ASSOCIATION FOR BEHAVIORAL ISSN 0278-8403 AND COGNITIVE THERAPIES VOLUME 32, NO. 7 • OCTOBER 2009 the Behavior Therapist

Contents President’s Message President’s Message Sunk Costs: Backward- Robert L. Leahy Sunk Costs: Backward-Looking Decisions • 137 Looking Decisions Series on Technology Robert L. Leahy, American Institute for Michael D. Anestis and Joye C. Anestis Cognitive Therapy Using Social Media Tools in Clinical Psychology: The Experience of Psychotherapy Brown Bag • 140 e are all familiar with the following: Research Forum WYou pay good money for a suit or dress, take Bruce E. Wampold, Zac E. Imel, and Scott D. Miller it home, look at it, and hang it Barriers to the Dissemination of Empirically Supported in the closet. Years go by, you Treatments: Matching Messages to the Evidence • 144 take it out and look at it and say, “It’s not me—I’ll wear something else.” You Book Review can’t seem to throw it out although you really know you won’t wear it again. You say, “I can’t Reviewed by Chad E. Drake throw it out. It’s hardly been used. I paid good Roemer & Orsillo (2009), Mindfulness- and Acceptance-Based money for it.” Or, more significantly, you have Behavioral Therapy in Practice • 156 been stuck in a dead-end relationship that has dragged on for years. You know—“ratio- Multimedia Journal nally”—it makes sense to get out, but you can’t. Your friends urge you to look at the costs and Maureen Whittal benefits of staying versus getting out. You know Looking to the Future of Cognitive and Behavioral Practice • 157 rationally they are right, but you can’t pull the plug. In both cases, you are “honoring” the sunk Letter to the Editor costs of prior decisions. You can’t abandon the sunk cost because you believe you have to justify Patti Lou Watkins and George A. Clum why you have stayed in so long. You say, “If I left Empirically Evaluated Self-Help Therapies • 157 it would mean I wasted all that time”; “I can’t stand the feeling of loss”; “If I left it would prove At ABCT I am a failure”; or “You don’t understand. There really are good things there. I just have to wait Kristene A. Doyle for things to turn around.” In fact, your reasons To Lead or Not to Lead? • 159 for staying may continue to change—because Virginia Rutter you are highly motivated to prove that you are not wrong in staying in the first place. Your deci- Three Recipients of the Neil S. Jacobson Research Award sion is “backward-looking,” attempting to jus- for Outstanding and Innovative Clinical Research • 160 tify what you have done in the past. Ironically, CALL for AWARD NOMINATIONS • 161 the longer you stay in, the greater the sunk cost and the greater the need to justify your decision WELCOME, NEW MEMBERS • 162 to stay. You are making decisions looking back-

October • 2009 137 the Behavior Therapist Published by the Association for Behavioral and Cognitive Therapies 305 Seventh Avenue - 16th Floor New York, NY 10001-6008 (212) 647-1890/Fax: (212) 647-1865 www.abct.org

EDITOR · · · · · · · · · · · · Drew Anderson Editorial Assistant ...... Melissa Them Behavior Assessment . . . Timothy R. Stickle Book Reviews · · · · · · · · · · · C. Alix Timko Clinical Forum· · · · · · · · · · · John P. Forsyth Clinical Dialogues ...... Brian P. Marx International Scene ...... Rod Holland Institutional Settings...... David Penn Tamara Penix Sbraga Lighter Side · · · · · · · · · · · · Elizabeth Moore List Serve Editor ...... Laura E. Dreer News and Notes...... David DiLillo Laura E. Dreer James W. Sturges Public Health Issues. . . . Jennifer Lundgren Research-Practice Links· · · · · · · · · · · · · · · · David J. Hansen Research-Training Links· · · · · · · · · · · · · · · · Gayle Y. Iwamasa Science Forum· · · · · · · · · · · Jeffrey M. Lohr Special Interest Groups · · · · · · · · · · Andrea Seidner Burling Technology Update...... James A. Carter INSTRUCTIONS Ñçê AUTHORS

ABCT President ...... Robert L. Leahy The Association for Behavioral and Submissions must be accompanied by Executive Director· · · · · · Mary Jane Eimer Cognitive Therapies publishes the Behavior a Copyright Transfer Form (a form is Director of Education & Therapist as a service to its membership. printed on p. 24 of the January 2008 issue Meeting Services ...... Mary Ellen Brown Eight issues are published annually. The of tBT, or contact the ABCT central of- Director of Communications David Teisler purpose is to provide a vehicle for the rapid fice): submissions will not be reviewed without Managing Editor . . . . . Stephanie Schwartz dissemination of news, recent advances, a copyright transfer form. Prior to publication and innovative applications in behavior authors will be asked to submit a final therapy. electronic version of their manuscript. Copyright © 2009 by the Association for Behavioral Authors submitting materials to tBT do so and Cognitive Therapies. All rights reserved. No Feature articles that are approximately part of this publication may be reproduced or trans- 16 double-spaced manuscript pages may with the understanding that the copyright mitted in any form, or by any means, electronic or be submitted. of the published materials shall be as- mechanical, including photocopy, recording, or any signed exclusively to ABCT. Submissions information storage and retrieval system, without Brief articles, approximately 6 to 12 permission in writing from the copyright owner. via e-mail are preferred and should be sent Subscription information: the Behavior Therapist is double-spaced manuscript pages, are to the editor at [email protected]. published in 8 issues per year. It is provided free to preferred. ABCT members. Nonmember subscriptions are Please include the phrase tBT submission available at $40.00 per year (+$32.00 airmail Feature articles and brief articles in the subject line of your e-mail. Include postage outside North America). should be accompanied by a 75- to the first author’s e-mail address on the Change of address: 6 to 8 weeks are required for address changes. Send both old and new addresses to 100-word abstract. cover page of the manuscript attachment. the ABCT office. Letters to the Editor may be used to By conventional mail, please send manu- ABCT is committed to a policy of equal opportu- nity in all of its activities, including employment. respond to articles published in the scripts to: ABCT does not discriminate on the basis of race, Behavior Therapist or to voice a profes- Drew A. Anderson, Ph.D. color, creed, religion, national or ethnic origin, sex, sional opinion. Letters should be lim- sexual orientation, gender identity or expression, SUNY–Albany age, disability, or veteran status. ited to approximately 3 double-spaced Dept. of Psychology/SS369 All items published in the Behavior Therapist, manuscript pages. including advertisements, are for the information of 1400 Washington Ave. our readers, and publication does not imply endorse- Albany, NY 12222 ment by the Association.

138 ward to past investments and not making make the trap more familiar (Leahy, 2000). References decisions based on future utility. Third, you can divide (or bifurcate) the deci- Rational decision-making models argue Arkes, H. R. (1996). The psychology of waste. sion: “If you had never gotten into this be- Journal of Behavioral Decision Making, 9, 213- that we make choices based on future util- havior, would you make a decision to get 224. ity, but evidence for sunk costs suggests that into it now?” Fourth, the patient can exam- we are often trapped by past commitments Arkes, H. R., & Ayton, P. (1999). The sunk cost ine the justifications and challenges to these and Concorde effects: Are humans less ratio- and investments. Indeed, the greater the rationalizations: “I have too much invested nal than lower animals? Psychological Bulletin, sunk cost, the greater the escalation of com- to walk away”; “I now have a responsibility 125, 591-600. mitment. There are endless examples of Arkes, H. R., & Blumer, C. (1985). The psychol- sunk costs. Along with your out-of-style to make it work out”; or “I’m not frivo- lous—I don’t walk away from my commit- ogy of sunk cost. Organizational Behavior & jacket or dress, there are sunk costs in rela- Human Decision Processes, 35, 124-140. tionships, careers, purchases, and even in ments.” These assumptions may be examined utilizing cognitive therapy tech- Festinger, L. (1957). A theory of cognitive disso- foreign policy. The Vietnam War is a much- nance. Palo Alto, CA: Stanford University agreed-on sunk cost, but when the United niques: “What if you looked at your prior Press. States was engaged in that war a significant investments as lost costs that you can never Festinger, L. (1961). The psychological effects of majority of Americans supported the war. recover? How would putting more of your- insufficient rewards. American Psychologist, An entire nation at times was committed to self into this help you achieve your ultimate 16, 1-11. honoring sunk costs. President Johnson in goals?” Fifth, you can externalize the deci- Gilovich, T., & Medvec, V. H. (1994). The tem- fact made the bold sunk-cost justification sion by asking, “What if your friends had to poral pattern to the experience of regret. for staying, claiming that we couldn’t give make the decision for you? What would Journal of Personality & Social Psychology, 67, up because we had lost so many men. Sunk they decide?” This helps decouple the decider 357-365. costs are common in behavioral finance from the decision. Sixth, you can identify the Gilovich, T., Medvec, V. H., & Chen, S. (1995). where investors double-up on a losing in- Commission, omission, and dissonance re- fear of “wasting,” which often underlies the vestment to “get their money back.” We duction: Coping with regret in the “Monty often “ride a loser.” fear that walking away from the sunk cost is Hall” problem. Personality & Social Psychology Humans are the only animals who honor an admission of having wasted time and re- Bulletin, 21, 182-190. sunk costs (Arkes & Ayton, 1999). sources. This fear can be addressed by rec- Jones, E. E., & Davis, K. E. (1965). From acts to Laboratory rats may show a burst of activity ognizing that losses (or wasting) are always dispositions: The attribution process in per- as they face extinction trials when reinforce- involved in decision making, but the self-in- son perception. In L. Berkowitz (Ed.), ments have been eliminated, but they terest strategy would be not to throw good Advances in experimental social psychology (Vol. 2, pp. 219-266). New York: Academic Press. quickly learn to look somewhere else for re- money after bad. Seventh, many people wards. Why are rats “smarter” than hu- stay in sunk costs because of the fear of hu- Kahneman, D., & Tversky, A. (1979). Prospect mans? Or are we too smart for our own theory: An analysis of decision under risk. miliation: “I would be telling everyone that Econometrica, 47, 263-291. good? Unlike the “rational” rat, humans I was wrong and they were right.” This con- appear condemned to continually reflect on Kiesler, C. A., Nisbett, R. E., & Zanna, M. P. cern can be addressed by recognizing that (1969). On inferring one’s beliefs from one’s their past decisions, attempting to make most friends will be happy to have you behavior. Journal of Personality & Social “sense” of them and to justify their future agree with them and happy that you are out Psychology, 11, 321-327. decisions by reference to the past. Honoring of your misery but, in the event that they Leahy, R. L. (2000). Sunk costs and resistance to sunk costs can be explained by loss aversion use this as a reason for criticism, it may be a change. Journal of Cognitive Psychotherapy: an (Wilson, Arvai, & Arkes, 2008), commit- price worth paying to cut your losses. International Quarterly, 14, 355-371. ment theory (Kiesler, Nisbett, & Zanna, Leahy, R. L. (2004). Decision making processes 1969), cognitive-dissonance theory Eighth, some people fear the flood of nega- tive feelings following abandoning a sunk and psychopathology. In R. L. Leahy (Ed.), (Festinger, 1957, 1961), prospect theory Contemporary cognitive therapy: Theory, research, and loss frames (Kahneman & Tversky, cost. This can be addressed by an analogy of and practice (pp. 116-138). New York: 1979), fear of wasting (Arkes, 1996; Arkes pulling a splint from a toe. It hurts until it Guilford Press. & Blumer, 1985), attribution processes (for stops hurting and then it is followed by re- Wilson, R. S., Arvai, J. L., & Arkes, H. R. (2008). example, Jones & Davis, 1965), and inac- lief. Being stuck in a sunk cost is the ulti- My loss is your loss...sometimes: Loss aver- tion inertia (Gilovich & Medvec, 1994; mate helplessness and is a guarantee for sion and the effect of motivational biases. Gilovich, Medvec, & Chen, 1995). In each depression, anger, and hopelessness (Leahy, Risk Analysis, 28, 929-938. case it is the absence of reward that makes 2000, 2004). this puzzling until we recognize that it is the We often get trapped by our need to jus- ... “interpretation” of change and the “need to tify the decisions that have continued our explain” the past that keeps us trapped. misery—looking backward to the past for Correspondence to Robert L. Leahy, Ph.D., How can we liberate ourselves from the justification, rather than committing to ac- American Institute for Cognitive Therapy, 136 sunk cost trap? First, standard cognitive E. 57th St., Suite 1101, New York, NY tions for future utility. Focusing on valued therapy inquiries can be used, but may lead 10022; [email protected] nowhere. For example, one can ask about goals rather than valuing our past can help the costs and benefits of continuing in the liberate us from commitments whose pay- course of action. Patients often say, “I know offs have turned into deficits. Our “rational- it’s irrational, but I can’t get out.” Second, ity” may be less logical than we think and educating the patient about sunk costs (the more determined by rationalizing the past jacket in the closet) immediately helps to rather than pursuing a better future.

October • 2009 139 Series on Technology stand that our colleagues are extremely busy and that our invitations could serve as a bit of a burden, so we have had to develop Using Social Media Tools in Clinical tactful, understanding approaches to mak- ing such offers in order to entice contribu- Psychology: The Experience of tors without becoming a bother. Our efforts to develop a steady list of guest contributors Psychotherapy Brown Bag are still ongoing and, as such, the workload in these early days of the business is fairly Michael D. Anestis and Joye C. Anestis, Psychotherapy Brown Bag high as we take on the vast majority of the and Florida State University writing. As with any new online business, one of our initial priorities was to maximize traffic EDITOR’S NOTE: This article marks ing tools (e.g., Typepad versus Blogger) and to the site and general knowledge of our the first of a series of articles looking at po- the best way to obtain a domain name, and goals. We found ourselves somewhat un- tential uses of new technologies for ABCT we spent a considerable amount of our early sure about how to develop a following for members. If you have any ideas or sugges- PBB days brainstorming on the design of the site, as there did not seem to be an obvi- ous method by which to alert a wide audi- tions for articles, please send me an email. the site—but these activities were actually ence to our project. Granted, a significant —D.A. quite enjoyable, as they marked the begin- ning of an exciting new business venture in portion of the global population suffers with which we wholeheartedly believe and to or knows an individual suffering with a s a pair of advanced graduate stu- mental illness, but the general knowledge dents trained in the clinical science which we are fervently devoted. In our first 6 months, we have incurred some costs, as we regarding ESTs for mental illness and re- Atradition, the struggles of dissemi- search findings in clinical psychology is lim- nating empirically supported treatments invested in professional services to design a banner for the page and optimize our visi- ited enough that a website with our goals (ESTs) in a world full of misinformation has must seek out readers rather than simply often been at the forefront of our minds. In bility in search engines (e.g., Google), but we counter these costs through the use of scoop up an already existing audience. The fact, we have at times been downright de- constraints of the graduate student wallet moralized that all of this great research and advertisements and the creation of an online store run in cooperation with Amazon prevented us from utilizing high-cost, more these effective treatments exist, yet so few traditional advertising opportunities. As people know about them. We knew we through which we recommend research- based books, DVDs, and Kindle products such, we needed to find an alternative way wanted to do something about it, but found to promote our services in a cost-effective ourselves unsure how to make a difference. about psychology. PBB is updated every weekday, exclud- manner that would enable us to reach as After years of brainstorming ways in which broad an audience a possible, encompassing ing holidays and vacations, and we take we could effectively sing the praises of ESTs both professionals and nonprofessionals. turns supplying articles. One of the lucky to a wide audience while we are on graduate This is where social media tools became cru- things about running a business with your student wallets (which are slim) and sched- cial in our efforts. spouse is that your business partner always ules (which are full), we decided to stick our Our first attempt at publicity was simple knows your work availability, so it is easy to toes into the world of blogs (although we word of mouth. Through conversations and tend to say “online magazine”) and distribute tasks between us! The average ar- e-mails, we alerted family, friends, and col- launched Psychotherapy Brown Bag ticle takes us approximately 1 to 3 hours to leagues. This resulted in substantial encour- (http://www.psychotherapybrownbag.com) write. For some this might seem like too agement, but only a small flurry of visits to on March 1, 2009. The central aims of PBB much time outside of our academic respon- the site. Our next step was to create a pres- are to disseminate research findings in clini- sibilities, but to us it is definitely worth it. ence on Facebook (www.facebook.com), a cal psychology and information on ESTs for We also welcome articles from anyone who social media website that allows individuals mental illness to the general public (both wants to write one, as long as the informa- to follow the lives of others as well as to re- clinicians and consumers, thus ostensibly tion discussed is consonant with the goals of ceive news regarding causes, individuals, helping to bridge the research-practice gap) PBB. On the first weekday of every month, and organizations of interest (e.g., political and to help individuals find local clinics that we post a guest article from a distinguished figures, celebrities, support groups for par- provide such services. member of the clinical psychology commu- ticular illnesses). We already had experience The actual creation of PBB was far sim- nity—a professor, researcher, or clinician with Facebook, having maintained personal pler than we ever anticipated. In fact, the who is willing to contribute. Past featured pages for several years and being involved most difficult part of the process was com- contributors have included Robert Leahy, with several organizations via the website ing up with a plan for continuously updat- the current president of ABCT, as well as (including ABCT). Creating a Facebook ing the website and selecting a name. Once Craig Bryan of the United States Air Force, presence for Psychotherapy Brown Bag was those decisions were made, the rest was easy. Jill Holm-Denoma of the University of the next logical step. We created two types of We selected a blogging service, purchased a Denver, Sarah Fischer of the University of pages: a group (285 members as of domain name, and PBB was born! In all, Georgia, and several other notable profes- 9/8/2009) and a fan page (150 fans as of about 3 weeks lapsed between the day we sionals. Perhaps our greatest obstacle has 9/8/2009). Facebook has provided an av- began researching this endeavor and the been our own anxiety about approaching enue through which individuals we might launching of the website. We did have to others to write for the site. As graduate stu- not otherwise meet could discover PBB, spend time researching the best blog host- dents in a demanding program, we under- glance at links to our articles, recommend

140 the Behavior Therapist Behavior Therapy Associates, P.A. Proudly Celebrates Its 30th Anniversary 1979–2009

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BTA provides clinical services, consultation, and training using evidence based approaches within the context of sensitivity and compassion, while recognizing the uniqueness of each individual and setting.

PHONE: 732-873-1212 • FAX: 732-873-2584 • E-MAIL: [email protected] www.behaviortherapyassociates.com

October • 2009 141 the site to others, and communicate with the process of writing guest articles for our Study Professional Psychology us. After we publish a new post on site on areas that are outside of our areas of in the Pacific Northwest Psychotherapy Brown Bag, we alert indi- expertise but consistent with the overall viduals following us through Facebook by goals of PBB. So just like Facebook, Twitter PSY.D. in posting a link to our new article. Each has afforded us an opportunity to reach a week, we email all Facebook users following global audience with little effort and no cost CliniCal our group page and provide a list of the on our part. PSYChologY week’s articles as well as any news pieces of Our third and final significant interac- interest. With just a small amount of effort tion with social media tools has been with on our part and at absolutely no cost, Reddit (http://www.reddit.com). Individu- • APA accredited Facebook almost does the work for us, as als sign up for Reddit and post links either Psy.D. degree fans of PBB alert their friends to our pages to the general site or to one of the subhead- and services and those friends pass along in- ings. In our case, the psychology subheading • Practitioner-scholar formation again, and so on. (http://www.reddit.com/r model; contemporary From here, our next move was to create a /psychology) has proven to be the most use- curriculum presence on a similar social media site, al- ful. As of September 8, 2009, the psychol- beit one with which we had less personal ex- ogy subheading of Reddit had over 8,600 • School-operated perience: Twitter (http://www.twitter.com). subscribers. Subscribers click on links and training clinic and Twitter allows users to post links and com- evaluate them by providing a score, either a APA-accredited ments and to follow the comments of other plus or minus one. Links thus receive a total internship program individuals. In doing so, individuals can also score based upon the summed opinions of follow global conversations on particular readers. The higher the score, the further up • Near Portland, Mt. topics (e.g., depression, a particular on the list of headlines it appears, thus in- Hood, and the celebrity, a sporting event) or simply engage creasing the likelihood that it will be seen Oregon coast in conversations with an individual or group and read by a greater number of individuals of individuals on a smaller scale. Each mes- (although there are separate tabs for “dis- Faculty interests include: sage is brief— limited to a total of 140 char- liked” and “controversial” links as well for acters—so each post essentially serves as a individuals who wish to search for articles assessment, behavior therapy, child headline. It was our belief that by entering not necessarily popular with other readers). psychopathology, empirically sup- these conversations and posting links to our Subscribers also have the option of posting ported treatments, forensic psychol- articles, we could increase the degree to comments regarding the link, thus provid- ogy, health psychology, integra- which individuals know about, visit, and in- ing an additional opportunity to interact tive approaches, neuropsychology, teract with our site. This belief has thus far with readers, clarify any confusion, and as- organizational behavior, bilingual proven to be true. We were recently named sess which topics might interest readers psychotherapy with Latinos, psycho- as one of the top 100 science resources on more than others. Thus far, readers have therapy with minorities, and single Twitter by OnlineCourses.org and, as of been directed to our site through Reddit case research. September 8, 2009, we have more than from every continent except Antarctica, 1,800 individuals and organizations follow- with particularly heavy traffic in Europe. As ■■ ing our daily updates. That’s nearly 2,000 such, we have managed to develop new CONTACT US AT: people who are receiving daily information connections with individuals we would oth- Pacific University on ESTs—quite a success, in our opinion! erwise not have had any opportunity to Office of Admissions Additionally, Twitter has developed a social meet while simultaneously accomplishing HPC/Pacific University code by which individuals interact with one our goal of disseminating accurate, re- another. When one individual finds another search-based information on psychopathol- 222 SE 8th Avenue, Ste 212 individual’s post interesting, he or she ogy and psychological treatments. Again, Hillsboro, OR 97123 “retweets” the comment. Retweeting is a we reiterate this was low-effort and entirely 503-352-2218 slang term that refers to making the same free advertising. 800-933-9308 comment as another poster, crediting the Overall, our experience with social [email protected] original poster for the comment (including media tools has been positive. Traffic on our a link to that poster’s profile), and thus website continues to increase substantially, making the comment visible to all people enabling us to reach hundreds of readers per following his or her feed. As such, a single day. We remain optimistic that these tools comment can be made visible to thousands will continue to help our company grown of individuals in mere moments. This has and to reach a broader global audience. We proven to be a highly valuable form of free have also begun experimenting with addi- advertising. Additionally, because individu- tional social media tools such as Digg als only follow the comments of people they (http://www.digg.com) and StumbleUpon choose, the site provides an opportunity for (http://www.stumbleupon.com) and antici- like-minded individuals to network and de- pate experimenting with others as we learn velop professional connections. In this about them. It remains to be seen whether sense, we have found several individuals these sites are as useful as traditional adver- who have expressed an interest in or begun tising methods, but without question, they

142 the Behavior Therapist are a quick and cost-effective means to interpret and links to alternative sources through which to increase awareness of a of information that might explain the topic Study Evidence-Based Therapies cause, issue, company, or service and to tar- in a manner more easily understood by the in the Pacific Northwest get a particular audience likely to interact reader. In fact, we are not the only website with whatever is being marketed. Perhaps out there promoting mental health care and Master of arts in most importantly, utilizing social media we frequently link to such resources as we tools can help a website like ours or even a learn about them. Given the sensitive na- Counseling therapist in private practice to keep up with ture of much of the material covered by PsyChology current trends in the field, issues that are clinical psychologists, whether they work as gaining significant interest, and prominent therapists, researchers, or educators, such names receiving attention on particular considerations are pivotal, otherwise read- • Two-year program topics. Although the goal of our site is to ers will be hurt and, in all likelihood, turn to with late afternoon provide articles on a comprehensive variety other sources for information that might and evening classes of psychology-related topics, we also strive rely less upon research and, as such, be more to ensure that readers are able to find a mul- likely to encounter misinformation. A final • Emphasis on titude of articles on topics directly related to consideration for professionals considering Evidence-Based their interests. By interacting with readers incorporating social media tools into their Practices in Counseling on social media websites, we have been able lives is the issue of personal privacy. We un- (Child and Adult) to develop a greater sense of what topics derstand from discussions with colleagues and Elective Training currently spark the most interest amongst (for example, subscribers to the ABCT list- the widest array of individuals, thus helping serve) that many professionals are nervous in Organizational to capture a larger audience likely to return about having an online presence because of Behavior and Latino to the site and engage with other materials the potential for blurred therapist-client Mental Health we publish. boundaries. This is a legitimate concern, Despite all of the positive aspects of so- but one that can be avoided by being smart • Meets Oregon cial media tools, we remain cautious with and careful in one’s use of these technolo- LPC educational respect to how we present ourselves on gies. For example, on Facebook, we have requirements these websites, as we believe there are sev- been able to maintain both professional and eral potential risks that must be considered. personal identities by taking advantage of Faculty members are experienced Perhaps the greatest of these risks is the po- the many privacy options that Facebook in both practice and research. Their tential for individuals in crisis to misinter- provides. We have limited what the public interests include: behavioral and pret our services and seek emergency can see on our personal sites, while keeping cognitive behavioral therapy, child interventions through our website or our the Psychotherapy Brown Bag pages open and adolescent psychopathology, profiles on various social media tools. As to the public (see the Facebook blog post, anxiety and mood disorders, orga- such, we are careful to clearly state that “10 Privacy Settings Every Facebook User Psychotherapy Brown Bag is an educational Should Know” for details on how to do this: nizational behavior, program evalu- tool, not a therapy provider, and to provide http://www.allfacebook.com/2009/02/face- ation, mindfulness-based therapies, resources such as the National Suicide book-privacy/). Other social media sites can and multicultural counseling. Prevention Lifeline (1-800-273-TALK) for also be navigated and protected in a similar ■■ individuals in crisis. This is an equally im- manner. CONTACT US AT: portant consideration for therapists consid- In weighing the costs and benefits of uti- ering utilizing social media tools, as it is lizing social media tools, there is one final Pacific University entirely possible that individuals seeking point worthy of consideration: regardless of Office of Admissions immediate help will stumble upon a web- whether or not a particular psychologist HPC/Pacific University site and mistakenly interpret it as a source chooses to utilize these tools, other individu- 222 SE 8th Avenue, Ste 212 of help when, in fact, better alternatives als will make the choice to do so. Hillsboro, OR 97123 exist for their immediate situation. An addi- Unfortunately, many of those individuals tional risk—one more unique to the ser- will offer ineffective therapeutic interven- 503-352-2218 vices provided by Psychotherapy Brown tions or attempt to perpetuate misinforma- 800-933-9308 Bag—is the potential that individuals will tion. These individuals will, in large part, [email protected] misinterpret our postings in a manner that not do so out of malice, but rather igno- would result in the proliferation of misinfor- rance. Whether this represents a lack of ed- mation or, on a more personal level, hurt ucation regarding research methods and feelings. Translating complex research find- data analysis, a philosophical devotion to a ings published in fairly esoteric psychology particular therapeutic modality not sup- journals into prose more consistent with ported by research, or a bad personal experi- what one would read in a popular magazine ence with an otherwise effective treatment can be difficult, as some topics require a sig- approach, the end result is the same: a nificant amount of background information voice, widely accessible to the public, mak- in order to be explained clearly. As such, we ing claims that contradict empirical facts. take care to provide several different expla- Readers—consumers of psychological ser- nations for findings that might be difficult vices and information—lack sure-fire

October • 2009 143 methods by which to determine who is pro- In this sense, regardless of whether or not a Correspondence to Michael D. Anestis or viding accurate information and who is pro- clinical psychologist finds him- or herself in- Joye C. Anestis, Florida State University, 953, viding false hope. As such, if there are more terested in social media tools, it could be ar- Parkview Dr., Tallahassee, FL 32311 individuals utilizing social media tools who gued that it is beholden upon them to [email protected] are peddling misinformation and doing so engage in this new source of knowledge in [email protected] on a large stage in a charismatic manner, an effort to provide a voice to research and consumers will be defenseless and the pub- ESTs for mental illness. Psychotherapy lic will remain in the dark regarding data- Brown Bag is lending its voice to the de- driven conceptualizations of mental illness bate, and we hope others will join in the ef- and the most effective means for treating it. fort.

Research Forum Psychotherapy Treatments and a Possible Future The history of psychotherapy is charac- Barriers to the Dissemination of Empirically terized by efforts to promote particular the- Supported Treatments: Matching Messages to oretical perspectives (Cushman, 1992; Fancher, 1995; Wampold, in press). The the Evidence claims of the superiority of one method over another were endemic from the origins of Bruce E. Wampold, University of Wisconsin–Madison, Zac E. Imel, VA Puget psychotherapy, as Freud and his disciples ve- hemently argued about theory and practice Sound Healthcare System–Seattle Division and University of Washington, and (Makari, 2008). The disputes proliferated as Scott D. Miller, International Center for Clinical Excellence the behaviorists criticized the psychoana- lysts, the humanists took a different tack al- together, cognitive constructs were iven the complexity of the thera- treatments, have been limited by percep- accommodated by behavioral theories peutic endeavor, it is not surprising tions that all psychotherapies are equally ef- (Fishman & Franks, 1992), a third wave of Gthat interpreting the evidence is fective [the Dodo Bird verdict], and … “acceptance based” behavioral treatments complex—if it were not, the debate sur- ‘that common factors, therapist, and rela- emerged (Hayes, 2004), and integrationists rounding empirically supported treatments tionship variables account for the majority attempted to reconcile deficiencies in uni- (EST) would be inconspicuously absent. of the variance in therapy outcome studies’“ tary theories (Norcross & Goldfried, 2005). Evidence is not simply observation of phe- (as quoted in Siev, Huppert, & Chambless, These efforts have resulted in hundreds and nomena, regardless of whether the observa- 2009, p. 69). DiGiuseppe offered three al- hundreds of approaches to psychotherapy. tions were derived in experimentally ternatives: “Either we rebut these conclu- Norcross and Newman (1992) said it aptly: manipulated environments (e.g., random- sions, conduct new research to show they ized controlled trials [RCTs]) or naturalistic are wrong, or we accept them and change Rivalry among theoretical orientations has a settings. Rather, evidence involves the in- our message” (as quoted in Siev et al., p. long and undistinguished history in psy- ferences that flow from observations. What 69). chotherapy, dating back to Freud. In the in- constitutes evidence is ultimately decided Siev et al. (2009) have accepted the fancy of the field, therapy systems, like by a confluence of two factors—the phe- premise that barriers to the dissemination of battling siblings, competed for attention nomenon itself and people (Hacking, 1983; ESTs are due to the rhetorical talents of the and affection in a “dogma eat dogma” envi- Latour, 1999). The phenomenon, under dodo birders and have chosen to rebut what ronment... Mutual antipathy and exchange various environmental conditions, is ob- they believe are misguided conclusions of puerile insults between adherents of rival served by people (i.e., the scientists), who about the nature of psychotherapy. orientations were much the order of the day. then draw conclusions about the phenome- Although their article purports to “respond (p. 3) non. The road from observation to conclu- to these contentions and to present an up- sion is saturated with social influences on date on recent research bearing directly on A seemingly reasonable way to settle the scientist. Ultimately, it is the scientific the Dodo Bird verdict” (p. 69), it mostly re- disputes between rival schools is to sift and community that decides which conclusions capitulates old criticisms and ignores con- winnow the various approaches based on are valid and disseminated. tradictory, and at times vast, evidence. their efficacy—treatments that produce Accordingly, publications are, in some Barriers to the dissemination of ESTs are not demonstrable benefits should be preferred sense, rhetorical devices, the purpose of the result of sophistry, but a rational reac- to others. Indeed, such logic gave birth to which is to influence the scientific commu- tion to an interpretation of the evidence. and guided the EST movement (Chambless nity about what is the “proper” evidence We take this opportunity to present evi- & Hollon, 1998; Task Force on Promotion (Latour, 1999). With respect to the ongoing dence that has been omitted and address and Dissemination of Psychological EST debate, Raymond DiGiuseppe (2007) several important questions raised by Siev Procedures, 1995). Unfortunately, agree- recently lamented that “efforts to dissemi- et al. ment about both the type and meaning of nate empirically supported treatments the evidence has proven to be more complex (ESTs), and especially cognitive-behavioral than anticipated.

144 the Behavior Therapist The difficulty in using evidence from affect in the rational condition), the thera- what many consider the “gold standard” of pist redirected the patient to their cogni- sources—RCTs of psychological treat- tions about an event if the patient expressed ments—is illustrated by a taking a hypo- emotion. Additionally, therapists were pro- thetical visit to the future. scribed from using language that referenced emotion. The patient was encouraged to ex- A Hypothetical Future: plore their thoughts about events in their The Ascendance of Affect lives and the therapist was instructed not to POrtlAnd dBt In 2020, due to advances in affective focus on particular themes, but rather allow PrOgrAM, PC the patient to talk about what he or she neuroscience (see Davidson, Sherer, & 5200 SW Macadam Ave. Ste. 580 Goldsmith, 2003), Federico Perla devel- thought was important. Perla trained the Portland, Oregon 97239 oped a new psychotherapy, which he named four therapists used in Study 1 to conduct RC as well as ACP and supervised all treat- DBT is a research-supported treatment affect-centered psychotherapy (ACP). The that combines cognitive-behavioral premise of ACP is that affect evolved to reg- ment. One therapist was removed prior to the study because she could not adhere to theory and methods with Eastern ulate social interactions in nonhuman and meditative principles and practices. eventually human animals. The cognitions the requirement to ignore affect in the RC The Portland DBT Program provides generated by individuals are post-hoc ex- condition. Patients were randomly assigned to conditions and adherence measures treatment for adults, teens, couples, planations of experience that interfere with and families including: the encoding and decoding of emotion, showed adequate fidelity. It was found that ACP was superior to RC on measures of • Standard DBT which in turn leads to dysfunction. ACP in- anxiety but was not definitively superior on • DBT for Adolescents volves a systematic program to emphasize secondary measures of depression and qual- • DBT for Eating Disorders primary emotional responding and mini- ity of life. • DBT for Substance Abuse mize cognitive involvement. Similar to Perla, having shown that ACP was supe- • Trauma Recovery Program other therapies, ACP contains a number of rior to a treatment that contained the com- • Medication Management Services elements that are considered important and mon factors (i.e., a relationship with a • DBT-informed Couples/Family Therapy necessary but not constitutive of the treat- therapist), was convinced that the focus on • DBT Training/Consultation Services ment (Grünbaum, 1981), such as a rela- affect was critical to the successful treat- tionship with a therapist, a cogent For more information please visit our ment of GAD, sought to show that it was explanation, therapeutic actions, and ex- website at www.PortlandDBT.com superior to a well-accepted treatment, pectations for change. Perla, a charismatic or call 503-290-3291 namely cognitive-behavioral treatment and persuasive scientist-practitioner, having (CBT) of GAD, a well-established EST for successfully treated many anxiety disorders Subsequently, several other groups com- GAD (Chambless et al., 1998). However, to with ACP, designed three successive RCTs pared ACP to CBT and found divergent re- ensure that CBT did not work through any to establish the efficacy and specificity of sults. In one study, CBT was superior to mechanisms related to the encoding or de- ACP. ACP on GAD measures, in two studies coding of emotion, the therapists adminis- there were no significant differences, and on tering CBT, like those in the prior study Programmatic Research in ACP a fourth, ACP was superior to CBT on using RC, were proscribed from engaging GAD measures, although the size of the ef- The first study involved a comparison of in any conversations about emotion, or ACP to a waitlist condition. Using four of using any affective language or display of fect was smaller than in Perla’s study (viz., d his therapists, Perla randomized 30 patients emotional responses, and, finally, instructed = .32 vs. d = 1.02, respectively). No differ- with generalized anxiety disorder (GAD) to to redirect any affect-laden material arising ences in studies were found on ancillary one of the two conditions. Not surprisingly, in session to cognitions. The basic CBT pro- measures. Perla reasoned that in the studies ACP was superior to no treatment on tar- tocol was otherwise left unchanged. A wait- in which CBT was equivalent to ACP, CBT geted measures (i.e., measures related to list control group was included as well. worked because the therapists were not pro- GAD) and on other measures (e.g., mea- Additionally, the same three therapists con- scribed from discussing affect and that the sures of depression and quality of life). ducted both ACP and CBT. Because Perla affective components of CBT were responsi- Encouraged by the results and con- received training in the United States by a ble for the benefits of CBT. Moreover, he vinced that the focus on emotion was criti- prominent CBT therapist, he trained the claimed that when CBT was superior to cal to the successful treatment of GAD, therapists in CBT and supervised both ther- ACP, ACP was not delivered in an adequate Perla designed a trial that would control for apists in both modalities. Patients were ran- way. A meta-analysis of these studies the common factors. The control condition domly assigned to both treatments. showed that the aggregate effect size for the in this case was called rational counseling As in the prior studies, fidelity measures five studies was significantly larger than (RC), which involved an engaged therapist showed the treatments were delivered ac- zero (d = .36) for GAD measures with no who probed the patient to express how they cording to their respective protocols. On thought about events in their lives; the thera- measures of GAD symptoms, ACP was su- differences on other variables of psychologi- pist reinforced the verbalizations about cog- perior to CBT (d = 1.02); there were few cal functioning. Based on the totality of the nitions, but did not convey any value about significant differences between ACP and results, it was concluded that (a) ACP the rationality of the thoughts (i.e., did not CBT on ancillary measures, including de- should be designated as an EST, (b) ACP discriminate between adaptive and mal- pression and quality of life. Both treatments works through the specific ingredient of at- adaptive thoughts). To establish internal va- were superior to the no-treatment condition tending to affect, (c) ACP is preferred as a lidity (i.e., control for potential focus on on all measures. treatment of GAD to other treatments.

October • 2009 145 Problematic Conclusions both treatments by the developer of ACP. clusion that a focus on affect is a specific in- This failure of the double-blind is further gredient in the treatment of GAD. The history and conclusions about ACP exacerbated by the fact that the comparison Having briefly visited the past and fu- closely resemble developments in modern treatment, RC, is easily identified as a sham. ture of research on psychological treat- clinical practice—and are equally problem- For reasons of internal validity rather than ments, we now return to the present. In the atic. Anyone familiar with research on psy- quality of care, the therapists in the RC con- following sections, we apply the lessons chotherapy will not find the results of the dition were proscribed from actions that learned to the evidence reviewed by Siev et first trial, where ACP proved superior to no would be reasonable to most therapists al. (2009) and others (e.g., Crits-Christoph, treatment, surprising. Every reasonable (e.g., could not use language that referred 1997; Howard, Krause, Saunders, & treatment administered to patients seeking to affect). What consumer of mental health Kopta, 1997). treatment has been found to be effective rel- services would seek out a practitioner in any ative to no treatment, including such treat- profession who believed the services being The Complete Evidence Base: ments as eye movement desensitization and offered were bogus? And yet, this is exactly The Dodo Bird Redux reprocessing and present-centered therapy the case with the RC condition—therapists for PTSD (e.g., McDonagh et al., 2005; F. Siev et al.’s (2009) criticism of the dodo knew they were delivering a service that was Shapiro, 1989). More importantly, studies bird conclusion that psychological treat- not intended to be therapeutic. As such, the comparing a treatment to a no-treatment ments are equally effective is based largely finding that ACP was more effective is control do not indicate whether the sup- on two studies: (a) a meta-analysis pub- hardly surprising! posed “active” or specific ingredients of the lished almost 13 years ago (viz., Wampold, The third trial, in which it was found particular treatment are responsible for the Mondin, Moody, Stich, et al., 1997) that that ACP was superior to CBT, would rea- change (Wampold, 2001). In the case of corroborated the dodo bird conjecture, and sonably elicit the skepticism of CBT re- ACP, the benefits may be due to the fact (b) a new meta-analysis (viz., Siev & searchers. There are several consequential that ACP delivers a treatment that has a co- Chambless, 2007) that purportedly shows problems here. First, as was the case previ- gent rationale, creates positive expecta- the dodo bird conclusion to be false. Briefly, ously, the therapists had a clear allegiance to tions, involves a relationship with a skilled the study by Wampold, Mondin, Moody, ACP—they worked with Perla, were therapist who collaborates with the patient Stich, et al., utilized a test of effect size ho- trained by Perla, and were supervised by to set treatment goals and involves reason- mogeneity to meta-analytically review all Perla. Second, the CBT protocol was altered able tasks related to those goals (i.e., the direct comparisons of psychotherapies and to obviate any work on emotions, which, components that form the working al- found that the results were consistent with while justifiable as a research operation in- liance)—all factors known to be related to the dodo bird conclusion: There was not tended to tighten internal validity, an emo- successful psychotherapy (Anderson, sufficient evidence to reject the null hypoth- tionless CBT does not represent treatment Lunnen, & Ogles, in press; Imel & esis that the effect size for the comparison of as it would be delivered by a competent Wampold, 2008). various treatments was zero. Said another clinician. Moreover, the only significant dif- The second clinical trial, which com- way, no evidence for differences in efficacy ferences found were in the area of GAD pared ACP to RC, is also problematic. Over between psychological treatments were symptoms—both treatments were equally the years, the RCT has become the “gold found. For many, particularly the advocates effective in terms of addressing depression standard” of research in psychotherapy and of ESTs and, for that matter, anyone who and quality of life, which raises the issue of medicine. As most know, an essential ele- believes that the specific ingredients of par- whether ACP is truly superior to CBT or ment of the RCT in medicine is the double ticular treatments are responsible for the whether, as operationalized in this study, blind; both the patient and the provider of benefits of psychotherapy, this is a challeng- ACP is more focused on GAD symptoms, treatment are unaware of whether they are ing conclusion. raising the specter of reactivity of the mea- providing the real or sham treatment. To Although the conclusions of the sures (i.e., ACP was more focused on symp- point out the obvious, RCTs in psychother- Wampold, Mondin, Moody, Stich, et al. toms of GAD). apy are not double blinded (Seligman, (1997) meta-analysis were consistent with The superiority of ACP to CBT was 1995; Wampold, 2001). Indeed, as previous ones that examined the dodo bird based on only five studies and a reanalysis of Seligman has noted, “Whenever you hear conjecture (Grissom, 1994; D. Shapiro & these trials shows that the effect size for someone demanding the double-blind Shapiro, 1982a, 1982b; Smith, Glass, & GAD symptoms was due primarily to the study of psychotherapy, hold on to your Miller, 1980; see Wampold, 2001, for a re- one study conducted by Perla comparing wallet” (p. 965). Unlike medicine, where a view), a number of important issues that ACP and CBT (i.e., the Perla result was an pill that looks, tastes, and even mimics the limited the generalizability of the results outlier). Indeed, when the Perla study was side effects of the experimental drug makes were raised. In their article, Siev et al. removed from the meta-analysis, the aggre- it difficult for providers to tell the difference (2009) combined these earlier criticisms of gate effect size was not significantly differ- between the experimental and control the Wampold, Mondin, Moody, Stich, et al. ent from zero. Thus, in terms of GAD treatments, control psychotherapies are study with findings from the more recent symptoms, it would be difficult to conclude easy to identify. In the ACP versus RC com- meta-analysis by Siev and Chambless that ACP was superior to CBT. The equiva- parison, the therapists knew about both (2007), identifying four specific method- lence of ACP and CBT for ancillary mea- treatments they were delivering (i.e., the ological flaws with the evidence in support sures adds strength to the conclusion that design was crossed). In addition, the thera- of the dodo verdict: (a) meta-analyses that there may be negligible differences between pists were knowledgeable of the hypothesis aggregate data across disorders masks dif- ACP and CBT. This meta-analysis provides regarding the two therapies, had an alle- ferences between specific treatments for little evidence to suggest that CBT is not in- giance to one of those approaches (viz., specific disorders; (b) meta-analyses that dicated for GAD. In practical terms, there ACP), and were trained and supervised in aggregate primary and secondary outcome is insufficient evidence to support the con-

146 the Behavior Therapist measures preclude the discovery of any spe- order (PTSD; Benish et al., 2008), depres- duced small to moderate effects in favor of cific effects for targeted treatments; (c) the sion (Wampold, Minami, Baskin, & CBT (d = .38, .32, and .20) or small effect in similarity between the treatments included Tierney, 2002), GAD (Siev & Chambless, favor of RT (d = -.20). Indeed, there was in the supporting meta-analyses accounts 2007), and pediatric disorders (Miller, relatively large heterogeneity among the ef- for the failure to find differences in out- Wampold, & Varhely, 2008, when alle- fects but the hypothesis of homogeneity come; and (d) the way these same meta- giance was controlled, which is discussed in was not rejected because five studies yields a analyses classify treatments as bona fide is a following section; Spielmans, Pasek, & drastically underpowered test of homo- circular, eliminating treatments that are not McFall, 2007). geneity (Siev and Chambless calculated efficacious. These issues are not new and The new meta-analysis cited by Siev et 37% of the variability in effects was due to have indeed been helpful in guiding and al. (2009) as evidence that “broad judg- between study variability, although we cal- structuring a program of systematic re- ments about the relative importance of culated 50%). search conducted over the last decade. As technique … can be misleading” (p. 75) was But here is what is very important: The will be discussed below, Siev et al. failed to conducted by Siev and Chambless (2007). advantage to CBT in the Siev and cite this body of research, thereby present- Briefly, the study compared CBT and relax- Chambless (2007) meta-analysis was en- ing an incomplete picture of the evidence. ation therapy (RT) for panic disorder with- tirely accounted for by the one study that We now respond to each of the points raised out agoraphobia and GAD. No differences found a large effect for CBT (d = 1.02), a by Siev et al., citing prior published re- were found between CBT and RT for GAD. study conducted by Clark et al. (1994) sponses to earlier criticisms, and presenting However, for panic disorder, CBT was supe- more than 15 years ago. When that single existing evidence. rior to RT for panic-related symptoms but study is eliminated, the aggregate effect size not for other symptoms of anxiety or de- for CBT versus RT is not statistically differ- Meta-Analyses Were Conducted Across pression. Based on these results, Siev and ent from zero and the between-study vari- Disorders Chambless concluded, “The finding that ability goes from 37% (50% in our Wampold, Mondin, Moody, Stich, et CT and RT do not differ in the treatment of calculation) to 0%. In other words, the al.’s (1997) conclusion about the lack of GAD, but do for PD [panic disorder], is ev- Clark et al. result is, statistically speaking, treatment differences was based on examin- idence for the specificity of treatment to dis- an outlier, without which there is no differ- ing direct comparisons of treatments pub- order, even for 2 treatments within a CBT ence between CBT and RT for any class of lished between 1970 and 1995 in six class, and 2 disorders within an anxiety measures. The basis of Siev et al.’s claim that the journals that typically publish psychother- class” (p. 513). Importantly, they arrive at dodo bird conjecture is false and that there is sub- apy RCTs, regardless of the disorders being such a conclusion despite the fact that (a) no stantial evidence for specificity rests solely on this treated. Siev et al. (2009) raised what was, a priori prediction of such a pattern of re- one study that found that CBT was superior to at the time the study appeared, an impor- sults was made, and (b) no description is RT. tant point to consider (Crits-Christoph, given of the specific mechanism believed to Some would argue that, rather than 1997; DeRubeis, Brotman, & Gibbons, be present in CBT for panic that is responsi- being an anomaly, an outlier might reveal 2005), namely that ignoring disorder may ble for the superiority for panic symptoms an important phenomenon that is obscured well mask differences between treatments only. Exactly what is the specific ingredient in other studies. With that possibility in for particular disorders. DeRubeis et al. of CBT that makes it more effective in re- mind, it is worth taking a closer look at this (2005) articulated this quite clearly: ducing panic-related symptoms in patients one study, as so much rests on its validity. Ignoring disorder “is akin to asking with panic disorder but has no effect on pa- The one outlier in favor of CBT is a study whether insulin or an antibiotic is better, tients with GAD and depression? Finally, it comparing CBT, RT, and imipramine for without knowing the condition for which is ironic that specificity based on a the treatment of panic disorder (a no-treat- these treatments are to be given…. GAD/panic disorder distinction is critical to ment condition was also included) con- Alternatively, researchers should begin with promoting and disseminating CBT when a ducted by Clark and colleagues (1994). a problem and ask how treatments compare perspicuous effort in CBT is to develop pro- There are several aspects of the Clark et al. in their effectiveness for that problem” (p. tocols that are effective across the range of study that are important to note when con- 175). emotional disorders, based on a common sidering the results. The relaxation treat- There are two responses to this argu- diathesis of such disorders (see, e.g., Moses ment in this study was Öst’s (1987) applied ment, however. First, the trials examined by & Barlow, 2006). relaxation, which was modified in two ways Wampold, Mondin, Moody, Stich, et al. Despite the relatively weak evidence for for the comparison with CBT. The first (1997) were, in each case, two treatments specificity, it could be claimed that the supe- modification was changing the rationale for a particular disorder—they were not simply riority of CBT to RT for the treatment of presented to the patients to exclude men- two treatments selected at random or arbi- panic seems to be a clear counter-example tioning that the premise of Öst’s applied re- trarily. Second, and more to the point, there to the dodo bird conjecture determined by laxation involved “a vicious circle in which have been numerous subsequent meta- meta-analytic methods. Let’s examine this the physical symptoms of anxiety are aug- analyses that addressed the criticism of dis- result on which so much rests. In the meta- mented by negative thoughts” (Clark et al., order heterogeneity that have found no analysis conducted by Siev and Chambless p. 761) and instead used a behavioral expla- differences among treatments for particular (2007), the conclusion that CBT was supe- nation that excluded mentioning that disorders, meta-analyses that Siev et al. rior to RT for panic-related measures and thoughts were involved. We would assume (2009) did not mention. These meta-analy- not for generalized anxiety or depression this was done to increase internal validity ses span a number of disorders, including al- was based on five studies. For the panic (thereby preventing excessive discussion of cohol use disorders (Imel, Wampold, Miller, symptom measures, one study had an effect thoughts) and not to improve the quality of & Fleming, 2008), posttraumatic stress dis- that was very large in favor of CBT (d = RT. 1.02) while the remaining four studies pro-

October • 2009 147 The second modification, more conse- equivalent benefit. Or, alternatively, the specific to a disorder (e.g., diagnostic crite- quential, was that in Öst’s development of consumer may well benefit from psychody- ria) may be due to the focus of a treatment RT, exposure to anxiety-provoking stimuli namic therapy, a treatment recently shown on these particular symptoms. was not introduced until after training in re- to be efficacious in the treatment of panic Of more clinical importance, the issue of laxation was completed (8 to 10 sessions), disorder (Milrod et al., 2007). primary and secondary variables attenuates whereas in Clark et al.’s version, exposure So, to a large extent, the claim that the the importance of psychological function- was begun after four sessions—that is to dodo bird conjecture is false rests on the Siev ing of patients and emphasizes diagnostic say, Clark et al. exposed patients to the feared and Chambless (2007) meta-analysis—a criteria instead. Siev et al. (2009) make a stimuli before they had learned to relax. Thus, it study that found no differences between point to show that targeted measures in is quite possible that Clark et al. may have treatments for GAD but did find differ- panic disorder are quite large compared to actually conditioned panic symptoms (i.e., ences for the treatment of panic disorder, all other effects (see panel 3 of their Figure patients were exposed to the feared stimu- but only on panic measures, but not anxiety 1). Their results, as displayed in Figure 1, lus without skills to cope with fear) whereas and depression. More importantly, these re- show that CBT is superior to RT with re- Öst’s protocol correctly desensitized the pa- sults are based entirely on a single study gard to panic symptoms, but not for other tients because they would have the coping (viz., Clark et al., 1994), one which severely, quite important measures of psychological skills to reduce anxiety in the presence of if not fatally, modified RT and for whom the well-being—generalized anxiety and de- the feared stimuli. clinicians delivering the treatments had a pression. It is disappointing that psy- Clark et al.’s (1994) modifications make distinct allegiance to the superior treat- chotherapy research has come to the point it difficult to argue that this trial was a com- ment. If for some, the dodo bird conjecture is that demonstrating relative advantage on parison of CBT and RT, as RT has been devel- to fall because CBT was superior to RT in targeted symptom measures but having lit- oped, administered, and tested. Recall the the Clark et al. study, so be it. The similari- tle impact on important measures of the discussion of hypothetical model of the fu- ties to Perla and the conclusion that ACP is quality of patients’ lives is viewed as com- ture. Perla’s comparison of ACP and CBT superior to CBT, which was worrisome sci- pelling evidence from which to argue for was flawed because Perla modified CBT to entifically, are unmistakable. The (hypo- specificity. Removing symptoms but not increase the validity of the comparison with thetical) future is the present. benefitting patients generally is not a desir- ACP, but in the process the CBT delivered able outcome to many—most importantly in Perla’s comparison was not CBT as de- It Is Inappropriate to Aggregate Primary to patients. signed and delivered by CBT therapists. and Secondary Measures To illustrate the imprudence of focusing Indeed, it is not unusual that when a cogni- exclusively on the symptoms of a particular Siev et al. (2009) emphasized that meta- tive or behavioral treatment is found to be disorder, consider a trial comparing CBT analyses should not aggregate across out- inferior to another treatment (e.g., an in- and present-centered therapy for PTSD come measures because certain patterns of sight-oriented treatment), the claim is (McDonagh et al., 2005). Present-centered results would fail to be revealed—an argu- made that the CBT was not delivered faith- therapy is based on a problem-solving ment that echoes criticisms made by Crits- fully or skillfully, despite adequate fidelity model and similar to condition in the Perla Christoph (1997), who raised a similar ratings (see Jacobson, 1991). example; RC and present-centered therapy argument when Wampold, Mondin, Another consequential aspect of the were both purposefully developed so as not Moody, Stich, et al. (1997) was initially Clark et al. (1994) study was also foreshad- to contain any specific ingredients of the ex- published. Siev et al. failed to reference that, owed in the Perla story—namely, the thera- perimental treatment (e.g., exposure or in response to Crits-Christoph, the trials pists involved in the trials. The therapists in cognitive restructuring) believed to be re- meta-analyzed by Wampold, Mondin, the Clark et al. trial were Ann Hackmann medial to the disorder. In the McDonagh et Moody, Stich, et al. were re-analyzed by and Paul M. Salkovskis, widely regarded as al. study, the only significant difference in Wampold and his students (Wampold, accomplished CBT therapists, co-authors of outcomes between the CBT and PCT was Mondin, Moody, & Ahn, 1997) and it was the article, and closely allied with Clark. for the completers in terms of proportion of found that the dodo bird conclusion applied to Indeed, Salkovskis, along with Clark, devel- patients meeting diagnostic criteria at fol- targeted as well as secondary variables. As well, oped the CBT used in this trial and Ann low-up. Said another way, significantly we have published meta-analyses that now Hackmann has published many articles on fewer patients who completed CBT met di- segregate analyses for primary measures, CBT and has been involved in the develop- agnostic criteria for PTSD at the follow-up and in these meta-analyses no differences ment of various cognitive-behavioral treat- assessment—a difference was not signifi- are found among treatments for primary ments. Both therapists were supervised by cant in the intent-to-treat sample. There variables for a number of disorders (e.g., David Clark. Despite Siev et al.’s (2009) were no differences between the two treat- Benish et al., 2008; Imel et al., 2008). contention that the trials in the meta-analy- ments in terms of anxiety, depression, disso- Moreover, there is strong evidence that pri- sis were fair because therapists “were ciative experiences, hostility, anger, and mary and secondary measures are not con- crossed with treatment condition,” the quality of life. What conclusion can one ceptually or psychometrically distinct therapists in the Clark et al. study were make about a treatment that impacts the (Flückiger, Regli, Grawe, & Lutz, 2007; clearly aligned with and had allegiance to criteria used to make the original diagnosis Krueger, 1999; McGlinchey & CBT. Perhaps there is a clinical implication and offers little other relative advantage? Zimmerman, 2007; Meyer, Pilkonis, & of this study: A consumer seeing either of Combined with the fact that over 40% of Krupnick, 2002; Moses & Barlow, 2006; these two therapists would rather receive patients in CBT dropped out versus less Tanaka-Matsumi & Kameoka, 1986). This CBT than RT, as administered in this trial. than 10% in present-centered therapy, one suggests that making a distinction between However, the same consumer seeing a ther- has to question the emphasis placed on these two classes is not appropriate and apist who has an allegiance to RT and who meeting criteria for a disorder and ignoring raises the specter that changes in measures followed Öst’s protocol may well attain an measures of psychological functioning and

148 the Behavior Therapist well-being and the acceptance of the treat- comes for patients who undergo a treat- could lead to therapeutic exposure, then ment (see, as well, Schnurr et al., 2003, ment that is fully intended to be therapeu- questions are raised about the necessity of which found a similar result). Certainly, psy- tic” (p. 158). The intent of Wampold and prolonged and repeated exposure to the chotherapy can do better. And certainly we colleagues’ meta-analysis was to examine trauma memory in the form of PE (e.g., lis- have to be cautious about disseminating the relative efficacy of various psychothera- tening to tapes, etc.). Conversely, if merely CBT prematurely, given the high dropout pies that were plausibly therapeutic and to talking about the trauma is not sufficient, rate in this study. exclude treatments that were shams created why restrict the conversations? Supportive for the purpose of controlling for common counseling in this instance is as credible as Preponderance of CBT and Behavioral factors. Perla’s rational counseling. How are we to Treatments in Meta-Analyses As was clear in the Perla scenario, some interpret the meaning of differences be- comparison treatments, such as rational tween the two conditions? Are they the re- With regard to the preponderance of counseling, are designed to control for some sult of curative power of exposure, or CBT and behavioral treatments, Siev et al. common factors, but are not legitimate perhaps some other factor? We believe the (2009) again noted earlier criticisms of the treatments. Such comparison treatments, answer is ambiguous at best. Wampold, Mondin, Moody, Stich, et al. often called supportive counseling, com- To identify those treatment conditions (1997) meta-analysis without considering mon factor controls, or psychological place- that were not intended to be therapeutic, published responses or recent studies that bos, do not have cogent psychological Wampold and colleagues (Wampold, addressed these criticisms. Crits-Christoph rationales, proscribe the therapist from ac- Mondin, Moody, Stich, et al., 1997) used (1997) first suggested that the similarity of tions that most therapist would consider the following criteria to designate a treat- treatments in the Wampold, Mondin, fundamental and therapeutic, and often ment as bona fide: Moody, Stich, et al. meta-analysis was re- have no coherent actions intended to be sponsible for lack of difference in outcome. therapeutic. In the trials that use these First, the treatment must have involved a Siev et al. did not mention that Wampold, treatments, the therapists delivering them therapist with at least a master’s degree and Mondin, Moody, Stich et al. showed that know full well they are not intended to be a meeting with a patient in which the thera- the dissimilarity of the treatments com- therapeutic (as was clear in the Perla sce- pist developed a relationship with the pa- pared was not correlated with the effect size nario), which demonstrates the pernicious tient and tailored the treatment to the (i.e., comparisons of more dissimilar treat- effects of not being able to blind psy- patient. Thus, any study that used solely ments did not produce larger effects). chotherapy trials. tape-recorded instructions to patients or a Neither did Siev et al. cite an extensive dis- A good example of a treatment not in- protocol that was administered regardless cussion of this criticism by Wampold and tended to be therapeutic is the supportive of patient behavior (e.g., a progressive re- colleagues (Wampold, Mondin, Moody, & counseling condition designed by Foa as a laxation protocol that was not modified in Ahn, 1997). As just one example, Crits- control for a CBT/exposure treatment for any way for particular patients) was ex- Christoph (1997) classified many treat- PTSD with women who had experienced cluded. Second, the problem addressed by ments as cognitive behavioral when clearly childhood sexual abuse (Foa, Rothbaum, the treatment must have been one that they were not (e.g., Greenberg’s emotion- Riggs, & Murdock, 1991). To rule out cog- would reasonably be treated by psychother- focused therapy). Finally, there are several nitive components and exposure, the thera- apy, although it was not required that the subsequent meta-analyses containing treat- pists providing supportive counseling were sample treated be classified as clinically dys- ments with diverse theoretical bases that not allowed to explore or discuss patients’ functional. For example, treatments to in- have found no differences in outcome. For attributions about their abuse or their cur- crease time that a participant could keep a example, the meta-analysis of PTSD that rent problems and the therapists could not hand submerged in cold water would be ex- showed no differences contained treatments allow patients to discuss their abuse, as the cluded because cold-water stress would not as variable as CBT, eye-movement desensi- latter would involve covert exposure and reasonably be considered a problem for tization and reprocessing, hypnotherapy, desensitization. Rather, their patients were which one would present to a psychothera- present-centered therapy, psychodynamic taught a general problem-solving strategy. pist. However, any treatment for depression therapy, and exposure (Benish et al., 2008). Therapists were allowed to respond indi- was included whether the participants met Similarly, with regard to the alcohol use dis- rectly and with unconditional support. diagnostic criteria for any depressive disor- orders, inclusion of treatments based on Critically, however, whenever a patient in der or scored below standard cutoffs on de- cognitive-behavioral principles, motiva- the study tried to talk about the sexual as- pression scales. Finally, the treatment had to tional interviewing, and 12-step principles sault they had experienced, therapists in the satisfy two of the following four conditions: did not reveal significant differences among supportive control condition were limited (a) a citation was made to an established ap- treatments (Imel et al., 2008). to redirecting the discussion to everyday proach to psychotherapy (e.g., a reference If It Works Then It’s Bona Fide problems. What therapist would provide to Rogers’s, 1951, client-centered therapy), such a treatment, much less believe in the (b) a description of the therapy was con- One of the features of Wampold, efficacy of such a treatment? Some might tained in the article and the description con- Mondin, Moody, Stich, et al.’s (1997) meta- not believe in repeated and prolonged tained a reference to psychological processes analysis was that the comparisons involved imaginal exposure to the trauma as the pri- (e.g., operant conditioning), (c) a manual only treatments that were intended to be mary curative ingredient of trauma therapy, for the treatment existed and was used to therapeutic, a hypothesis proposed by but we know of few therapists who would guide the administration of the psychother- Lambert and Bergin (1994): “Research car- advocate prolonged, intentional, and sys- apy, and (d) the active ingredients of the ried out with the intent of contrasting two tematic redirection away from discussion of treatment were identified and citations pro- or more bona fide treatments show surpris- the very topic that brought the patient to vided for those ingredients. Accordingly, ingly small differences between the out- therapy. If merely talking about the trauma any treatments designed to control for com-

October • 2009 149 mon or nonspecific factors, such as placebo different criticism than the issue of circular- viewed with the therapist. A full description control groups, alternative therapies, or ity. For example, RT would not be excluded of PCT is available in the therapy manual. nonspecific therapies, were excluded. (pp. as a bona fide treatment for depression be- (p. 518) 206-207) cause it is not currently an EST for depres- sion or because clinical experience suggests Both supportive counseling and present- The criteria for differentiating the bona- it does not work. It would be excluded be- centered therapy involved contact with a fide treatments from shams are objective, cause the researchers that used it intended reasonably skilled therapist, both were de- and can be applied to any treatment, re- for it to be a control condition not fully signed to exclude cognitive and exposure gardless of how effective the treatment is meant to work (i.e., no credible explanation ingredients, and both involve aspects of generally thought to be, based on clinical for its effectiveness was given) and the ther- problem solving as a coping mechanism. experience or past research. Importantly, in apists in the trial were aware that it was not Present-centered therapy, however, had a the meta-analyses conducted to date, coders intended to be therapeutic. It seems plausi- cogent rationale, incorporated and refer- applied the criteria for determining whether ble that some dedicated researcher could enced the psychological bases of the treat- a treatment was intended to be therapeutic develop a bona fide RT for depression or any ment, involved tasks reasonably related to or not while remaining blind to the results of other disorder, but we are not aware of any the patient’s distress, contained aspects of the individual trials being assessed. Coders such attempts. treatment related to the particular patient’s were given only the description of the treat- To illustrate the nuances of determining problems, and contained homework that ment provided in the method section of the whether a treatment is designed as a control was integrated into the treatments. trial in which the treatments were de- for common factors (i.e., is not intended to Moreover, the therapists in the supportive scribed. be therapeutic) and a treatment that is counseling condition were trained by one of Despite blind ratings and objective cri- plausibly therapeutic, contrast the support- the two authors of the study, who had an al- teria, Siev et al. (2009) object to the classifi- ive counseling condition used by Foa et al. legiance to the two CBT conditions and cation scheme, contending that the criteria (1991) discussed earlier and present-cen- were supervised by Foa, the first author and are circular: tered therapy, a treatment designated as developer of one the treatments. On the “intended to be therapeutic” by Benish et other hand, the therapists in the present- Wampold and colleagues (e.g., Ahn & al. (2008). Present-centered therapy was centered therapy condition were trained Wampold, 2001; Messer & Wampold, described by McDonagh et al. (2005) in the and supervised by the developers of the pre- 2002) conclude that treatment outcome following way: sent-centered manual. The present-cen- studies are futile because comparisons be- tered therapy met Wampold and tween bona fide treatments yield clinically The first two sessions of PCT were spent es- colleagues’ (Wampold, Mondin, Moody, insignificant differences and those between tablishing rapport, giving an overview of Stich, et al., 1997) criteria of a treatment in- bona fide treatments and controls yield un- the treatment, presenting the psychoeduca- tended to be therapeutic, whereas supportive interesting differences. This contention is tional material, and establishing a treat- counseling did not. somewhat circular, however, because cate- ment plan based on the client’s choices of The goal of designing RCTs that com- gorization as a bona fide treatment is both a problems to address. The framework used pare an EST to an alternative is not to de- criterion for inclusion in, and an implication to assist in understanding the ways in which sign comparison treatments that might of, the results of clinical experience and CSA trauma can impact the client’s current formally meet criteria for treatments in- treatment outcome research (and meta life was that of traumagenic dynamics. tended to be therapeutic, but rather to find analyses that synthesize multiple such stud- Traumagenic dynamics organizes the conse- an adequate comparison treatment that will ies). (p. 72) quences of the experience of CSA into four provide evidence about which treatment is categories—a sense of betrayal, powerless- most efficacious or evidence about the To summarize Siev et al.’s (2009) argu- ness, stigmatization, and traumatic sexual- mechanisms of change. Poorly designed al- ment, they believe that a bona fide treat- ization (Finkelhor, 1987). Clients were ternative treatments do neither. When ment is synonymous with an effective guided in noticing these dynamics in cur- comparison treatments are better designed, treatment. They suggest that if it became rent life difficulties and factoring them in as it appears that they are as effective as the ev- known that treatments that exclude cogni- information in the problem-solving model. idence-based treatments to which they are tive or behavioral components are less effec- The problem-solving model was a modifi- compared (Baskin, Tierney, Minami, & tive than cognitive/behavior treatments, it cation of systematic problem solving, which Wampold, 2003). would be impossible to design a therapy has demonstrated efficacy in the treatment As an aside, it is important to note just without these components that would not of depression (DeShazer et al., 1986; how well supportive counseling type and be considered inferior. How they arrived at D’Zurilla & Goldfried, 1971; Nezu et al., other stripped-down interventions can such a conclusion is unclear and a misinter- 1989). Therapists were encouraged to pro- be—especially given the deficiencies in pretation of Wampold and colleagues’ vide empathy, unconditional regard, and these treatments vis-à-vis what therapists method. Stated succinctly, designating a genuineness in their sessions (Meador & would find to be reasonable treatments. treatment as bona fide has nothing to do Rogers, 1973). The foci of subsequent ses- Cottraux and colleagues (2008) compared with either the efficacy of the treatment or sions were determined by the participants’ CBT to Rogerian therapy for the treatment whether it contains ingredients that are be- choice of current issues to address with the of PTSD in an RCT. Rogerian therapy was lieved to work. The equivalency of bona fide problem-solving skills. Homework was de- more focused than many alternative treat- treatments is an implication, not an a priori signed to assist clients in consolidating the ments but the description remained quite requirement of Wampold and colleagues’ information conveyed in sessions, writing regimented, naïve, and obsolete compared research. To be sure, quibbles can be made about their problem solving efforts and, to what modern experiential or humanistic about the specific criteria, but that is a very tracking those efforts in a journal to be re- therapists would employ currently (cf.

150 the Behavior Therapist Elliott & Greenberg, 2007; Ellison & be able to make valid inferences about the come across treatments, including psy- Greenberg, 2007; Greenberg, 2008; efficacy of treatments. Allegiance is best chopharmacology (Horvath & Bedi, 2002; Pascual-Leone & Greenberg, 2007). The controlled when therapists are nested Martin, Garske, & Davis, 2000; Wampold, therapists in this study were CBT thera- within treatment (each therapist gives only 2001). Moreover, there is research that indi- pists, Cottraux is an advocate of CBT, and one treatment) such that the treatment is cates that the alliance is not a result of early the trial was conducted in centers known delivered by therapists who have an alle- symptom change (Baldwin, Wampold, & for delivering CBT (the patients may well giance to the treatment they provide and Imel, 2007; Klein et al., 2003), although have desired CBT). Nevertheless, there are trained and supervised by experts in the the evidence is not entirely conclusive. were no differences in outcomes for the respective treatments (see Wampold, Without a doubt, alliance is difficult to completers (and few in the intent-to-treat 2001). For example, in a trial of process-ex- study because levels of the alliance cannot samples), although CBT retained more pa- periential therapy versus CBT for depres- be experimentally manipulated, but that tients in treatment. Certainly, such findings sion, Watson, Gordon, Stermac, Kaloger- does not preclude the possibility that the al- as this (see also McDonagh et al., 2005; akos, and Steckley (2003) ensured that their liance is causal to outcomes in psychother- Schnurr et al., 2003) must pique the inter- allegiance to process-experiential therapy apy. est of those who claim specificity of treat- was controlled by having experts in the two Interestingly, medicine is increasingly ment: How can Rogerian therapy for the respective therapies train, supervise, and interested in relationship factors. For exam- treatment of PTSD be as, or even nearly as, conduct the respective therapies and CBT ple, relationship factors between physician effective as CBT? was not altered in any way. RCTs and meta- and patient have been found to reduce the analyses need to control for the allegiance duration of the common cold (Rakel et al., Allegiance Effects effects if one is ever to sort out the nature of 2009). No therapist, whether psychody- A confound alluded to in this critique of treatment differences. namic, CBT, or humanistic, would suggest RCTs and Siev et al.’s (2009) conclusion is that their relationship with the patient and researcher allegiance. Perla and Clark, in Common Factors: their collaboration around the goals and our hypothetical and real-world examples, Alliance and Therapist Effects tasks of therapy, the elements of the thera- peutic alliance, is unimportant. Clinical have an allegiance to a particular treatment. Having criticized the conclusion that psychology will not be well served by mini- Allegiance is not simply a hypothetical con- there are negligible treatment differences, mizing the importance of relationship and jecture—the effects are demonstrable (see Siev et al. (2009) go on to argue that the ev- collaboration. Let us agree to differ on Luborsky et al., 1999; Wampold, 2001). idence related to the common factors is whether the alliance is the primary cause of Apparent differences among treatments are flawed as well. Two common factors, al- change or is necessary for the delivery of often explained by differences in allegiance liance and the therapist, were called into specific ingredients, as that is a question (e.g., Imel et al., 2008; Robinson, Berman, & question. Although Siev et al. highlight po- worthy of research effort. Neimeyer, 1990)—the researcher’s alle- tentially important limitations to common Siev et al. (2009) raised an interesting giance to a treatment increases the likeli- factor research, we will show that their crit- point when they suggest that when thera- hood that this treatment will be shown to icisms fail to acknowledge extant research pists address the alliance, the “very focus on be superior to alternatives. evidence and minimize the evidence that alliance becomes a treatment technique” (p. Although the presence of researcher alle- supports the alliance and therapists. 74). This raises a critical issue in under- giance effects is apparent, its causes have Alliance. Siev et al. (2009) echo a variety standing common factors and specific in- not been well determined (Leykin & of critiques of the alliance literature (see gredients. Common factors models as early DeRubeis, 2009; Luborsky et al., 1999; particularly DeRubeis et al., 2005), cor- as Jerome Frank’s discussion of healing Wampold, 2001). On the one hand, alle- rectly noting that various meta-analyses (Frank, 1961) have emphasized that a co- giance may be manifest by the design of have found that the alliance, measured early gent rationale and therapeutic actions are comparison groups (e.g., by creating com- in therapy, is correlated with final outcome, essential ingredients of any healing practice parison treatments that have no cogent ra- with an estimate in the neighborhood of (Wampold, 2007). Indeed, there are treat- tionale, a lack of focus on the patient’s .22, which indicates about 5% of the vari- ments for which work on the relationship problems, and proscribe therapists from ac- ability in final outcome is associated with with the therapist is the focus of treatment tions that most therapists would think ther- the alliance. What Siev et al. fail to mention (e.g., Safran, Muran, Samstag, & Stevens, apeutic) or by therapist beliefs that one of is that Wampold determined that differ- 2002). Common factor models posit that a the treatments is preferred and more effec- ences among treatments account for at most cogent rationale and therapeutic actions of tive. On the other hand, researcher alle- 1% (Wampold, 2001), so the 5% figure is some type are necessary and Siev et al. seem giance may result in better outcomes for a quite impressive. Indeed, there is noth- to agree: Focusing on the alliance will be specific treatment because the therapists ing—absolutely no other variable, except therapeutic if that is the focus of the treat- have particular expertise; for example, initial severity—that can be measured so ment, in the same way that CBT is thera- Perla’s therapists may be extraordinarily early in therapy that correlates so highly peutic by focusing on cognitions, ACP is skilled at providing ACP and the extraordi- with outcome. Siev et al. (2009) then go on therapeutic by focusing on affect, and dy- nary results (vis-à-vis either RC or CBT) to cite a few studies that demonstrate an ef- namic therapies are therapeutic by focusing demonstrate the efficacy of ACP when de- fect that supports their argument and deni- on the unconscious and attachment histo- livered by therapists who have allegiance grate meta-analyses as means to understand ries. We agree with Siev et al. that therapeu- and competence to deliver ACP (Leykin & the evidence of a corpus of studies on the al- tic techniques are needed, when they are DeRubeis, 2009). Whatever the explana- liance. endemic to a cogently constructed treat- tion, the impact of allegiance on outcome The evidence is clear: The alliance has ment that the therapist believes will be demands that RCTs control for it in order to been shown to be robustly predictive of out- therapeutic. This is exactly why we have so

October • 2009 151 much difficulty with the poorly constructed which is the basis of attempts to dissemi- be safe to say that we agree that psychologi- “supportive counseling” type control nate ESTs, then it is necessary for the RCTs cal treatments are effective. There is also groups—it seems the goal of these therapies to provide evidence that is generalizable to agreement that to be effective, a treatment is for the therapist to do their very best to do such settings. There is a reasonable debate must have a cogent rationale, actions con- nothing (or not do something) while still to be had about whether clinical trials pro- sistent with the rationale, and collaborative providing some modicum of benefit to the duce evidence that is generalizable (Stirman work on the goals and tasks of therapy — patient. They do not control for important & DeRubeis, 2006; Westen, 2006), but treatment is not simply listening to a pa- ingredients common to psychotherapy and what is clear is that the operations of the tient. In Siev et al.’s (1990) terminology, they cannot be faithfully executed by thera- study must be sufficient to make general- techniques are necessary. There is also an pists. izations—and this has unambiguous conse- agreement that it is imperative to improve Therapist effects. Therapist effects, which quences for designing RCTs and estimating the quality of services in routine practice. are well established as noted by Siev et al. therapist effects. To be generalizable to Such efforts can certainly involve continued (2009), is an area where all psychothera- therapists in routine care, therapists must work to develop, refine, and test treat- pists, researchers, and patients covertly be considered a random effect and should be ments. Not surprisingly, there is also agree- agree—the person of the therapist makes a representative of therapists to whom one ment that measuring outcomes in practice difference. Rarely, if ever, are therapists ran- wishes to generalize (Crits-Christoph & and using that information to improve the domly selected to deliver treatments in Mintz, 1991; Serlin & Lapsley, 1985; Serlin quality of services is a strategy than spans RCTs. Perla used effective therapists to de- et al., 2003; Wampold & Serlin, 2000). multiple perspectives on psychotherapy liver ACP, and the same is true of Clark et al. Using a select group of therapists, as Perla (Duncan, Miller, Hubble, & Wampold, in (1994). The important issue, and the one on and Clark have done in their trials, limits press; Lambert, Harmon, Slade, Whipple, which Siev et al. (2009) focuses, is deter- dramatically the inferences that can be & Hawkins, 2005; Miller, Duncan, & mining the characteristics and actions of ef- made to how therapists in routine care Hubble, 2005). fective therapists. Siev et al. speculate about might deliver the treatment (i.e., the notion So, where is the divergence? Siev et al. therapist differences: “Some therapists are of dissemination), particularly because in (2009) and other EST advocates make some likely more adept than others at using some clinical trials the training, supervision, and claims that not only appear to be contrary techniques, formulating treatment plans, monitoring of therapists would be extraor- to the evidence, but also diverge sharply encouraging their patients to do difficult dinary in routine care (clearly dissemination from the experience of therapists to whom exposures, etc., even within CBT” (p. 74). involves training, but not nearly at the level they wish to disseminate the ESTs. First, the In some ways, the evidence does not sup- provided in clinical trials). Moreover, to esti- claim that treatments are specific rests on port this contention, as adherence to and mate therapist effects, there needs to be suf- criticisms of previous meta-analyses that competence in a particular treatment have ficient numbers of therapists—they are have been addressed, and on one meta- not been particularly strong predictors of considered to be drawn from a population analysis that showed one treatment to be outcome (Schnurr et al., 2003; Shaw et al., of therapists. Just as the case for number of superior to another treatment for symptom 1999; Wampold, 2001). However, Siev et patients in a trial, there must be a sufficient measures only. And the one result that is of- al.’s suggestion that effective therapists are number of therapists (at least 10) to make a fered to support specificity rests on a single skilled in persuading patients to follow the reasonable estimation of the variability in and flawed study—not a reassuring bit of treatment protocol is well taken—this is ex- outcomes. The partition of variance for flotsum in a sea of evidence. actly part of the alliance involved in collabo- Clark et al. (2006) in Siev et al.’s (2009) pie To add to the evidence, when control rative agreement about the tasks and goals treatments without active ingredients are chart is problematic because the Clark trial of therapy. That is, effective therapists are well designed with a rationale and thera- contained only 4 therapists—nobody able to form alliances across a range of pa- peutic actions, they often are as, or nearly would make conclusions about a treatment tients. This is remarkably consistent with as, effective as “first-line” ESTs (Baskin et with only four patients. The generalizability Baldwin, Wampold, and Imel (2007), who al., 2003; Cottraux et al., 2001; McDonagh of any trial that uses an extraordinarily found that it was the therapist’s contribu- et al., 2005). Moreover, dismantling studies small number of therapists, particularly if tions to the alliance that predicted out- rarely if ever identify a particular ingredient the therapists were selected in a way that comes and that the therapist’s ability to that is necessary for the efficacy of a treat- makes them unusual (e.g., they developed form an alliance (i.e., form a bond and col- ment (Ahn & Wampold, 2001). Cognitive laborate on the tasks and goals of therapy) ac- the treatment), received extraordinary therapy for depression does not need the counted for the therapist differences in training, supervision, and monitoring, is se- cognitive components (Jacobson et al., outcomes. A recent study has shown that verely limited. Testing therapist effects in a 1996), cognitive processing therapy for interpersonal skill of the therapist also ac- study with less than 10 therapists is unlikely PTSD does not need the cognitive process- counts for therapist differences (Anderson, to be illuminating; ignoring therapist ef- ing or the writing components (Resick et Ogles, Patterson, Lambert, & Vermeersch, fects (i.e., not estimating therapist effects) al., 2008), and CBT for PTSD does not in press). in such studies does not improve the situa- need cognitive restructuring (Foa et al., If one is serious about studying therapist tion (actually, it makes it worse; see R. C. 2005). effects, then attention must be paid to the Serlin et al., 2003; Wampold & Serlin, Establishing specificity requires the de- proper design of RCTs to provide valid esti- 2000). tailed display of system-specific demonstra- mates of these effects (Serlin, Wampold, & tions of mechanisms (Wampold, 2007) as Conclusions Levin, 2003; Wampold, 2001; Wampold & well as a simple superiority of one treatment Serlin, 2000). If, as Siev et al. (2009) sug- For a moment, let us talk about the over another. Interestingly, there is evidence gest, the goal is to use evidence from RCTs points the various sides in the common ver- that CBT provides patients with coping to improve the quality of routine care, sus specific factors debate agree on. It might skills that are vital to lasting benefits. In a

152 the Behavior Therapist study of 35 clients who responded to CBT competent therapists who believe in the Cottraux, J., Note, I., Yao, S. N., de Mey- for depression, it was found that those treatment, to patients seeking treatment, Guillard, C., Bonasse, F. o., Djamoussian, D., clients who acquired cognitive coping skills are equally effective, or (b) the therapeutic et al. (2008). Randomized controlled com- and displayed evidence that they were using alliance and therapists are potent therapeu- parison of cognitive behavior therapy with CBT principles had lower relapse rates dur- tic ingredients. Therefore, consideration Rogerian supportive therapy in chronic post- traumatic stress disorder: A 2-year follow- ing the year following treatment (Strunk, should be given to the DiGiuseppe’s third up. Psychotherapy and Psychosomatics, 77, DeRubeis, Chiu, & Alvarez, 2007). This option, in light of the evidence. 101-110. type of research is needed to clearly under- References Cottraux, J., Note, I., Yao, S. N., Lafont, S., stand mechanisms of change in an EST. Note, B., Mollard, E., et al. (2001). A ran- Minimizing the importance of the al- Ahn, H., & Wampold, B. E. (2001). A meta- domized controlled trial of cognitive therapy liance and of therapist effects, despite the analysis of component studies: Where is the versus intensive behavior therapy in obses- evidence that exists, seems unnecessary. evidence for the specificity of psychotherapy? sive compulsive disorder. Psychotherapy and One can accept the importance of the al- Journal of Counseling Psychology, 48, 251-257. Psychosomatics, 70, 288-297. liance and therapists and remain committed Anderson, T., Lunnen, K. M., & Ogles, B. M. (in Crits-Christoph, P. (1997). Limitations of the to developing and improving treatments. press). Putting models and techniques in dodo bird verdict and the role of clinical trials To say that “if the goal of psychotherapy re- context. In S. D. Miller, B. L. Duncan, M. A. in psychotherapy research: Comment on search is to determine the best ways to re- Hubble, & B. E. Wampold (Eds.), The heart Wampold et al. (1997). Psychological Bulletin, lieve suffering for the most people, and soul of change (2nd ed.). Washington, DC: 122, 216-220. researchers need to continue to focus on the American Psychological Association. Crits-Christoph, P., & Mintz, J. (1991). areas that are most manipulable, such as Anderson, T., Ogles, B. M., Patterson, C. L., Implications of therapist effects for the de- technique” (Siev et al., 2009, p. 74) is to Lambert, M. J., & Vermeersch, D. A. (in sign and analysis of comparative studies of deny that there are ways to improve out- press). Therapist effects: Facilitative interper- psychotherapies. Journal of Consulting and , 20-26. comes by focusing on areas other than tech- sonal skills as a predictor of therapist success. Clinical Psychology, 59 nique. Indeed, Siev et al. go on to say that Journal of Clinical Psychology, 65, 755-768. Cushman, P. (1992). Psychotherapy to 1992: A using efforts that “integrate … the impor- Baldwin, S. A., Wampold, B. E., & Imel, Z. E. history situated interpretation. In D. K. (2007). Untangling the alliance-outcome Freedheim (Ed.), History of psychotherapy: A tance of the technique, alliance, and thera- century of change (pp. 21-64). Washington, pist factors” are needed (p. 74)—and we correlation: Exploring the relative impor- tance of therapist and patient variability in DC: American Psychological Association. agree. It would be informative to know how the alliance. Journal of Consulting and Clinical Davidson, R. J., Sherer, K. R., & Goldsmith, H. therapists use feedback to improve perfor- Psychology, 75, 842-852. H. (Eds.). (2003). Handbook of affective sciences. mance: Do they alter techniques, address Baskin, T. W., Tierney, S. C., Minami, T., & New York: Oxford University Press. ruptures in the alliance, or engage patients Wampold, B. E. (2003). Establishing speci- DeRubeis, R. J., Brotman, M. A., & Gibbons, C. in an examination of progress? ficity in psychotherapy: A meta-analysis of J. (2005). A conceptual and methodological Instead of insisting that therapists learn structural equivalence of placebo controls. analysis of the nonspecifics argument. and deliver ESTs, perhaps we should insist Journal of Consulting and Clinical Psychology, Clinical Psychology: Science and Practice, 12, that therapists attain a reasonable bench- 71, 973-979. 174-183. mark regardless of the treatment they de- Benish, S., Imel, Z. E., & Wampold, B. E. Duncan, B., Miller, S. D., Hubble, M., & liver (Minami et al., 2008). Therapists who (2008). The relative efficacy of bona fide psy- Wampold, B. E. (Eds.). (in press). The heart are achieving outcomes comparable to or in chotherapies of post-traumatic stress disor- and soul of change: Delivering what works (2nd excess of those achieved in clinical trials of der: A meta-analysis of direct comparisons. ed.). Washington, DC: American Psycholo- ESTs might understandably be resentful of Clinical Psychology Review, 28, 746-758. gical Association. efforts to mandate the type of treatment Chambless, D. L., Baker, M. J., Baucom, D. H., Elliott, R., & Greenberg, L. S. (2007). The they deliver. Beutler, L. E., Calhoun, K. S., Daiuto, A., et essence of process-experiential/emotion-fo- For us, the issue—the driving force be- al. (1998). Update on empirically validated cused therapy. American Journal of hind our work—is proper attention to the therapies, II. The Clinical Psychologist, 51, 3- Psychotherapy, 61, 241-254. 16. entire body of evidence. To be cast in the Ellison, J. A., & Greenberg, L. S. (2007). role of prevailing “in the broad court of pro- Chambless, D. L., & Hollon, S. D. (1998). Emotion-focused experiential therapy. New York: fessional opinion” on the basis of presenting Defining empirically supported therapies. Springer Science + Business Media. Journal of Consulting and Clinical Psychology, Fancher, R. T. (1995). Cultures of healing: a case “more aggressively to wide spread au- 66, 7-18. diences” (Siev et al., 2009, p. 75), rather Correcting the image of American mental health Clark, D. M., Ehlers, A., Hackmann, A., care. New York: W. H. Freeman. than on the basis of solid research evidence, McManus, F., Fennell, M., Grey, N., et al. is not a compliment many would want. Fishman, D. B., & Franks, C. M. (1992). (2006). Cognitive therapy versus exposure Evolution and differentiation within behav- DiGiuseppe offered three alternatives: and applied relaxation in social phobia: A “Either we rebut these conclusions, conduct ior therapy: A theoretical and epistemologi- randomized controlled trial. Journal of cal review. In D. K. Freedheim (Ed.), History new research to show they are wrong, or we Consulting and Clinical Psychology, 74, 568- of psychotherapy: A century of change (pp. 159- accept them and change our message” (as 578. 196). Washington, DC: American quoted in Seiv et al., p. 71). Siev et al. have Clark, D. M., Salkovskis, P. M., Hackmann, A., Psychological Association. neither rebutted nor presented sufficient Middleton, H., Anastasiades, P., & Gelder, Flückiger, C., Regli, D., Grawe, K., & Lutz, W. new research to reject the conjectures that M. (1994). A comparison of cognitive ther- (2007). Similarities and differences between (a) all treatments with cogent psychological apy, applied relaxation, and imipramine in retrospective and pre-post measurements of bases, therapeutic actions consistent with the treatment of panic disorder. British outcome. Psychotherapy Research, 17, 371- the rationale of the treatment (i.e., tech- Journal of Psychiatry, 164, 759-769. 377. niques in Siev et al.’s language) delivered by

October • 2009 153 Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. Klein, D. N., Schwartz, J. E., Santiago, N. J., Handbook of psychotherapy integration (2nd ed.). A. M., Riggs, D. S., Feeny, N. C., et al. Vivian, D., Vocisano, C., Castonguay, L. G., (pp. 84-102). New York: Oxford University (2005). Randomized trial of prolonged expo- et al. (2003). Therapeutic alliance in depres- Press. sure for posttraumatic stress disorder with sion treatment: Controlling for prior change Miller, S. D., Wampold, B. E., & Varhely, K. and without cognitive restructuring: and patient characteristics. Journal of (2008). Direct comparisons of treatment Outcome at academic and community clin- Consulting and Clinical Psychology, 71, 997- modalities for youth disorders: A meta- ics. Journal of Consulting and Clinical 1006. analysis. Psychotherapy Research, 18, 5-14. Psychology, 73, 953-964. Krueger, R. F. (1999). The structure of common Milrod, B., Leon, A. C., Busch, F., Rudden, M., Foa, E. B., Rothbaum, B. O., Riggs, D. S., & mental disorders. Archives of General Schwalberg, M., Clarkin, J., et al. (2007). A Murdock, T. B. (1991). Treatment of post- Psychiatry, 56, 921-926. randomized controlled clinical trial of psy- traumatic stress disorder in rape victims: A Lambert, M. J., & Bergin, A. E. (1994). The ef- choanalytic psychotherapy for panic disorder. comparison between cognitive-behavioral fectiveness of psychotherapy. In A. E. Bergin American Journal of Psychiatry, 164, 265-272. procedures and counseling. Journal of & S. L. Garfield (Eds.), Handbook of psychother- Minami, T., Wampold, B. E., Serlin, R. C., Consulting and Clinical Psychology, 59, 715- apy and behavior change (4th ed., pp. 143- Hamilton, E., Brown, G. S., & Kircher, J. 723. 189). New York: Wiley. (2008). Benchmarking the effectiveness of Frank, J. D. (1961). Persuasion and healing: A Lambert, M. J., Harmon, C., Slade, K., psychotherapy treatment for adult depres- comparative study of psychotherapy. 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CLASSIFIED

POSTDOCTORAL FELLOWSHIP IN ABCT FAQ What are the registration hours ALCOHOL RESEARCH AT THE at the ABCT Annual Meeting in NYC? UNIVERSITY OF WASHINGTON. The fellowship will provide training for individuals who wish to pursue a career in • Thursday preregistration pick-up: 11:00 A.M. – 8:00 P.M. alcohol research, with an emphasis on the • On-site registration: 3:00 P.M. – 8:00 P.M. etiology and prevention of problem drink- • Friday: 7:30 A.M. – 3:00 P.M. ing and alcohol dependence. For more information please see our website: • Saturday: 8:00 A.M. – 3:00 P.M. http://depts.washington.edu/cshrb/ • Sunday: 8:00 A.M. – 11:30 P.M. newweb/postdoc.html

October • 2009 155 Book Review cover the gamut of concerns for a clinician. Chapters 1 through 3 discuss case concep- tualization, assessment, and treatment Roemer, L., & Orsillo, S. M. (2009). Mindfulness- and planning. Chapters 4 and 5 focus on the re- lationship between therapist and client and Acceptance-Based Behavioral Therapy in Practice. the development of a therapeutic contract. New York: The Guilford Press. Subsequent chapters expand upon the im- plementation of acceptance strategies (Chapter 6), values clarification (Chapter 7), Reviewed by Chad E. Drake, University of South Carolina-Aiken the promotion of mindful and values-con- sistent behavioral activation (Chapter 8), and the monitoring of progress and termi- oemer and Orsillo have generated a Relapse Prevention, among others. The au- nation of treatment (Chapter 9). Chapter thoughtful overview of acceptance- thors maintain a firm foothold in behavioral 10 weaves in the relevance of knowledge based behavioral therapies (abbrevi- practice, consistently relying on a func- R and techniques from cognitive and behav- ated as “ABBTs” throughout the book) that tional analysis of psychopathology. No par- ioral traditions while Chapter 11 discusses the reader may find difficult to classify. It is ticular diagnosis is given favor—the book the advantages of cultural sensitivity when not a textbook, though it provides a syn- provides a broad, comprehensive view of conducting ABBTs with diverse clients. The thetic view of theory and frequently cites re- treatment that is readily adaptable to a vari- book also contains an Appendix of recom- search findings when relevant. It is not a ety of clinical presentations. An emphasis mended resources. treatment protocol, though it presents a on theoretically driven processes and empir- Overall, the book is readable, compre- comprehensive guide for treatment activi- ically supported treatment components is hensive, and aptly titled. Trainees and prac- ties and includes numerous case examples balanced with acknowledgment of limita- titioners who have an interest would be and transcripts. Rather, the book reads like a tions in the available data on these matters. hard-pressed to find a better resource than guided meditation on the authors’ com- Their synthetic approach makes for a Mindfulness- and Acceptance-Based Behavioral bined knowledge and experience in practic- book with broad appeal, especially for those Therapies in Practice. ing behavior therapy with mindfulness as a who are still in training or wishing to ex- central treatment component. pand upon their training experience. ... The book is transtheoretical, drawing Cognitive and behavioral practitioners will from and at times using terminology and receive a thorough introduction to mindful- Correspondence to Chad E. Drake, Ph.D., techniques from Acceptance and ness techniques and interventions, while en- University of South Carolina, Aiken, 471 Commitment Therapy, Dialectical thusiasts of mindfulness who lack a strong University Parkway, Aiken, SC 29801 Behavior Therapy, Mindfulness-Based background in evidence-based treatment [email protected] Cognitive Therapy, Integrative Behavioral will benefit from solid behavioral theory Couple Therapy, and Mindfulness-Based and case conceptualization. Chapter topics

ABCT Annual Convention

SATURDAY Intensive Learning 8:15 a.m. – 10:15 a.m. j 5. Mindfulness for Two: An ACT Approach Opportunities to Mindfulness in Psychotherapy Kelly G. Wilson 2 CE Hours Master Clinician Seminars ( ) 10:30 a.m. – 12:30 p.m. FRIDAY 6. Introduction to Parent-Child Interaction 8:15 a.m. – 10:15 a.m. Therapy (Cheryl McNeil) 1. DBT Skills Training With Adolescents and Families: 12:45 p.m. – 2:45 p.m. Teaching Points Dos and Dont’s (Alec Miller & Jill Rathus) 7. The Reality of Conducting VR Exposure 10:30 a.m. – 12:30 p.m. Therapy: Expectations, Techniques, William Sanderson 2. Treating GAD: Evidence-Based Strategies ( ) and Limitations 12:45 p.m. – 2:45 p.m. (Mitchell Schare & Allen Grove) 3. Cognitive Therapy for Paranoia (Neil Rector) 3:00 p.m. – 5:00 p.m. 3:00 p.m. – 5:00 p.m. 8. “Why Would I Ever Want to Feel That?” 4. Ending on a Positive Note: Mastery of the Ethics and Practice Overcoming Emotional Avoidance Denise Davis of Termination ( ) in Cognitive Therapy (Stephen Holland)

156 the Behavior Therapist Multimedia Journal Letter to the Editor

ISSN 1077-7229 Looking to the Future of Empirically Maureen Whittal Editor Cognitive and Behavioral Cognitive and Behavioral Evaluated Self-Help Practice Practice Therapies

Maureen L. Whittal, Editor, Cognitive and Behavioral Patti Lou Watkins, Oregon State University, and George A. Clum, Practice, and University of British Columbia Virginia Tech

ommunicating the complexity of to manuscripts, the video components will he June 2009 issue of the Behavior treatment strategies can be difficult also undergo review. This review will be Therapist announced the advent of a Cusing the written word. However, handled by the action editor upon accep- T“Seal of Merit” system to be applied technology today offers us the opportunity tance of your manuscript. to self-help books “that are consistent with to enhance our learning experiences To introduce the use of this technology, a CBT principles and that incorporate scien- through the use of multimedia platforms video component is available and accompa- tifically tested strategies for overcoming such as video. The addition of video pro- nies the electronic version of this manu- these difficulties” (p. 110). In line with the vides the advantage of an alternate avenue script at www.sciencedirect.com. If you are overarching theme of the June 2009 issue, to learn, similar to attending a training interested in submitting a manuscript that this system seems designed to promote im- workshop without leaving your office or includes video clips, look for detailed in- proved dissemination of empirically vali- home. Imagine being able to access video structions in the “Guide for Authors” sec- dated self-help programs to practitioners segments that illustrate how to roll with re- tion on the C&BP web pages at Elsevier, and the general public alike. As researchers sistance, setting up and debriefing behav- www.elsevier.com/locate/cabp. I believe in this field, we laud ABCT’s move to edu- ioral experiments, or how to respond to that C&BP is the first psychology journal to cate consumers and promote the use of self- ruptures in the therapeutic alliance. Given make use of multimedia. It is my hope that help materials with demonstrated efficacy, the potential advantages, I am pleased to it will enhance the visibility and utility of especially given the plethora of self-help introduce the opportunity to augment this unique journal. products of dubious quality (Rosen, C&BP manuscripts with video components. In closing, I would like to thank you for Barrera, & Glasgow, 2008; Watkins, The first two issues of Volume 17 in your continued interest in the journal. I en- 2008). We would also like to bring atten- 2010 will contain invited contributions to courage you to continue submitting manu- tion to another resource that aims to spur illustrate the various ways in which this new scripts (with or without videos) and reading critical thinking about available self-help application can be utilized. Similar to mak- the work of your colleagues. If you have approaches and facilitate the dissemination ing reference to Tables and Figures in the feedback regarding the journal, be it posi- of approaches that have scientifically body of a manuscript, authors will now tive or negative, we are always happy to demonstrated effectiveness: Handbook of have the opportunity to embed video clips hear it. Or ultimate goal remains the same: Self-Help Therapies (Watkins & Clum, at key points in the paper. In the first issue to be an enduring resource for scientist- 2008). of 2010, the C&BP editorial team, includ- practitioners interested in empirically sup- As stated in the first chapter, which pro- ing myself, Associate Editors Steve Safren ported approaches. With the imminent vides an overview of definitions, history, ad- and Joaquin Borrego Jr., and Book Editor availability of multimedia manuscripts, we vantages, and limitations of self-help, “The Sabine Wilhelm, along with our colleagues hope to stay on the cutting edge, for at least lack of empirical evaluation of self-help ma- will be presenting manuscripts that include a little while! terials is, in fact, the impetus for this text” the use of video. In the second issue, outgo- (Watkins, 2008, p. 15). Following initial ing Publications Coordinator Phil Kendall ... chapters describing various considerations and Jack Rachman and their colleagues will in using self-help therapies as well as the be presenting their recent work, aug- Correspondence to Maureen Whittal, theoretical underpinnings of this modality, mented with video components. Ph.D., Vancouver CBT Centre, 708-777 W. the Handbook of Self-Help Therapies contains The purpose of these video components Broadway, Vancouver BC V5Z 4J7 Canada 11 chapters, each detailing the empirical is to concretize a concept or to illustrate the [email protected]. evidence for self-help methods to treat psy- specifics of a treatment strategy. The focus chiatric disorders such as depression and of the video should be the clinician and not sexual dysfunctions as well as behavioral the patient. Secondary to confidentiality, we health problems such as cigarette smoking ask that real patients not be used. As you and weight management. In fact, over half will see in the invited manuscripts, the of the inaugural titles that have received videos are shot with actors or manuscript ABCT’s “Self-Help Seal of Merit” are dis- collaborators. The number of clips will be cussed and referenced in these chapters. up to the author, but the length of each The text also contains a chapter specifically video should not exceed 7 minutes. Similar addressing the integration of self-help ther-

October • 2009 157 apies in primary care settings. For a critical havior therapy was based, but seem to have Ollendick, T. H. (November 2006). The evolution review of the Handbook of Self-Help Therapies, given way to the former in recent years of cognitive and behavioral treatment and assess- please see Wolleat (2008). (Ollendick, 2006). These recommendations ment: Past presidents’ panel. Paper presented at Indeed, lack of knowledge regarding are consistent with Becker, Nakamura, the 49th annual meeting of the Association which self-help interventions are effective Young, and Chorpita’s (2009) call in the for Behavioral and Cognitive Therapies, and appropriate for a given problem is a June issue of the Behavior Therapist for prac- Chicago, IL. barrier that has kept many clinicians from tice-based evaluation of interventions. Rosen, G. M., Barrera, M. Jr., & Glasgow, R. E. implementing this form of therapy. More Lastly, our hope with the Handbook of Self- (2008). Good intentions are not enough: alarmingly, many practitioners prescribe Help Therapies is “to achieve praxis, provid- Reflections on past and future efforts to ad- self-help books to their clients that advocate ing a resource that is both helpful to vance self-help. In P. L. Watkins, & G. A. treatment techniques with no empirical practitioners working directly with clients Clum (Eds.), Handbook of self-help therapies basis (Adams & Pitre, 2000). Rosen et al. and inspiring to researchers seeking to ex- (pp. 25-39). New York: Routledge. (2008), however, remind us that treatment tend the data base in this area” (Watkins & Watkins, P. L. (2008). Self-help: Past and pre- techniques with empirically demonstrated Clum, 2008, p. xii). As such, and again in sent. In P. L. Watkins & G. A. Clum (Eds.), efficacy, when implemented by a therapist line with Becker et al.’s recommendations, Handbook of self-help therapies (pp. 1-24). New in individual or group modalities, may not we envision this text as a potential resource York: Routledge. be similarly efficacious when translated into in graduate training so that scientist-practi- Watkins, P. L., & Clum, G. A. (Eds.). (2008). self-help formats. Thus, ongoing research of tioners might become as well-versed on self- Handbook of self-help therapies. New York: self-help programs, even those based on sci- help interventions as they are in individual Routledge. entifically tested treatment strategies in and group treatment modalities. Wilson, N. (2003). Commercializing mental other venues, is necessary. Wilson (2003) health issues: Entertainment, advertising, underscores the need for continued re- References and psychological advice. In S. O. Lilienfeld, S. search, voicing a concern that the self-help Adams, S. J., & Pitre, N. L. (2000). Who uses J. Lynn, & J. M. Lohr (Eds.), Science and pseu- industry, which is laden with nonvalidated doscience in clinical psychology (pp. 425-459), products, may cast aspersions on the vali- bibliotherapy and why? A survey from an underserviced area. Canadian Journal of New York: Guilford Press. dated products that do exist. She likens this Psychiatry, 45, 645-650. Wolleat, P. L. (2008). Evidence of efficacy of self- industry to a tumor, warning that it has help interventions. [Review of the book “used the mental health profession as a host, Becker, K. D., Nakamura, B. J., Young, J., & Chorpita, B. F. (2009). What better place Handbook of Self-Help Therapies]. Psyc- but it has metastasized in ways that than here? What better time than now? CRITIQUES—Contemporary Psychology: APA threaten to displace the profession itself ” (p. ABCT’s burgeoning role in the dissemina- Review of Books, 53 (Release 43), Article 8. 425). tion and implementation of evidence-based In the final chapter of the Handbook of practices. the Behavior Therapist, 32, 89-95. ... Self-Help Therapies (Clum & Watkins, 2008), Clum, G. A., & Watkins, P. L. (2008). Self-help Correspondence to Patti Lou Watkins, we provide recommendations for future re- therapies: Retrospect and prospect. In P. L. search that include both large-scale experi- Watkins, & G. A. Clum (Eds.), Handbook of Ph.D., Women Studies Program, 200 Gilkey mental designs as well as a return to self-help therapies (pp. 419-436). New York: Hall, Oregon State University, Corvallis, OR single-case designs on which the field of be- Routledge. 97331; [email protected]

On Our Website

Call Meet ABCT’s Featured for WORKSHOP SUBMISSIONS Clinicians of the Month 44th Annual Convention | November 18–21, 2009 Who are their mentors? San Francisco How do they avoid burnout? What are they reading? Do they have any other talents? Please send a 250-word abstract and a CV for How do they stay current? each presenter to: Most important, what do their Carolyn M. Pepper, Ph.D. waiting rooms look like? University of Wyoming Dept. of Psychology, Dept. 3415 Don’t miss these in-depth interviews on 16th and Gibbon ABCT’s home page. A different thera- Laramie, WY 82071 pist is highlighted each month. or email: [email protected]

http://www.abct.org DEADLINE for submissions: February 1, 2010 

158 the Behavior Therapist At ABCT at this year’s convention and drop your nominations in the CALL FOR NOMINATIONS box. You can also mail in your form to To Lead or Not to Lead? That Is the Question ABCT’s Central Office, or fax it to (212) 647-1865. We can’t accept email nomina- Kristene A. Doyle, Albert Ellis Institute, Chair, Leadership & Elections Committee tions as original signatures are a require- ment. All full members in good standing are eligible to be nominated. There is no limit to the number of members you may elieve it or not, nominating yourself Representative-at-Large position in the nominate. or a colleague for office in ABCT is 2010 election serves as the liaison to You’ll find the call for nominations form easier than getting to attend all that Academic and Professional Issues. The indi- B below, and in both the Winter and January you want to at the Annual Convention! viduals elected serve a year as “elect” to issues of tBT. A more thorough description These are exciting times for ABCT. Edwin allow for all of the important particulars to of each of the position appears in ABCT’s H. Friedman once said, “Leadership can be be learned by the incoming officer. Once bylaws at www.abct.org. thought of as a capacity to define oneself to every 3 years a strategic planning meeting is The individual elected as President-Elect others in a way that clarifies and expands a held to assure that all elected members par- (2010-2011) will serve as ABCT’s President vision of the future.” Make this the year you ticipate in at least one planning session dur- from 2011 to 2012. The Representative-at- take steps to guide your professional home ing their term of office. The next scheduled Large candidate will serve November 2010 and make a worthy contribution. If you ask strategic planning retreat will be held in through November 2013. members who have previously served in of- 2011 to accommodate ABCT’s cosponsor- The annual meeting of the Board takes fice, you’ll find that many share similar rea- ship of the 2010 World Congress with place the Thursday of the convention, with sons for doing so—they wanted to make a Boston University’s Center for Anxiety monthly conference calls the remaining 10 difference, and they did. So could you or Disorders and School of Social Work. months of the year. (There is no conferece someone you know. In addition to the in- Last year marked the first time ABCT call in August.) The President, Immediate herent satisfaction achieved from contribut- members could vote electronically. Feed- Past-President, President-Elect, and the ing to ABCT, you have the opportunity to back indicated that, overall, the process was Secretary-Treasurer comprise the Executive develop new friendships while reconnecting convenient and effortless. Whether or not Committee. Conference calls are scheduled with old ones. you run for office, we encourage you and on an as-needed basis to ensure the contin- Those members who receive the most your colleagues to vote for the individuals ued efficiency of ABCT. It is expected that nominations will appear on the ballot. In you believe will do the best job as soon as candidates have knowledge of ABCT’s mis- April, full and new professional members in you receive your ballot. sion, its bylaws, strategic plan, and existing good standing vote on the candidates of How to get nominated. If you or some- priorities. If you want this year to be the their choice to serve for 3 years. The candi- one you know possesses the skills, vision, year you (or a colleague) give it a shot, date elected as President serves as elect, sit- and dedication to ABCT and its mission, please nominate yourself or a colleague. ting, and past. The candidate who wins the then stop by the membership sign-up booth

NOMINATE the Next Candidates for ABCT Office 2010 Call for Nominations

I nominate the following individuals Every nomination counts! Encourage colleagues to run for office or consider running yourself. Nominate as many for the positions indicated: full members as you like for each office. The results will be tallied and the names of those individuals who receive the PRESIDENT-ELECT (2010–2011) most nominations will appear on the election ballot next April. Only those nomination forms bearing a signature and postmark on or before February 1, 2010, will be counted. Nomination acknowledges an individual's leadership REPRESENTATIVE-AT-LARGE (2010–2013) abilities and dedication to behavior therapy and/or cogni-  tive therapy, empirically supported science, and to ABCT. When completing the nomination form, please take into consideration that these individuals will be entrusted to represent the interests of ABCT members in important pol- NAME (printed) icy decisions in the coming years. Contact the Leadership and Elections Chair for more information about serving ABCT or to get more information on the positions. Please complete, sign, and send this nomination form SIGNATURE (required) to Kristene Doyle, Ph.D., Leadership & Elections Chair, ABCT, 305 Seventh Ave., New York, NY 10001.

October • 2009 159 Awards and Recognition PTSD-related impairment in autobio- graphical memory specificity leads to short- term changes in memory specificity, PTSD Three Recipients of the Neil S. Jacobson and depression symptoms, and vulnerabil- ity factors for the disorder. Results of this re- Research Award for Outstanding and search may suggest novel treatments, treatment components, or preventative in- Innovative Clinical Research terventions for PTSD that involve improv- ing specificity of retrieval. Virginia Rutter, Framingham State College Eddie Selby is a Ph.D. candidate in clin- ical psychology at Florida State University; he received B.A. and B.S. degrees in psy- hree talented young clinical re- cuses on how the brain changes in response chology and physiology/neuroscience at the searchers—Katherina Hauner, Sally to effective psychotherapy. For this disserta- University of Wyoming in 2005. He is pri- TMoore, and Eddie Selby—will re- tion project (supervised by Sue Mineka at marily interested in emotion dysregulation ceive the Neil S. Jacobson Research Awards Northwestern University), Ms. Hauner will as it relates to borderline personality disor- for Outstanding and Innovative Clinical employ neuroimaging to examine the ex- der, suicidal behaviors, and eating disorders. Research at 5:00 p.m. on Friday, November tinction of fear, by observing the brain His work on emotional cascades and behav- 20, 2009, during the awards and recogni- changes that are associated with successful ioral dysregulation has been published in tion ceremony at the ABCT Convention in exposure therapy for spider phobia. During the Journal of Abnormal Psychology, Review of New York City. The awards coincide with the study, participants who have lifetime di- General Psychology, and Behavior Research and the 10th anniversary of Neil S. Jacobson’s agnoses of spider phobia will receive a sin- Therapy. Mr. Selby’s project is “A Real Time death—and with his 60th birthday earlier gle, 2-hour session of exposure therapy; Evaluation of Emotional Cascades and this year. before and after the therapy, participants’ Dysregulated Behaviors in Borderline Neil Jacobson made original contribu- neural response to spider images will be ob- Personality Disorder” (supervised by tions in three areas of clinical psychology: served via fMRI, and the differences in the Thomas Joiner at Florida State University). couple therapy, depression treatment, and observed brain activity (pre- and post-ther- Mr. Selby, mindful that individuals with apy) will be compared. Ms. Hauner’s re- intimate partner violence. Much of his pro- borderline personality disorder (BPD) may search has been supported by grants from fessional and personal sense of accomplish- engage in many impulsive/dysregulated be- Northwestern University and a Society for ment, though, came from mentoring and haviors as a way of inhibiting emotional cas- the Science of Clinical Psychology training outstanding graduate students. cades and rumination can amplify negative Dissertation Award. These awards honor his contributions by emotion to an unbearable state in order to Sally Moore is a postdoctoral research recognizing and funding three innovative get some relief, devised a study that ex- fellow at the Seattle VA Medical Center’s young scholars in clinical psychology. Mental Illness Research, Education, and plores the relationship between emotional The award recipients, Katherina Hauner Clinical Center. In 2008, she received her cascades and dysregulated behaviors in in- (Northwestern University), Sally Moore Ph.D. in clinical psychology from the dividuals with BPD. The study will use ex- (Seattle Veterans Administration Medical University of Washington, where she stud- perience sampling, in which participants Center and University of Washington), and ied memory difficulties associated with complete records of interpersonal experi- Eddie Selby (Florida State University), were PTSD (under the mentorship of Lori ences, emotions, thoughts, and behaviors selected from 50 submissions. The Awards Zoellner). Her graduate research was over a period of multiple days using Palm Committee—consisting of Andrew Christ- funded by a National Research Service Pilots. It is expected that intense fluctua- ensen (UCLA), Sona Dimidjian (University Award from NIMH. Her primary research tions of rumination and negative affect will of Colorado, Boulder), Steven Hollon interests are in memory processes and emo- arise from interpersonal stressors, and that (Vanderbilt University), Bob Kohlenberg tion regulation difficulties associated with these fluctuations will significantly predict (University of Washington), and Virginia PTSD, exposure-based therapies, and treat- dysregulated behaviors in those with BPD. Rutter (Framingham State College)— ment development. Dr. Moore will be These recipients will be at the ABCT sought to identify work that showed the working on “Specific Memory Retrieval meeting to receive their Neil S. Jacobson kind of deep thinking about important Practice in Veterans With PTSD and Research Award for Outstanding and problems and novel methodology that Depression” (Tracy Simpson at the Seattle Innovative Clinical Research. In addition, characterized Neil’s early career. VA Medical Center is her sponsor for this Ms. Hauner will be presenting her work on study). In this project, Dr. Moore addresses fear extinction in a symposium on Sunday, About the Recipients how, in addition to intrusive memories of November 22, at 11:30 a.m.; Dr. Moore Katherina Hauner is a doctoral candi- trauma, individuals with PTSD have diffi- will be chairing and presenting at a sympo- date in clinical psychology at Northwestern culties retrieving specific memories of non- sium on information processing in PTSD on University, and is currently on clinical in- traumatic life events when they are Saturday, November 21, at 3:00 p.m.; and ternship at the University of Illinois at intentionally trying to do so. This difficulty Mr. Selby will be presenting a symposium Chicago. She received her B.S. from the appears to contribute to the maintenance of on self-injury in BPD on Sunday, November University of Chicago in psychology, with a PTSD symptoms over time and may repre- 22, at 9:45 a.m. Please join us in honoring specialization in biopsychology. Her pro- sent a vulnerability factor for the develop- these young scholars, and for remembering posal, “Neuroanatomical Substrates of Fear ment of PTSD. Dr. Moore’s study will Neil S. Jacobson and his many contribu- Extinction During Exposure Therapy,” fo- examine whether brief training to address tions.

160 the Behavior Therapist 16th Annual Awards & Recognition

for Award Call Nominations

The ABCT Awards and Recognition Committee, chaired by Shelley Robbins of Holy Family University, is pleased to announce the 2010 awards program. Nominations are requested in all categories listed below. Please see the specific nomination instructions in each category. Please note that award nominations may not be submitted by current members of the ABCT Board of Directors.

Outstanding Contribution by an Individual of your submission to ABCT, Student Dissertation Awards, 305 for for Research Activities Seventh Ave., New York, NY 10001. Eligible candidates for this award should be members of ABCT in good standing who have provided significant contributions to the Distinguished Friend to Behavior Therapy literature advancing our knowledge of behavior therapy. Past Eligible candidates for this award should NOT be members of recipients of this award include Alan E. Kazdin in 1998, David H. ABCT, but are individuals who have promoted the mission of cog- Barlow in 2001, Terence M. Keane in 2004, and Thomas nitive and/or behavioral work outside of our organization. Borkovec in 2007. Please complete an on-line nomination form Applications should include a letter of nomination, three letters of at www.abct.org. Then, e-mail the completed forms to srob- support, and a curriculum vitae of the nominee. Past recipients of [email protected]. Also, mail a hard copy of your submission this award include Jon Kabat-Zinn, Nora Volkow, John Allen, to ABCT, Outstanding Researcher, 305 Seventh Ave., New York, Anne Fletcher, Jack Gorman, Art Dykstra, and Michael Davis. NY 10001. Please complete an on-line nomination form at www.abct.org. Then, e-mail the completed forms to [email protected]. Also, mail a hard copy of your submission to ABCT, Distinguished Outstanding Mentor Friend to BT Award, 305 Seventh Ave., New York, NY 10001. This year we are seeking eligible candidates for the Outstanding Mentor award who are members of ABCT in good standing who Career/Lifetime Achievement have encouraged the clinical and/or academic and professional Eligible candidates for this award should be members of ABCT in excellence of psychology graduate students, interns, postdocs, good standing who have made significant contributions over a and/or residents. Outstanding mentors are considered those who number of years to cognitive and/or behavior therapy. have provided exceptional guidance to students through leader- Applications should include a letter of nomination, three letters of ship, advisement, and activities aimed at providing opportunities support, and a curriculum vitae of the nominee. Past recipients of for professional development, networking, and future growth. this award include Albert Ellis, Leonard Ullman, Leonard Krasner, Appropriate nominators are current or past students of the men- Steve Hayes, and David H. Barlow. Please complete an on-line tor. The first recipient of this award was Richard Heimberg in nomination form at www.abct.org. Then, e-mail the completed 2006, followed by G. Terence Wilson in 2008. Please complete forms to [email protected]. Also, mail a hard copy of your an on-line nomination form at www.abct.org. Then, e-mail the submission to ABCT, Career/Lifetime Achievement Award, 305 completed forms to [email protected]. Also, mail a hard Seventh Ave., New York, NY 10001. copy of your submission to ABCT, Outstanding Mentor, 305

Seventh Avenue, NY, NY 10001. NOMINATIONS FOR THE FOLLOWING AWARD ARE SOLICITED FROM MEMBERS OF THE ABCT GOVERNANCE: Student Dissertation Awards: Outstanding Service to ABCT • The Virginia A. Roswell Student Dissertation Award Members of the governance, please complete an on-line nomina- • The Leonard Krasner Student Dissertation Award tion by visiting www.abct.org. Then, e-mail the completed forms to Each award will be given to one student based on his/her doc- [email protected]. Also, mail a hard copy of your submis- toral dissertation proposal. The research should be relevant to sion to ABCT, Outstanding Service to ABCT Award, 305 Seventh behavior therapy. Accompanying this honor will be a $1,000 Ave., New York, NY 10001. award to be used in support of research (e.g., to pay participants, to purchase testing equipment) and/or to facilitate travel to the Questions? Contact: Shelley Robbins, Ph.D., Chair, ABCT Awards ABCT convention. Eligible candidates for this award should be & Recognition Committee; e-mail: [email protected] student members who have already had their dissertation pro- posal approved and are investigating an area of direct relevance to behavior therapy, broadly defined. A student's dissertation Nominate on line: www.abct.org mentor should complete the nomination. Please complete an on- line nomination form at www.abct.org. Then, e-mail the com- Deadline for all nominations: pleted forms to [email protected]. Also, mail a hard copy Monday, March 2, 2010

October • 2009 161 Welcome, New Members

Full Members Daniel Singley Jason W. Beaumier Kristin Elisabeth Naragon Alice Abarbanel Denise E. Stack Emily Becker-Weidman Gainey Robert T. Ammerman Jan Stampley Amanda Tennyson Berger Yuliana E. Gallegos Rodriguez Claudia Arlo Stephan Stevens Joshua Berger Miguelina German Daniel M. Bagner Nicole D. Swain Christopher Robert Berghoff Matthew E. Goldfine Christopher Barrick Jeff Szymanski L. Cinnamon Bidwell Benjamin Gottesman Madeleine Beaudry Yvette N. Tazeau Timothy Billings Renee Grinnell Michelle Bell Dana S. Thordarson Jason Oliver Black Jessica Grossman Silvia Bernardini Frances P. Thorndike Lora Black Kathleen M. Grubbs John Ross Bradley Jill-Marie Tiedemann Sasha Collins Blackwell Nate G. Gruner Pascale Brillon Tero Timonen Jennifer Bolden Jennifer Guadagno Wally Bzdell Karen Cameron Wells Alexa Noelle Bonacquisti Liza Lin Guequierre Anil Chacko Laura Farrell West Amanda Bordfeld Vito Guerra Cheryl A. Chessick Lena A-K Wiklund Charmaine Borg Jessica Gundy Maria Clara Cuevas Karen Williams Hayden C. Bottoms Rebekah L. Haas Dara Delancy Carolyn Z. Wilson Evan Bronstein Courtney Haight Renda Dionne Michael D. Young Jelena C. Bubanj Kate V. Hardy Rachel Eddins Melanie Ariel Burns Rebecca Hashim Michelle M. Ernst New Professionals Sabine Calle Christina Hauke Gabrielle Faggella Gina Di Giulio Steven R. Caplan Adrienne J. Heinz Anne M. Fatone Robert Ferguson Kristin V. Christodulu Jennifer L. Herring Roberto Flachier Maxine E. Holmqvist Brooke E. Coccia Andrea L Hobkirk Greta Francis Robert D. Latzman Shiri Cohen Jessica Hughes Claire A. B. Freeland Amy B. Lerner Peter Colvin Alexis M. Inabinet Shannon Ann Glenn Gosta Liljeholm Martha Anne Combs Matthew Thomas Jameson Susan Golden Monica C. Mann-Wrobel Melisa Constantiner Alexandra Johnson Lisa J. Hoffmeyer Perry L. Masoti Erin B. Cooper Grace W. Jones Marcus J. H. Huibers Melisa Moore Tara K. Cossel Sara Jucaj Soledad Iucci Cyndi R. I. Murrer Lisa M. Couperthwaite Kristine M. Kent Cynthia Rheney Johnson Sarah K. Ravin Cerissa L. Creeden Lauren King Elizabeth C. Katz Rachel E. Rubin Taya Cromley Laura A. Knight Peter James Kelly Veronika I. Voyages Katherine Cunningham Ellen Kolomeyer Bruria L Kleinman Loren Watt Emily D’Antonio Grace Kong Kristin Knapp-Ines Kim R. Zlomke Maria Fernanda Dasilva Alla Kryss Naomi B. Knoble Joshua L. Davis Sadie E. Larsen Jaimelyn Kost Post-Baccalaureates Genevieve L. Davis Federica Latta Jeffrey C. Lanfear Gina Marie Cossavella Kelly B. Decker Allison L. Lebowitz Marlena Larson Kathryn DeYoung Ashleigh Nicole DeFries Jenna Lenhardt Rachel E. Lauber Aubrey Edson John Parkinson Dehlin Jessica C. Levenson Earl E. Ledford Jr. Jason Daniel Jones John E. Dencoff Sara Levenson Ryan Robert Lindsay Mary Munroe Gohar Derhovanesian Michelle Levy Duane A. Lundervold Ashley Marie Smith Dan DeSena Elana R. Light Melissa Marcantuone Jonathan P. Stange Whitney A. Dicterow Victoria Josefina Limon Melanie McConnell Debora Anna D’Iuso Sara E. Little Elizabeth Valarie Michael Students Halina J. Dour Thailyn Lopez Nandita Mishra Idan Moshe Aderka Jordan H. Drackett Muhammad Hassan Majeed Rachael Cheri Murrihy Sara Afienko Chris Drescher Jonathan W. Martin Darcy Clothier Norling Gillian Marta Alcolado Claudia Drossel Lisa Matthews Richard L. Osburn Kimberly M. Alexander Maria Drvoshanov Melissa Maxwell Wendy A. Ossman Jennifer Alosso Maha Alex Eidi Tina Mayes Kanako Otsui Carrie E. Ambrose Natasha Elkovitch Jessica McCarthy Amy Marie Pacos Lena S. Andersen Kristen Ellison Salena McCaslin Peter Pramataris Kristin Anderson Kendra L Ellway Megan Leigh McCormick Cynthia S. Randolph Maria R. Anthony Laura J. Ely Christine Catherine McDunn James E. Rosser Kristin E. Austin Jonathan Feiner Metta McGarvey Gail A. Rothman-Marshall Megan Lee Avery Bill R. Ferguson Andrew Miller Kristen Leigh Schmidt Effie Avgoustis Karla C. Fettich Jennifer Minarcik Kathleen Shay Sharon Michelle Batista Kathi M. Fine Dominic C. Moceri Ian David Shulman Emily Rebecca Beamon Kelci Cornelia Flowers Oswaldo Moreno

162 the Behavior Therapist New Student Members, continued Arezou Mortazavi Elise Resnick Randi Melissa Schuster Alison A. Tebbett Beth L. Mugno Kimberly Lynn Rinehart Nisha Sethi Jasmine H. Teleki Hillary E. Nammack Dixie Robinson Cara Anne Settipani Ryan Trim Aaron Martin Norr Ashley Ross Melina Sevlever Samantha P. VanHorn Kathleen A. O’Malley Jennifer A. Roters Alison M Shanholtzer Jennifer Celene Veilleux Adjoa T Osei Jennifer Nicole Rough Christina B. Shook Lana M. Wald Natalie Pastelak Julia Rovinsky Mark Matthew Silvestri Caitlin Elizabeth Walsh Jessica C. Payne-Murphy Ashley Brett Rudnick Lauren Sippel Lindsay Washington Alexander M. Penney Laura Rusch Gina Sita Tiffany West Andrew Philip Sheila C. Russell Kathryn E. Smith Michelle Woidneck Emily Pichler Minette Russell-Irace Melody K. Sorenson Dorothy Porter Arthur R. Sandt Paige Spencer Matthew Worley Chelsea Price Dana A. Satir Adrianne L. Stevens Andrea Woznica Steven L. Proctor Lindsay Adele Sauers Suzanne Stone Jodi B. Yarnell Nicky Elizabeth Pugh Rachel Schafer sherin talebian Andrea Yee Katarina Radisavljevic Chris Scheller Rachel L. Talero David Yood Yevgeniya Ratnovsky Sara W. Schonwetter Ryan Eric Talley Yiling Zhang Bonney Reed-Knight Luke T. Schultz Annie Yuh-Jiun Tang Marian Rose Zimmerman Invited Panel NEW ABCT • 43rd Annual Convention • Nov. 19–22, 2009 • Marriott Marquis

YORK register today! www.abct.org CITY Overcoming the Glass Ceiling–Lessons Learned and Lessons to Give: A Conversation With the Trailblazers MODERATORS: Lata K. McGinn, Yeshiva University, and Michelle Newman, Pennsylvania State University PANELISTS: Dianne Chambless, Edna Foa, Robin Jarrett, Marsha Linehan, Barbara McCrady, Susan Mineka, Rosemery Nelson, Patricia Resick, Antonette Zeiss

Friday, November 20 | 2:45 P.M. | Broadway North

This unique panel will address the following topics: • The impact of being a woman, including decisions made and challenges or adversities faced during participants’ career building years; • Ways in which participants prevented or overcame any adversities or challenges faced; • Potential challenges faced by participants and women professionals in general today and how they may differ from early challenges; • Lessons that emerging female professionals can learn from experiences faced by participants; • Discussion of strategies to further break the glass ceiling: (e.g., mentorship of younger female pro- fessionals, development and maintenance of informal networks (an old girl’s club), raising aware- ness of subtle biases faced by women today).

October • 2009 163 the Behavior Therapist PRSRT STD Association for Behavioral U.S. POSTAGE and Cognitive Therapies PAID 305 Seventh Avenue, 16th floor New York, NY 10001-6008 Hanover, PA 212-647-1890 | www.abct.org Permit No. 4 ADDRESS SERVICE REQUESTED

Professional Development NEW ABCT • 43rd Annual Convention • Nov. 19–22, 2009 • Marriott Marquis

YORK register today! www.abct.org CITY

INTERNSHIP PANEL Internship Training Site Overview | Jeanette Hsu & Justin Nash Friday, Nov. 20, Manhattan Ballroom, 8:45 a.m.

POSTGRADUATE PANEL Postdoctoral Paths for Professional Development | Richard Seime & Antonette Zeisss Friday, Nov. 20, Marquis B & C, 10:30 a.m.

MEMBERSHIP PANEL DISCUSSION What Every Graduate Student, Postdoc, and Early Career Professional Needs to Know About the NIHM Loan Repayment Programs | Borrego et al. Friday, Nov. 20, Cantor/Jolson, 1:00 p.m.