xvi, 90 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Empirical support for the efficacy of CBT in treating depression suggests that the majority of clients will respond to this intervention. However, the more nuanced, and clinically relevant, question of "Which clients will respond to CBT for depression?" has been difficult to answer. Research efforts have focused on two different approaches to this question. One approach focuses on trajectories of symptom change within the first weeks of treatment to identify clients who are most likely to achieve response. A second approach looks to pretreatment client variables such as hopelessness and dysfunctional attitudes to identify clients who are more likely to respond. The current study is the first to simultaneously compare these two approaches to the prediction of treatment outcome. The sample consists of 222 clients (65.32% female, 92.79% Caucasian), ages 18 through 64 (M =27.85, SD = 11.28), receiving treatment for mood and anxiety disorders (59% met criteria for comorhid disorders) in a CBT oriented psychology training clinic. Results suggest that the rate of change in depressive symptoms over the first five treatment sessions significantly and consistently predicted outcome over and above the majority of pretreatment variables, except for precontemplation stages of change scores and initial severity of depression and anxiety symptoms. Similarly, rate of change in anxiety symptoms significantly predicted outcome on two of the three measures over and above the majority of pretreatment variables, except for hopelessness and initial severity of anxiety symptoms. Post hoc analyses revealed different predictors of outcome when trajectories of change and pretreatment variables were examined separately. Both rates of change and a number of pretreatment variables predicted outcome. Finally, pretreatment predictors of rate of early symptom change such as a contemplative orientation to change and therapist experience, were identified which may suggest that therapists should target these factors to potentially maximize rapid early symptom change, and in turn outcome. The findings are discussed in terms of their implications regarding methodological approaches to treatment outcome research and treatment planning for adults with comorbidities. / Committee in charge: Anne Simons, Chairperson, Psychology; Philip Fisher, Member, Psychology; Hyoun Kim, Member, Not from U of O; Jane Mendle, Member, Psychology; Jeff Todahl, Outside Member, Counseling; Psychology and Human Services

Efficacy of multidisciplinary inpatient treatment of feeding disordered children was sought through retrospective chart review of 40 G-tube dependent children ages 22 months to 7 years. Premature births were 55% of the sample ranging from 23 to 36 weeks gestation. The majority of co-occurring medical conditions included congenital anomalies (50%), gastroesophageal reflux disease (25%) and chronic lung disease (25%). Treatment effect analyzed from pre and post treatment measures of oral and G-tube caloric intakes resulted in a significant difference from admission to discharge for both oral intake, t (39) = 5.76, p < 0.001, d = 1.02, and G-tube dependency, t(39) = 10.94, p < 0.001, d = 2.03 with both showing strong treatment effects. Results indicated a highly reliable and valid method of treating severe pediatric feeding disorders.

The present study examined whether or not the temporal pattern of symptom change defined as sudden gains is applicable to and has significant ramifications for understanding recovery from eating disorders. Sudden gains were defined as stable and clinically significant changes that take place between two sessions of treatment. Data for the current study were drawn from an efficacy study of CBT for eating disorders which included session-by-session measures of eating disorder symptomatology. Predictors of sudden gains were measured by an observer coded scale that included ratings of therapist use interventions, client change in behaviors and beliefs, client engagement, and homework completion. Three research questions were addressed: First, is the phenomenon of sudden gains present in CBT for eating disorders? Second, do sudden gains in CBT for eating disorders follow the three-stage model proposed for sudden gain recovery in other disorders (i.e., cognitive changes during critical sessions => sudden gains => upward spiral that includes further cognitive changes and greater long-term symptom improvement (Tang & DeRubeis, 1999b)? Third, what are the predictors of sudden gains in CBT for eating disorders that distinguish the critical session that takes place right before the sudden gain? Findings suggest that many eating disordered clients (62%) experienced at least one sudden gain during the course of CBT treatment. Three distinct types of sudden gains were identified: total symptom sudden gains, eating-related sudden gains, and body-related sudden gains. The average magnitude of these sudden gains was large representing on average 35% of total symptom improvement. Clients who experienced total symptom and body-related sudden gains demonstrated fewer eating disordered symptoms than the other clients at posttreatment. During the session preceding the sudden gain, therapists had increased levels of cognitive interventions and empathy, and clients experienced more cognitive changes and increased motivation.

Obsessive-compulsive disorder (OCD) is associated with substantial impairment across a number of life domains. Recently increased interest has been focused on the bi-directional relationship between OCD and family processes, particularly a subset of family reactions to OCD symptoms that are termed "accommodation." Accommodation consists of any changes in family members' behavior aimed at preventing or reducing the patient's rituals or their distress related to OCD symptoms. For example, family members may provide patients with supplies they need to ritualize (e.g., extra soap), or may engage in rituals themselves (e.g., excessive washing). Previous research has indicated high levels of accommodation are associated with more severe OCD symptoms and functional impairment on the part of patients, and may interfere with the first line psychosocial treatment for OCD, a form of cognitive behavior therapy (CBT) consisting of exposure (to cues provoking obsessions) and ritual prevention (ERP). Thus, the aims of this research project were to develop and test a brief intervention focused on reducing accommodation in the family members of adult OCD patients with the aim of facilitating the implementation of ERP. Eighteen patient and family member dyads participated in the study. All patients received a course of standard individual ERP for OCD. Family members were randomized to either the intervention group or a control group that did not receive any intervention. The goals of the two-session intervention were to identify current accommodation behaviors and provide alternative ways of responding to OCD symptoms. Patients and family members were assessed at baseline and regularly throughout the 25-week study. Results revealed that the intervention successfully reduced accommodation with a large effect size. Patients whose family members received the intervention showed greater levels of symptom reduction than patients whose family members had not. Hierarchical regression analyses revealed that change in family accommodation from baseline accounted for a significant amount of variance in later OCD symptoms. These results suggest that this intervention successfully enhanced the outcomes of standard CBT including ERP for adults with OCD. The findings support further exploration of this intervention in larger samples and in other diagnostic groups where accommodation is likely to occur.

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Guidelines for conducting effective exposure treatment with anxious youth emphasize content (e.g., preparation for and processing of the exposure) and process (e.g., collaboration and youth involvement) variables as important elements of exposure task sessions, but there is a paucity of research examining these guidelines. Using multiple regression, this study evaluated the extent to which independent observers' ratings of process (i.e., collaboration and youth involvement) and content variables (i.e., preparation for and processing after the exposure task) were predictive of treatment outcome in a sample of 61 anxiety-disordered youth. Results indicated that collaboration between the youth and therapist significantly predicted improvement in treatment outcome as measured by youth-, parent-, and teacher-reports. Youth involvement in exposure task sessions predicted improved outcome as measured by teacher-report. Contrary to expectation, preparation for exposure did not predict outcome, but post-event processing of the exposure task was significantly predictive of clinician-rated diagnostic outcome. Exploratory analyses suggest that treatment responders were more likely to be assigned between-session exposure tasks as "homework" and were more likely to be rewarded for their efforts in session. Treatment implications and future directions are discussed. / Psychology

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The current study extended earlier findings about the RealVictory program by using a larger sample and by examining Victory Seeker phone use in more detail. Using a sample of 144 juveniles, it was found that as the number of calls answered increased, the likelihood of a rearrest and the number of rearrests decreased slightly but the differences were not statistically significant. However, as the number of calls increased, the likelihood of a felony rearrest decreased significantly and the total number of felony arrests decreased significantly. These findings suggest that Victory Seeker may be a useful tool to reinforce and provide follow-up after treatment.

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