Handbook of Clinical Behavior Therapy with Adults

Handbook of Clinical Behavior Therapy with Adults

Edited by

MICHEL HERSEN Wcsicril Ps)/chililric llishiule 1111<1 Ciillic UlliL'frsi01 (If Pllisburgh Schoo/ of lvicdicille Plltsburg!l, PCllIIS)lbllll<l

and

ALAN S. BELLACK Medi"t/ C"I/cgc of Pc lIo!;/t'li II ill III EPPI Phil'liifll'!lill, PCIIIIS!lh'lIllili

Plenum Press • New York and London

Library of Congress Cataloging in Publication Dat a

Main entry undc r title:

Handbook of clinical beha"ior therapy with adu lts.

Indudes bibliographil.':i and indc~.

l. Behavior therapy. l. Il erscn, Michel. ll. lleUack. Alan S. [DNLM : l. Beh,wi"r Therapy - in adulthood-handbooks. 2. "leutal Diw rders _ theral')·_ han dbooks. WM 34 112J6) RC489. B4H37S 1985

ISBN-13: 978-1-4612-9-477-1

001: 10. 10071978-1-4613·2427·0

@ 1 98~ Plenum Pre ... New York

616.89' )42

e-ISBN-13: 978·1-4613-2427·0

Soncover reprint of the hardcover 1st edition 1985 A Dj"ision of I'lenom Publi.hing Cor]lOration 233 Spring S,reet. New York. N.Y. tOO t3

No 1"''' o(,hi. book ma y be ",prOOuc~d. stored in" ",";oyal 'y",c'". or tran. ",ined in any form 'IT by any me.n •. dec"""ic, mechanical. photocopying. microfilming. n:wrdinS. or oth"",., j"" . .... jthout written ""nlt; .. ion from the Publisher

To Our

Parents

Contributors

MARGRET A. APPEL, Department of Psychology, Porter Hall, Ohio University, Athens,

Ohio

JACK S. ANNON, The Royal Queen Emma, Suite 604, 222 South Vineyard Street, Honolulu, Hawaii

BERNARD J. BALLEWEG, Department of Psychology, University of Montana, Mis­soula, Montana

ROBERT E. BECKER, Behavior Therapy Unit, Department of Psychiatry, Medical Col­lege of Pennsylvania at EPPI, 3200 Henry Avenue, Philadelphia, Pennsylvania

ALAN S. BELLACK, The Medical College of Pennsylvania at EPPI, 3200 Henry Ave­nue, Philadelphia, Pennsylvania

MARY JANE BLACK, Department of Psychiatry, St. Luke's Hospital, Cleveland, Ohio

PHILIP H. BORNSTEIN, Department of Psychology, University of Montana, Missoula, Montana

HENRY M. BOUDIN, Center for Psychological Services, Suite 310, Chin Hills Build­ing, 3915 Talbot Road South, Renton, Washington

DIANNE L. CHAMBLESS, Department of Psychology, The American University, Wash­ington, District of Columbia

vii

viii

CONTRIBUTORS

CAROL E. CORNELL, J. Hillis Miller Health Center, Department of Basic Dental Sciences, University of Florida, Box J-4 2 4, Gainesville, Florida

LINDA WILCOXON CRAIGHEAD, Division of Counseling and Educational Psy­chology, The Pennsylvania State University, University Park, Pennsylvania

JAMES P. CURRAN, Veterans Administration Medical Center, Brown University Med­ical School, Providence, Rhode Island

C. J. DAVIS, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana

STEPHEN V. FARAONE, Veterans Administration Medical Center, Brown University Medical School, Providence, Rhode Island

VIVIAN FERNANDEZ, Department of Psychology, University of Southern California, Seeley G. Mudd Building, University Park, Los Angeles, California

SUZANNE M. FISCHER, Department of Psychology, Memphis State University, Mem­phis, Tennessee

EDNA B. FOA, Department of Psychiatry, Behavior Therapy Section, Eastern EPPI, 3300 Henry Avenue, Philadelphia, Pennsylvania

K. GUNNAR GOTESTAM, Department of Psychiatry and Behavioural Medicine, Uni­versity of Trondheim, Trondheim, Norway

JONATHAN B. GRAYSON, Department of Psychiatry, Behavior Therapy Section, East­ern EPPI, 3300 Henry Avenue, Philadelphia, Pennsylvania

SIMONE GUENETTE, Veterans Administration Medical Center, Davis Park, Provi­dence, Rhode Island

FRANCIS C. HARRIS, Western Psychiatric Institute and Clinic, University of Pitts­burgh School of Medicine, Pittsburgh, Pennsylvania

RICHARD G. HEIMBERG, Center for Stress and Anxiety Disorders, State University of New York at Albany, 1535 Western Avenue, Albany, New York

MICHEL HERSEN, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

STEVEN D. HOLLON, Department of Psychology, University of Minnesota and St. Paul-Ramsey Medical Center, Minneapolis, Minnesota

KENNETH A. HOLROYD, Department of Psychology, Porter Hall, Ohio University, Athens, Ohio

VIRGINIA JACOBSON, Ramsey County Adult Mental Health Center, St. Paul, Minnesota

JEFFREY A. KELLY, Department of Psychiatry, University of Mississippi Medical Cen­ter, 2500 North State Street, jackson, Mississippi

DANUTA M. LAMPARSKI, Department of Psychiatry, University of Mississippi Med­ical Center, 2500 North State Street, jackson, Mississippi

DAVID M. LAWSON, Division of Psychology, Shaughnessy Hospital, 4500 Oak Street, Vancouver, British Columbia and Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada

PAUL M. LEHRER, Department of Psychology, Rutgers Medical School, University of Medicine and Dentistry of New jersey, Piscataway, New jersey

KENNETH L. LICHSTEIN, Department of Psychology, Memphis State University, Memphis, Tennessee

STEVEN J. LINTON, Department of Occupational Medicine, Drebro Medical Centre Hospital, Orebro, Sweden

GAYLA MARGOLIN, Department of Psychology, University of Southern California, Seeley C. Mudd Building, University Park, Los Angeles, California

NATHANIEL McCONAGHY, Psychiatry Unit, Prince of Wales Hospital, Randwick, New South Wales, Australia

F. DUDLEY McGLYNN,]. Hillis Miller Health Center, Department of Basic Dental Sciences, University of Florida, Box j-424, Gainesville, Florida

ix

CONTRIBUTORS

x

CONTRIBUTORS

JAMES R. MOON, Department of Aging Programs, Florida Mental Health Institute, The University of South Florida, Tampa, Florida

ROGER L. PATTERSON, Director, Geriatric Rehabilitation Project (116B), Veterans Administration Medical Center, Tuskegee, Alabama

CAROLYN F. PHELPS, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania

PATRICIA A. RESICK, Department of Psychology, University of Missouri-St. Louis, St. Louis, Missouri

C. STEVEN RICHARDS, Department of Psychology, College of Arts and Sciences, Syr­acuse University, Syracuse, New York

CRAIG H. ROBINSON, The Royal Queen Emma, Suite 604, 222 South Vineyard Street, Honolulu, Hawaii

LAURIE RUGGIERO, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana

PATRICE G. SAAB, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania

HAROLD E. SCHROEDER, Department of Psychology, Kent State University, Kent, Ohio

GAIL STEKETEE, Department of Psychiatry, Temple University, Philadelphia, Pennsylvania

ROBERT G. SUTTON, Veterans Administration Medical Center, Davis Park, Provi­dence, Rhode Island

SUSAN R. WALEN, Baltimore Center for Cognitive Therapy, 6303 Greenspring Ave­nue, Baltimore, Maryland

CHARLES E. WEISSER, Department of Psychology, University of Montana, Missoula, Montana

DONALD A. WILLIAMSON, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana

ROBERT L. WOOLFOLK, Department of Psychology, Busch Campus, Rutgers Uni­versity, New Brunswick, New Jersey

xi

CONTRIBUTORS

Preface

Despite the occasional outcries to the contrary, the field of behavior therapy is still

growing, and the asymptote has not been reached yet. The umbrella of behavior

therapy continues to enlarge and still is able to encompass new theories, new con­cepts, new research, new data, and new clinical techniques. Although the number of new behavioral journals now has stabilized, we still see a proliferation of books

on the subject. In the past few years, however, we have seen considerable specialization within

behavior therapy. No longer is it possible to be a generalist and remain fully abreast of all the relevant developments. Thus, we see behavior therapists who deal with

adults, those who deal with children, those whose specialty is hospital psychiatry,

and those who see themselves as practitioners of behavioral medicine. Even within

a subarea such as behavioral medicine, specialization runs supreme to the extent

that there are experts in the specific addictions, adult medical problems, and child

medical problems. Given the extent of specialization, there are numerous ways "to skin" the pro­

verbial "cat." We therefore have chosen to look at the contemporary work in

behavior therapy that is being carried out with adults, in part, of course, because

of our long-standing interest in this area as teachers, researchers, and clinicians. In so doing, we have chosen to highlight the clinical aspects of the endeavor but

not at the expense of the rich research heritage for each of the specific adult disorders.

The thrust of this handbook is more clinical than competing works because we

find that many of our students and some colleagues with differing theoretical per­

suasions still consider what behavior therapists do in their clinical encounters to be

somewhat of a mystery. Thus, for pedagogic reasons, we have asked each of our contributors to follow, to the extent feasible, a general outline for the discussion of the specific disorders: (a) introduction and description; (b) assessment; (c) range

of treatment techniques available; (d) limitations and problems with the techniques;

(e) illustrative case study, with actual therapist-patient dialogue when available; and (f) problems encountered during the course of treatment. But all of the

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PREFACE

aforementioned does appear within the context of extant clinical-research findings.

The book is divided into six parts. Following Part I (Introduction) we have five chapters dealing with the Anxiety Disorders (Part II). Part III (Depression) includes two different treatment approaches currently being carried out for the depressive disorders, whereas Part IV (Behavioral Medicine) includes seven chap­ters dealing with medical problems. Two approaches (inpatient and outpatient) are devoted to the treatment of Schizophrenia in Part V. Finally, in Part VI we have eight chapters on a variety of issues that fall under the general rubric of Special Problems.

Many people have devoted time and effort to the development and production of this handbook. First and foremost are our contributors who agreed to share their expertise with us. To them, we express our heartfelt thanks. Second are our secretaries and technicians (Susan Capozzoli, Florence Levito, Mary Newell, and Janet Twomey) without whom we could not have carried out a project of this mag­nitude. Finally, we thank the good people at Plenum Press for their excellent work­manship, and particularly Eliot Werner, our editor, who agreed as to the timeliness of this project in the first place.

MICHEL HERSEN

ALAN S. BELLACK

Contents

I. INTRODUCTION

1. General Considerations 3 Alan S. Bellack and Michel Hersen

II. ANXIETY DISORDERS

2. Simple Phobia 23 F. Dudley McGlynn and Carol E. Cornell

3. Agoraphobia 49 Dianne L. Chambless

4. Stress and Generalized Anxiety 89 Robert L. Woolfolk and Paul M. Lehrer

5. Social Anxiety 109 Susan R. Walen

6. Obsessive-Compulsive Disorder 133 jonathan B. Grayson, Edna B. Foa, and Gail Steketee

III. DEPRESSION

7. Cognitive Approaches 169 Steven D. Hollon and Virginia jacobson

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xvi 8. Social Skills Training Approaches 201

CONTENTS Robert E. Becker and Richard G. Heimberg

IV. BEHAVIORAL MEDICINE

9. A Problem-Solving Approach to the Treatment of Obesity 229 Linda Wilcoxon Craighead

10. Anorexia Nervosa 269 Francis C. Harris and Carolyn F. Phelps

II. Alcohol and Drug Abuse 293 David M. Lawson and Henry M. Boudin

12. Insomnia 319 Kenneth L. Lichstein and Suzanne M. Fischer

13. Pain 353 K. Gunnar G6testam and Steven J. Linton

14. Cardiovascular Disorders 381 Margret A. Appel, Patrice G. Saab, and Kenneth A. Holroyd

15. Headache 417 Donald A. Williamson, Laurie Ruggiero, and C. J. Davis

V. SCHIZOPHRENIA

16. Inpatient Approaches 445 James P. Curran, Robert G. Sutton, Stephen V. Faraone, and Simone Guenette

17. Outpatient Treatment of Schizophrenics: Social Skills and Problem-Solving Training 485 Jeffrey A. Kelly and Danuta M. Lamparski

VI. SPECIAL PROBLEMS

18. Unassertiveness 509 Harold E. Schroeder and Mary Jane Black

19. Sex Role Considerations for the Behavior Therapist Patricia A. Resick

20. Work and Study Problems 557 C. Steven Richards

21. Aging 573 Roger L. Patterson and James R. Moon

22. Anger and Violent Behavior 603

531

Philip H. Bornstein, Charles E. Weisser, and Bernard J. Balleweg

23. Sexual Deviation 631 Jack S. Annon and Craig H. Robinson

24. Psychosexual Dysfunction 659 Nathaniel McConaghy

25. Marital Dysfunction 693 Gayla Margolin and Vivian Fernandez

Index 729

xvii

CONTENTS