA methylation analysis on the 5' region of the active and inactive mouse HPRT alleles and compared these results with those from the human HPRT gene. We found multiple footprinted sites on the active mouse HPRT allele and no footprints on the inactive allele. Comparison of the footprint patterns of the mouse and human HPRT genes demonstrated that the in vivo binding of regulatory proteins between these species is generally conserved but not identical. Detailed nucleotide sequence comparison of footprinted regions in the mouse and human genes revealed a novel 9-bp sequence associated with transcription factor binding near the transcription sites of both genes, suggesting the identification of a new conserved initiator element. Ligation-mediated PCR genomic sequencing showed that all CpG dinucleotides examined on the active allele are unmethylated, while the majority of CpGs on the inactive allele are methylated and interspersed with a few hypomethylated sites. This pattern of methylation on the inactive mouse allele is notably different from the unusual methylation pattern of the inactive human gene, which exhibited strong hypomethylation specifically at GC boxes. These studies, in conjunction with other genomic sequencing studies of X-linked genes, demonstrate that (i) the active alleles are essentially unmethylated, (ii) the inactive alleles are hypermethylated, and (iii) the high-resolution methylation patterns of the hypermethylated inactive alleles are not strictly conserved. There is no obvious correlation between the pattern of methylated sites on the inactive alleles and the pattern of binding sites for transcription factors on the active alleles. These results are discussed in relationship to potential mechanisms of transcriptional regulation by X-chromosome inactivation.

Presurgical satisfaction with facial appearance in orthognathic surgery patients

Orthognathic surgery and orthodontic therapy are most often performed to improve the patient's appearance. However, not all patients are satisfied with the result though the procedure may be considered successful by the orthodontist and the maxillofacial surgeon. It has been suggested that the patient's satisfaction with his or her facial appearance before the surgery can predict later satisfaction with orthognathic procedures. The present study examined the role of several potential predictor variables in satisfaction with facial appearance before orthognathic treatment. The variables, identified in previous research, included severity of facial disharmony, self-concept, psychological distress, gender, age, and socioeconomic status. Questionnaires were gathered from 54 patients in 10 orthodontic practices in Connecticut and New York. Contrary to expectations, gender, age and socioeconomic status failed to predict patients' presurgical satisfaction with appearance. Self-concept, psychological distress, and orthodontists' ratings of total facial appearance (from a lateral view) were bivariate predictors of satisfaction. When all variables were analyzed with a multiple regression analysis, however, only self-concept emerged as a significant independent predictor of satisfaction with appearance. This accounted for 15% of the variance in satisfaction. Orthodontists' ratings of facial views, considered here objective measures of disharmony, were predictive neither of satisfaction with appearance nor of self-concept. It is suggested that self-concept may be a predictor of postsurgical as well as presurgical satisfaction with appearance and that self-concept itself may be unaffected by severity of facial disharmony, at least in young adults. Orthodontists may need to pay special attention to those patients with poor self-concept, because these patients may be more likely to report unsatisfactory surgical outcomes.

Self-efficacy as a component of active coping: effects on cardiovascular reactivity

Active coping remains a poorly understood construct in cardiovascular reactivity testing. We have shown that active coping comprises two independent effects: the enhanced control and the effort of exercising control. The present study tested the proposition that, with effort left unconstrained, increased self-efficacy will increase cardiovascular response. Forty women were assigned to low or high self-efficacy conditions; self-efficacy was manipulated using false feedback. Subjects then engaged in a video game shape-matching task, while blood pressure and heart rate were monitored. SBP and DBP changes were smaller in the low self-efficacy group, as predicted: 17.9 versus 25.2 mmHG for SBP (p < 0.05); and 8.7 versus 13.0 mmHG for DBP (p = 0.07). Heart rate was similar for the two conditions. We conclude that self-efficacy for a task may be an integral part of the active coping process, indirectly affecting the blood pressure response by acting on the effort involved in the coping response.

A model of pain and anxiety associated with acute stressors: distress in dental procedures

Many acute stressful experiences are not inherently very harmful, yet are associated with great pain and anxiety. The characteristics and experiences that the person brings to the situation are more important than any objective characteristics of the experience itself in determining how aversive the experience will be. Dental procedures are excellent examples of this type of stressor. Drawing primarily on the literature related to dental procedures, the present article discusses the nature of pain and anxiety in the face of an acute stressor, and presents the dispositional and situational factors that contribute to the perception of an acute stressor as aversive. A model is presented illustrating how the various factors interact. It is argued that, in addition to being descriptive, the model is also prescriptive of measures that may be taken to ameliorate the distress of persons subjected to acute stressors like dental procedures.

Preparation for oral surgery: evaluating elements of coping

Third-molar extraction patients (N = 231) underwent one of five preparatory interventions offering different levels of relaxation, control, and self-efficacy to evaluate the relative importance of each of these elements of coping in the context of an acute stressor. Prior to surgery subjects completed measures of monitoring and blunting. Results indicated that relaxation, perceived control, and self-efficacy were each significant, and roughly equivalent, contributors to coping, and operated in an additive way. Intervention type, and the interaction of intervention type with blunting score, significantly predicted distress prior to and during surgery. It was concluded that no single element is crucial to effective coping and that interventions that provide more coping elements are generally superior. Additionally, the interaction of coping style with intervention is as strong a contributor to coping outcome as the other factors. Those who prefer to distract themselves may benefit most from interventions that require the least possible personal investment of effort and attention.

Craniomaxillofacial trauma in the elderly

PURPOSE

Limited data are currently available regarding the nature of craniomaxillofacial fractures in the geriatric population. This retrospective study reviews 109 hospital records dating from 1981 to mid-1993. The goal of this study was to provide details relevant to these types of injuries.

RESULTS

Most patients were injured in motor vehicle accidents (MVA) or fall-related episodes. Females sustained 43.9% of the fractures while males sustained 56.1%. In females, falls were the most common cause of fractures, while in males MVAs caused the majority of fractures (P < .01). Most fractures were found in the upper midface region (60.3%) and the mandible (27.5%). MVAs and falls were responsible for 82.7% of all mandibular fractures. The majority of fractures were treated nonsurgically (49.5%); however, 37.6% were treated with open reduction and internal fixation. The in-hospital mortality rate was 11.1%, and there were three postoperative complications.

CONCLUSION

The geriatric craniomaxillofacial trauma patient is readily treatable with both aggressive surgical measures and more conservative approaches. Elderly patients often have an underlying medical condition that may subsequently alter the patient's treatment. The findings of this study also suggest that more preventive measures and methods of minimizing mortality and morbidity need to be implemented.

Self-efficacy as a moderator of perceived control effects on cardiovascular reactivity: is enhanced control always beneficial?

We have found that enhanced control has an attenuating effect on cardiovascular reactivity when effort of responding is maintained constant; however, not all individuals will react to increased control in the same manner. In the present study, 40 subjects engaged in a mental arithmetic task under high control (self-paced) and low control (externally paced) conditions. Subjects' self-efficacy concerning this task was assessed. As expected, significant main effects were found for control condition, with high control producing smaller blood pressure and heart rate changes than low control (11.4 vs. 20.4 mm Hg (systolic blood pressure), 4.4 vs. 11.4 mm Hg (diastolic blood pressure), and 6.2 vs. 7.9 beats per minute (heart rate)). No main effects were found for self-efficacy. However, the interaction between control and self-efficacy was significant for systolic blood pressure and heart rate and marginally significant for diastolic blood pressure; post hoc tests showed that this was due to the effect of self-efficacy classification under high control conditions; subjects with low self-efficacy for the mental arithmetic task evidenced cardiovascular changes that were significantly greater than those of the high self-efficacy group (8.0 vs. 14.8 mm Hg (systolic blood pressure), 2.7 vs. 6.1 mm Hg (diastolic blood pressure), and 5.2 vs. 7.1 beats per minute (heart rate). The data suggest that the reactivity observed during active coping is due in part to the effort of responding and in part to the match between the demands of the task and certain mastery-related attributes of the individual.

Multidimensional causal model of dental caries development in low-income preschool children

Despite the decline in the incidence of dental caries in the United States over the past several years, the condition remains a significant problem for the nation's poor children. Efforts to identify the factors responsible for caries development in samples of children of low socioeconomic status have primarily focused on a limited number of variables, and those have been predominantly biological (mutans streptococci, for example). Resulting models of caries development have usually shown good sensitivity but poor specificity. They have had limited implications for treatment. In an effort to produce a comprehensive model of caries development, 184 low-income preschool children were clinically assessed for mutans streptococci and for decayed, missing, or filled surfaces of deciduous teeth twice, first at age 4 years (baseline) and again a year later (year 1 assessment). As the clinical assessments were being done, caretakers were being interviewed to obtain data from five domains: demographics, social status, dental health behaviors, cognitive factors such as self-efficacy (self-confidence) and controllability, and perceived life stress. Data were analyzed using a structural equations modeling approach in which variables from all domains, plus baseline decayed missing and filled surfaces and baseline mutants, were used together to create a model of caries development in the year 1 assessment. Results confirmed earlier work that suggested that caries development at a 1-year followup was strongly dependent on earlier caries development. Early caries development in this sample was determined in part by mutans levels and by dental health behaviors. These behaviors themselves were accounted for partly by a cognitive factor. The results support the advantages of employing multidimensional models and provide some direction for intervention to reduce caries incidence.

The type A/type B distinction. Subtyping alcoholics according to indicators of vulnerability and severity

Multidimensional typologies of alcoholics are reviewed, including Cloninger's neurobiological learning model, Morey and Skinner's hybrid model, and Zucker's developmental model. The more recent Type A/Type B typology proposed by Babor and colleagues is reviewed in more depth, as is a previous replication and extension by Litt and colleagues. Both the original study and the replication indicate this typology is a useful tool in classifying alcoholic inpatients into two groups and in matching alcoholics to the most suitable treatment. The present study replicates the typology using outpatient samples of male alcoholics. The resulting two clusters are very similar to those identified by the two earlier studies. As expected, the relative proportion of Type A alcoholics is higher in the outpatient samples than in the previously studied inpatient samples. Preliminary analysis of the typology's clinical efficiency suggests that the variables used to classify subjects might be appreciably reduced, thus effecting a considerable time savings in assessment. A discriminant function analysis indicates that using only 5 of the original 16 clustering variables results in a correct classification rate of almost 95%. Future research directions are addressed.

Coping with oral surgery by self-efficacy enhancement and perceptions of control

Recent work has suggested that patients' coping could be improved in stressful dental situations if perceptions of self-efficacy and control could be enhanced. To test this hypothesis, 70 first-time third-molar extraction patients were randomly assigned to one of four surgery preparation conditions: standard preparation, oral premedication, relaxation, and a relaxation+efficacy-enhancing feed-back condition in which subjects were given false galvanic skin response (GSR) biofeedback leading them to believe that they were highly skilled at relaxing. Analyses indicated that: (1) all treatments were seen as equally credible (controlling for placebo effects); (2) a priori contrasts showed that both the relaxation-only treatment and the relaxation+efficacy-enhancement treatment were superior to the premedication and standard preparations in raising coping self-efficacy; (3) regardless of treatment condition, increase in reported coping self-efficacy was significantly correlated with pre-operative anxiety, with self-reported peri-operative distress, and with behavioral ratings of peri-operative distress; and (4) the relaxation treatments resulted in lower pre-operative anxiety than the other interventions, and linear contrasts showed significant trends in which the relaxation+efficacy-enhancing condition was superior to the relaxation-only condition, which was in turn superior to the medication condition and the standard preparation in reducing both pre-operative anxiety and behavioral ratings of peri-operative distress. It was concluded that thoughts related to self-confidence and control can be manipulated, and that these thoughts can in part determine how well a person copes in stressful dental situations.

Relationship between role-play measures of coping skills and alcoholism treatment outcome

Alcoholic clients were given role-play tests, involving various social and drinking-related scenarios, before and after two types of aftercare treatment. The assessments were used both to evaluate the effects of treatment and to determine whether any dimensions of pretreatment role-play performance interact with treatment type to predict treatment outcome. Eighty-nine patients were randomly assigned to aftercare group treatment involving either interactional therapy or coping skills training. Clients in both treatments experienced declines in their urge to drink during the role-play scenes from pre- to posttreatment, and these declines were related to reductions in heavy drinking. Three pretreatment role-play variables interacted with type of treatment to predict outcome: observer-rated skill, observer-rated anxiety, and self-reported urge to drink. In general, those patients who did better in the role plays had better drinking outcomes following interactional therapy. Those who experienced more difficulty in the role plays fared best with coping skills training. The results suggest that role-play measures could be used for patient-treatment matching, although it remains to be determined whether they will be superior to more easily assessed patient characteristics.

Types of alcoholics, II. Application of an empirically derived typology to treatment matching

Data from 79 male alcoholics who were randomly assigned to either coping skills training or interactional group psychotherapy were used to replicate a multidimensional, empirically derived typology and to evaluate the typology's usefulness in matching patients to treatment. Consistent with previous cluster analysis research, indicators of risk for alcoholism, alcohol dependence, drinking history, and psychopathological impairment distinguished alcoholics along two broad dimensions of vulnerability and severity, with one subtype (type B alcoholics) manifesting an earlier onset of problem drinking, more familial alcoholism, greater dependence on alcohol, and more symptoms of antisocial personality than the other subtype (type A alcoholics). Analyses of outcome indicated that type A alcoholics fared better in interactional treatment and more poorly with coping skills training. Conversely, type B alcoholics had better outcomes with the coping skills treatment and worse outcomes with interactional therapy. Differences in treatment response were maintained for 2 years from the beginning of aftercare treatment.

Measuring treatment process in coping skills and interactional group therapies for alcoholism

An instrument designed to measure components of two distinct alcoholism aftercare treatments was developed and evaluated for reliability and validity. Trained judges reliably rated audiotaped samples of coping skills and interactional group therapy sessions. Coping skills groups engaged in significantly more education and skill training, problem solving, and role playing. Interactional groups showed more interpersonal learning, expression/exploration of feelings, and here-and-now focus. Groups that employed more education and skill training, less expression and exploration of feelings, and less here-and-now focus were associated with fewer members reporting subsequent drinking-related problems. None of the ratings of group activities was related to abstinence.

Coping with gastrointestinal endoscopy: self-efficacy enhancement and coping style

Forty-eight men scheduled for endoscopy were assessed for preferred coping style and assigned to one of four preparation conditions: (a) relaxation plus coping self-efficacy (SE) enhancement, (b) relaxation only, (c) procedural information, and (d) no preparation. It was hypothesized that increases in SE would be associated with better behavioral and self-report assessments of coping with endoscopy, and that coping style would moderate effects of SE enhancement. Hypotheses were largely confirmed. Ss in SE enhancement preparation experienced greater increases in coping SE and greater decreases in distress before and during endoscopy than did other Ss. Changes in coping SE were negatively correlated with changes in anticipatory anxiety, and SE ratings were significantly related to distress during endoscopy. Ss classed as monitors fared most poorly with no-preparation, whereas blunters did most poorly with procedural information.

Coping and cognitive factors in adaptation to in vitro fertilization failure

Characteristics were identified that predict adaptation following an unsuccessful attempt at in vitro fertilization (IVF). Forty-one women and their husbands were interviewed and administered questionnaires prior to IVF and 2 weeks after notice of a positive or negative pregnancy test. Of the 36 couples who failed to conceive as a result of IVF, 6 of the women studied developed clinical depressive symptoms. Those women who reported poorest adaptation to IVF failure were more likely to have reported depressive symptoms prior to IVF, were more likely to have reported feeling a general loss of control over their lives as a result of infertility, tended to use escape as a coping strategy, and reported having felt some responsibility for their IVF failure. Dispositional optimism, as well as a sense of being partially responsible for the infertility, was protective of distress following IVF failure.

Coping with gastrointestinal endoscopy: self-efficacy enhancement and coping style

Forty-eight men scheduled for endoscopy were assessed for preferred coping style and assigned to one of four preparation conditions: (a) relaxation plus coping self-efficacy (SE) enhancement, (b) relaxation only, (c) procedural information, and (d) no preparation. It was hypothesized that increases in SE would be associated with better behavioral and self-report assessments of coping with endoscopy, and that coping style would moderate effects of SE enhancement. Hypotheses were largely confirmed. Ss in SE enhancement preparation experienced greater increases in coping SE and greater decreases in distress before and during endoscopy than did other Ss. Changes in coping SE were negatively correlated with changes in anticipatory anxiety, and SE ratings were significantly related to distress during endoscopy. Ss classed as monitors fared most poorly with no-preparation, whereas blunters did most poorly with procedural information.

Matching alcoholics to coping skills or interactional therapies: two-year follow-up results

Ninety-six subjects were recruited from an inpatient alcoholism treatment program and randomly assigned to aftercare group treatment with either coping skills training or interactional therapy. Survival analyses using 2-year outcome data provided evidence for the durability of matching interaction effects. The data supported a priori hypotheses that individuals scoring high on measures of sociopathy or global psychopathology have better outcomes in coping skills treatment, whereas patients low on these dimensions have better outcomes in interactional treatment. Contrary to the original hypothesis, patients with cognitive impairment had better outcomes in interactional treatment, and patients without cognitive impairment did better in coping skills treatment.

Matching alcoholics to coping skills or interactional therapies: Two-year follow-up results

Ninety-six subjects were recruited from an inpatient alcoholism treatment program and randomly assigned to aftercare group treatment with either coping skills training or interactional therapy. Survival analyses using 2-year outcome data provided evidence for the durability of matching interaction effects. The data supported a priori hypotheses that individuals scoring high on measures of sociopathy or global psychopathology have better outcomes in coping skills treatment, whereas patients low on these dimensions have better outcomes in interactional treatment. Contrary to the original hypothesis, patients with cognitive impairment had better outcomes in interactional treatment, and patients without cognitive impairment did better in coping skills treatment.

Reactivity to alcohol cues and induced moods in alcoholics

It has been theorized that respondent conditioning processes in part underlie desire for alcohol and thus contribute to relapse after alcoholism treatment. One implication of this theory is that the relevant conditioned responses could be eliminated by respondent extinction, in which the alcoholic patient is exposed to alcohol-related stimuli while being prevented from consuming alcohol. However, exteroceptive cues such as the sight and smell of alcoholic beverages are not always sufficient to elicit desire for alcohol. In view of this, it has been suggested that interoceptive cues, such as mood states, may also play a role in eliciting desire for alcohol. To test this, eight alcoholic subjects were induced to experience negative or neutral moods on four separate days, and then exposed to the sight and smell of their favorite alcoholic drink, and to a neutral stimulus (seltzer water), in a within-subjects design. Results from this work indicate that: (a) negative moods can be reliably induced in the laboratory as confirmed by subjects' reports; (b) exposure to alcohol cues had no effect on desire for alcohol while subjects were in a relaxed, neutral mood state; (c) the presence of negative mood states alone appeared to be sufficient to elicit desire for alcohol in some subjects, regardless of whether alcohol or water was presented. These data argue that negative mood states may cue desire for alcohol independent of other cues. The data also suggest that reactivity to alcohol cues may be substantially reduced by relaxation.

A comparison of methods for assessing sociopathy in male and female alcoholics

This study compared four methods for assessing sociopathy in alcoholics. A total of 79 male and 39 female inpatient alcoholics were administered the following scales: (1) the NIMH Diagnostic Interview Schedule (DIS) which provides a DSM-III diagnosis of antisocial personality disorder (APD) and an antisocial symptom count; (2) the Hare Psychopathy Checklist; (3) the Socialization scale from the California Psychological Inventory (CPI-So); and (4) the MMPI-168 Psychopathic Deviate (Pd) scale. Factor analysis for the four continuous measures (DIS symptom count, Hare, CPI-So, MMPI-168 Pd) resulted in a one factor solution, implying that all four scales measure a single underlying construct. The CPI-So had the highest loading, indicating that this measure has the strongest degree of association with the underlying construct of sociopathy. Results of a discriminant function analysis indicated that only the CPI-So reliably discriminated between alcoholics diagnosed APD and non-APD by the DIS. These findings indicate that CPI-So is a valid and easily administered continuous measure of sociopathy in alcoholic patients.

Matching alcoholics to coping skills or interactional therapies: posttreatment results

This study tested the hypothesis that patients could be matched to effective treatments on the basis of certain pretreatment characteristics. Specifically, it was hypothesized that those Ss who showed more sociopathy, more psychopathology, and greater neuropsychological impairment would have better outcomes when treated with coping skills training and, conversely, that those with less impairment in these areas would have better outcomes with interactional treatment. Ninety-six male and female Ss were recruited from an inpatient alcoholism treatment program and randomly assigned to 1 of these 2 types of aftercare group treatment. Linear and logistic regression analyses partially confirmed the hypotheses. Coping skills training was more effective for Ss higher in sociopathy or psychopathology, and interactional therapy was more effective for Ss lower in sociopathy. Generally, both treatments appeared equally effective for Ss lower in psychopathology. Contrary to expectations, those more neuropsychologically impaired appeared to have better outcomes after interactional therapy.

Matching alcoholics to coping skills or interactional therapies: Posttreatment results

This study tested the hypothesis that patients could be matched to effective treatments on the basis of certain pretreatment characteristics. Specifically, it was hypothesized that those Ss who showed more sociopathy, more psychopathology, and greater neuropsychological impairment would have better outcomes when treated with coping skills training and, conversely, that those with less impairment in these areas would have better outcomes with interactional treatment. Ninety-six male and female Ss were recruited from an inpatient alcoholism treatment program and randomly assigned to 1 of these 2 types of aftercare group treatment. Linear and logistic regression analyses partially confirmed the hypotheses. Coping skills training was more effective for Ss higher in sociopathy or psychopathology, and interactional therapy was more effective for Ss lower in sociopathy. Generally, both treatments appeared equally effective for Ss lower in psychopathology. Contrary to expectations, those more neuropsychologically impaired appeared to have better outcomes after interactional therapy.

Self-efficacy and perceived control: cognitive mediators of pain tolerance

The cold-pressor task was used with 102 female undergraduates in 2 experiments to determine (a) whether self-efficacy has validity as a true causal determinant of behavior change or is a correlate of change that has already occurred and (b) how perceptions of control and self-efficacy interact to determine choice behavior, persistence, and the impact of an aversive stimulus. Results of Experiment 1 indicate that self-efficacy expectations affected performance beyond what would have been expected from past performance alone. Changes in self-efficacy expectations predicted changes in cold-pressor tolerance. These findings suggest that self-efficacy expectations can be causal determinants of behavior in an aversive situation. Results of Experiment 2 indicate that self-efficacy was separable from control and that performance was best if both high levels of perceived control and self-efficacy were present. These findings support the notion that self-efficacy expectations can mediate the desirability of providing control, in that those who benefit most from control are those who are most confident they can exercise it.

Self-efficacy and perceived control: Cognitive mediators of pain tolerance

The cold-pressor task was used with 102 female undergraduates in 2 experiments to determine (a) whether self-efficacy has validity as a true causal determinant of behavior change or is a correlate of change that has already occurred and (b) how perceptions of control and self-efficacy interact to determine choice behavior, persistence, and the impact of an aversive stimulus. Results of Experiment 1 indicate that self-efficacy expectations affected performance beyond what would have been expected from past performance alone. Changes in self-efficacy expectations predicted changes in cold-pressor tolerance. These findings suggest that self-efficacy expectations can be causal determinants of behavior in an aversive situation. Results of Experiment 2 indicate that self-efficacy was separable from control and that performance was best if both high levels of perceived control and self-efficacy were present. These findings support the notion that self-efficacy expectations can mediate the desirability of providing control, in that those who benefit most from control are those who are most confident they can exercise it.

Cognitive-behavioral intervention for irritable bowel syndrome

A 41-year-old white man with a 2-year history of irritable bowel syndrome (IBS) was referred for psychological treatment. At the time of assessment he was being treated with Metamucil and Darvocet N-100s with little success. A detailed psychosocial assessment indicated several areas for cognitive-behavioral intervention. Nine months after the patient began treatment, the frequency of IBS episodes had greatly reduced, he was off narcotic pain medication, and his general health was improved as measured by clinic and emergency room visits. We suggest that psychological interventions of the type described here can be an efficacious and cost-effective treatment for IBS.

Mediating factors in non-medical treatment for migraine headache: toward an interactional model

The inadequacy of traditional (i.e. pharmacological) treatment for migraine headache has led to the development of numerous non-medical interventions (e.g. biofeedback, relaxation, cognitive-behavioral programs). All of these non-medical interventions have produced at least some success in reducing migraine headache parameters. However the mechanism of treatment efficacy is unclear, with a number of not mutually exclusive relationships proposed. Purported mediators of successful outcome in these treatments include specific control of vascular activity, general reduction of autonomic arousal, biochemical changes, cognitive, affective, and behavioral change, therapist contact and support, and credibility and placebo expectancy. The present paper attempts to discuss and evaluate the mechanisms of change that have been proposed as mediators of successful treatment of migraine headache. An interactional model of adaptive change as a function of treatment is presented. The implications of the model for assessment and treatment are discussed. It is suggested that the interactional model may be applicable to the treatment of a range of chronic pain problems.

Seeking urgent pediatric treatment: Factors contributing to frequency, delay, and appropriateness

The present study explored the factors that contribute to mothers' decisions to seek urgent medical attention for their children when symptoms are not of a traumatic nature. One hundred mothers seeking treatment for their children at a prepaid clinic completed a questionnaire eliciting their expectations regarding the course of their children's problems, seriousness of the problems, perceived responsibility for the symptoms, and extent to which a variety of factors contributed to their decisions to seek treatment. Demographic data and information about each child's symptoms and medical history were also obtained. Four major "reasons for seeking treatment" factors were identified: family history of the presenting complaint, worry regarding the symptoms, situational variables, and the extent of the child's illness behavior. The appropriateness of the visit, delay in seeking treatment, and frequency of mothers' use of the pediatric clinic were predicted by the nature of the presenting symptoms (particularly the presence of fever), the ages of the mother and child, and two of the reasons for seeking treatment factors (i.e., family history and child's illness behavior). The present study suggests that mothers pay more attention to presenting symptoms and to the children's behavior than to psychosocial stressors in deciding to seek urgent care.