Journal of Pediatric Psychology, Vol. 27, No. 4, 2002, pp. 325-337
© 2002 Society of Pediatric Psychology
Empirically Supported Treatments in Pediatric Psychology: Where Is the Diversity?
The University of Iowa
All correspondence should be sent to Daniel L. Clay, Psychological & Quantitative Foundations, 361 Lindquist Center, The University of Iowa, Iowa City, Iowa 52242. E-mail: daniel-clay{at}uiowa.edu .
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Abstract |
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Objective: To examine the extent to which studies used to support empirically supported treatments for asthma, cancer, diabetes, and obesity address issues of cultural diversity.
Method: We chose original articles (71) of treatments used to support empirically supported treatments (ESTs) published as part of a special series on ESTs in the Journal of Pediatric Psychology. Trained coders reviewed each study to determine if the following were reported: race/ethnicity and socioeconomic status (SES) of the sample, moderating cultural variables, cultural assumptions or biases of the treatment, larger cultural issues, and measurement or procedure bias.
Results: Results revealed that few studies addressed cultural variables in any way. Only 27% of the studies reported the race or ethnicity and 18% reported the SES of research participants. Additionally, 6% discussed potential moderating cultural variables. The remaining variables were addressed in 7% or less of the studies.
Conclusions: These data support the criticism that ESTs fail to address important issues of culture and call into question the external validity of ESTs to diverse populations. Future research should explicitly address cultural issues according to the nine recommendations described here.
Key words: culture; ethnic minorities; empirically supported treatment; diversity.
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Introduction |
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Recent changes in managed care have led to the need to demonstrate the efficacy of our treatment approaches in psychology. Market and professional forces have since led to the development of empirically supported treatments (ESTs; Christopherson & Mortweet, 2001
; Nathan & Gorman,
1998). Treatment approaches are considered ESTs when specific
criteria are met for demonstrated efficacy through scientific research
(Chambless & Hollon, 1998;
Nathan & Gorman, 1998).
Much attention in research and training is now focusing on ESTs, and the
movement toward empirically supported treatments has had a substantial impact
on the delivery of psychological services. For example, scientific journals
such as the Journal of Pediatric Psychology have devoted special
issues and sections to ESTs. Although the importance of the concept of ESTs is
well accepted, the application of ESTS to diverse populations has drawn
criticism from proponents of multiculturalism. The problem lies not with the
use of ESTs per se, but rather with the use of research studies to support
them that fail to attend to the needs of diverse populations when they do not
incorporate important cultural issues and variables.
Most forms of psychotherapy, particularly those now considered an EST, were
developed from the white, middle-class perspective
(Sue & Sue, 1990). Thus,
the extent to which current ESTs take into account important cultural issues,
and consequently their value for work with culturally diverse populations, is
in question (Bernal &
Scharron-Del-Rio, 2001; Hall,
2001; Sue, Bingham,
Porche-Burke, & Vazquez, 1999). Sue
(1999) argues that ESTs fail
to adequately address issues of multiculturalism due to a selective adherence
to internal validity of research at the expense of external validity.
Likewise, the research used to support ESTs has been criticized for its lack
of attention to multicultural issues such as using samples with ethnic
minority representation, using culturally appropriate measurements,
acknowledging the cultural assumptions and biases of specific theories and
treatment approaches, and examining the impact of cultural variables as
mediators of treatment effects. Although certain treatments may be
efficacious, they may not be effective with individuals from minority
cultures, given these stated concerns. In fact, a recent discussion by
Chambless and Hollon (1998)
failed to expound upon the importance of cultural variables such as social
class, race, and ethnicity in their discussion of ESTs. While an emphasis on
internal validity is initially important in establishing the efficacy of a
specific treatment, more needs to be done to ensure the validity of such
treatments with diverse samples.
Why is multiculturalism important to pediatric psychology? First, race and
ethnicity have been associated with differential prevalence rates and outcomes
for overall health and for specific health conditions such as asthma, cancer,
diabetes, sickle cell disease, obesity, substance abuse, injury, heart
disease, and liver disease, to name a few
(Flack et al., 1995;
Johnson et al., 1995). This is
especially important given the changing demographics of the United States.
Additionally, outcomes such as the extent of disability resulting from
illness, mortality rates, early intervention, continued management of chronic
health problems, and health care access and utilization have also been related
to race, ethnicity, and culture (Flack et
al., 1995; Johnson et al.,
1995). Second, psychological and medical treatment issues are also
related to race, ethnicity, and culture. These issues include acceptability of
and receptiveness to treatments, expectations, treatment adherence, as well as
health care behaviors and beliefs (Bagley,
Angel, Dilworth-Anderson, Liu, and Schinke, 1995;
Flack et al., 1995;
Johnson et al., 1995;
Meyers, Kagawa-Singer, Kumanyika, Lex,
& Markides, 1995; Penn,
Kar, Kramer, Skinner, & Zambrana, 1995). For example,
minorities and nonaffluent populations have many more barriers to treatment
adherence. Consequently, recent funding opportunities by the National
Institutes of Health (RFA-HL-01-005) have specifically targeted issues of
treatment barriers and adherence for minorities and persons living in poverty
(National Institutes of Health,
2001). Such differential prevalence rates, mortality rates, and
outcomes are one of the most critical public health problems we currently
face.
In addition to differential prevalence rates and outcomes, cultural definitions and values play an important role in health-related disorders. For example, values about obesity and body size vary widely between cultures and socioeconomic groups. Consequently, pediatric psychologists assessing and employing treatments with children with chronic illness and their families must consider such cultural variables to ensure that culturally competent services are provided, thereby maximizing positive outcomes.
Culture can also influence treatment through an interaction of the person's
culture with specific cultural aspects or assumptions of the treatment. A
treatment that conflicts with the patient's culture or lifestyle may reduce
treatment adherence and acceptability and eventually result in poorer outcome
(Clay, 2000;
Penn et al., 1995). More
specifically, aspects of a treatment that are incongruent with the patient's
cultural norms or values are likely to be less palatable to the individual,
thereby leading to less compliance, more premature dropout, and a decrease in
response to treatment. On the other hand, attention to specific aspects of
culture, such as family functioning in Hispanic populations, can serve to
capitalize on strengths and facilitate better treatment outcomes.
Currently, the field appears to be proceeding in the direction of greater
specificity in evaluating psychological treatments. With an arguably
substantial menu of treatments documented as efficacious, the next generation
of studies has focused on determining which components of treatment are
effective, consideration of treatment and client match, as well as
consideration of the environment of service delivery
(Bergin & Garfield, 1994;
Kiesler, 1995). However,
consideration of cultural variables still lags behind. Ethnicity and culture
are significant components of an individual that should not be ignored in the
therapy effectiveness literature.
Given the criticism of ESTs by proponents of multiculturalism and the relationship of race, ethnicity, and culture to health and health care treatments, this study examined the extent to which ESTs for pediatric health problems address critical issues of race, ethnicity, and culture. To this end, we examined 71 original studies used to support ESTs for diabetes, asthma, cancer, and obesity. These conditions were chosen for three reasons: (1) they are common conditions requiring treatment by pediatric psychologists; (2) data have linked these conditions specifically to race, ethnicity, and culture; and (3) ESTs for these conditions recently appeared in the special section on empirically supported treatments in the Journal of Pediatric Psychology.
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Method |
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Procedure
Original research articles were identified through review articles published as part of a special series on empirically supported treatments for pediatric asthma, cancer, obesity, and diabetes published in the Journal of Pediatric Psychology (Jelalian & Saelens, 1999
; McQuaid
& Nassau, 1999). (See the appendix for information on included
articles.) Only articles with random assignment of subjects to treatment
groups were included in the area of obesity treatment. Original articles cited
in support of an EST were examined by two graduate research assistants who
coded the variables according to the criteria listed below. Coders were
trained in advanced research methodology and multicultural issues in practice
and research. Once the operational definitions of the variables were derived
from the extant multicultural literature, the coders and the primary author
reviewed scenarios and discussed the coding process until consensus on the
process and decision rules for each category were obtained. Reviewers met
after approximately five articles were coded to discuss the utility of the
established decision rules. Discussion during the coding process led to few
major changes in the system or rules, although greater specification of the
moderating cultural variables category and a broadening of the concepts
considered in the larger cultural issues category were agreed upon. Agreement
rates for the two reviewers for each of the variables were: ethnicity (99%),
socioeconomic status (SES) (100%), moderating cultural variables (96%), EST
cultural bias (96%), larger cultural issues (99%), and measurement/procedure
bias (100%). The overall agreement rate was 92%. After each person had a
chance to review all 71 articles, reviewers jointly examined instances in
which they disagreed and evaluated the stated criterion for coding that
variable. Each rater explained the rationale for his or her decision utilizing
operational definitions and discussed the specific rating until consensus was
reached. Two meetings were sufficient to resolve the few discrepancies and
obtain consensus for all codes.
Variables
Original research articles were examined to determine whether the studies
addressed important cultural issues. The variables were identified in the
literature as important cultural aspects of treatments and treatment research
(Anderson, 1995a,
1995b;
Sue, 1999). A determination
was made as to whether an article addressed each of the issues as defined by
the questions below. To ensure that all cultural variables were identified,
liberal decision rules were adopted. For example, we recognized that SES of
participants was addressed if the authors described SES only as
"wide-ranging." While this does not in itself make the study more
generalizable to diverse populations, this criterion was used to ensure that
even studies that scarcely addressed the issues were identified.
Race/Ethnicity. Articles were coded as "yes" if the
race, ethnic, or nationality breakdown of the research sample was specified.
If the authors of the original study simply reported the race or ethnicity of
the research participants, this was coded as "yes," including
participants described as white. At the very least, an article must report the
racial or ethnic makeup of the sample employed to assess the extent to which
research is externally valid or can be generalized beyond the sample employed
(Sue, 1999).
Socioeconomic Status. Raters asked, "Does the article describe the socioeconomic status (SES) of the study sample?" The answer was "yes" when the article made any reference to sample characteristics associated with SES including standard indexes of SES, income, occupation, or education. Informal and general descriptions of SES such as "wide-ranging" were also coded in the affirmative.
Moderating Cultural Variables. Two aspects were considered in this category: (1) whether the article mentions a specific ethnic-related variable shown or hypothesized to be associated with any aspect of the disease including prevalence, presentation, or treatment and (2) statement that groups or individuals differ in reference to the aforementioned variable. Both aspects had to be present for the article to be coded in the affirmative for this category. For example, simply mentioning diet as an important variable for obesity is not sufficient, although noting that ethnic groups or individuals may differ in regard to diet (e.g., ethnic food preference) obtains a "yes" in this domain. Similarly, discussion of stress as an important variable to consider when treating asthma is not sufficient while noting differential experience of a type of stress that is ethnically related (e.g., racism) is sufficient. Specific common variables in reviewed articles include genetics, environment, and ethnic beliefs. Reviewers asked, "Does the article mention specific variables that have been shown or are hypothesized to be related to the disease? Does the article acknowledge that individuals or groups differ on the ethnic variables mentioned?"
ESTs Cultural Bias. Acknowledgment of differential treatment effects for diverse groups of people was evaluated. Whereas the previous category of moderating cultural variables can reflect variables associated with any aspect of the disease (e.g., prevalence, presentation, or treatment), this category refers solely to treatment aspects. An additional difference is that a more general statement of different treatment effects was sufficient to gain a "yes" in this category, whereas mention of a more specific ethnic-related variable was required in the previous category. For example, an article containing a general statement that ethnic group membership has been associated with treatment outcome with no further speculation of the specific variables that may influence differential outcome would receive a "no" code for the moderating cultural variables category and a "yes" code for the EST's cultural bias category. Similarly, an article stating that a treatment program was developed for Spanish patients but did not describe how Spanish status specifically influenced treatment or how the treatment differed from a treatment designed for non-Spanish patients was given a similar pattern of codes for these two categories. Although it is theoretically possible to obtain the reverse pattern of a "yes" code for the moderating cultural variables category and a "no" code for the EST's cultural bias category (e.g., if a specific variable was noted as important to disease prevalence but not mentioned as influencing treatment), this pattern was not observed in any of the articles. Reviewers asked, "Does the text address the extent to which the treatment as a whole or an individual aspect of the treatment has differential process or outcome depending on cultural factors? Is there evidence that the treatment or treatment protocol was altered to accommodate ethnic differences?" If any potential differences in treatment due to ethnic group membership or potential differences in treatment acceptability or outcome based on ethnic group membership was addressed, this variable was coded "yes."
Larger Cultural Issues. Articles were judged according to the extent to which they addressed and incorporated larger societal or professional issues related to culture. Issues discussed could involve a variety of subject areas, although the content of the discussion had to extend beyond the initial aspects of the study. Reviewers considered whether the article made general statements regarding the status of our empirical knowledge about how ethnicity influences the particular disease and treatment. This category is different from other categories in that it involves discussion in the larger context of general societal or professional trends (for example, an article calling for future studies clarifying the relationship between "demographic factors" and treatment strategies without specifying which demographic factor by name would be coded as a "yes" for the larger cultural issues category but as a "no" for the moderating cultural variables category). In contrast, an article calling for more research on the relationship between ethnic healing beliefs and treatment would be coded as a "yes" for both categories. Are societal trends or professional trends related to culture described in the article? Does the article make predictions or give opinions regarding how and to what extent cultural factors should be incorporated in future research or treatment? Does the article call for a movement toward integrating more cultural variables into professional practice?
Measurement/Procedure Bias. Evidence supporting consideration of the cultural appropriateness of research procedures and measures was sought. Reviewers considered, "Does the author indicate whether measures were appropriate for the given sample? Were research measures altered to accommodate ethnic or ethnic-related differences between groups? Does the author mention potential biases in any aspects of the research procedure such as sampling bias or reaction to sequencing?" A code of "yes" indicated that appropriateness or alteration of procedures or measures was discussed.
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Results |
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Results of the analysis of the 71 existing studies used to support ESTs for each of the conditions are presented in Table I. Individual article characteristics are organized by medical condition. Results revealed that discussion of relevant diversity issues in all medical conditions was rare and typically brief. Only 19 (27%) of the studies reported the ethnic or racial composition of the sample employed, and only 8 (11%) reported sampling American minority participants such as Black, Asian American, and Hispanic. In most of these studies fewer than five persons of color participated. SES was reported in 13 (18%) studies, with the majority of those reporting SES in the middle-class range. Even fewer studies addressed more specific issues of culture, with four (6%) studies discussing moderating cultural variables, five (7%) recognizing cultural bias of treatments, four (6%) addressing larger cultural issues in disease and its treatment, and a single study that addressed the cultural appropriateness of the methodology and measures used.
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Discussion |
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The results of this study support the criticisms of the external validity of ESTs to diverse populations due to the failure to incorporate essential aspects of culture (Sue, 1999
). Most of the research reviewed in this study was conducted
in the 1970s and 1980s and contained research published up to 1997. While
there may be research published since then that begins to address these
issues, the articles published in the recent issues of the Journal of
Pediatric Psychology (1999) serve as a comprehensive, up-to-date review.
Consequently, practitioners and researchers alike will consider this
information as current.
These data are from studies demonstrating the efficacy of psychological
treatments for illnesses or conditions that have been closely linked to race,
ethnicity, and culture. One would expect that these bodies of research would
reflect examination of such important cultural variables given their links to
cultural variables, yet there is a striking consistency in the absence of even
descriptive information, much less a sophisticated integration of cultural
variables. Additionally, the liberal decision rules of whether a cultural
variable was identified likely underestimated the extent of the problem. For
example, SES of participant families is not reported in any of the pediatric
asthma literature, despite our knowledge that lower-income children have
higher rates of morbidity and mortality and have fewer resources for coping.
This failure to adequately describe cultural aspects of samples employed is
part of a broader set of sampling problems in pediatric research (Drotar &
Reikert, 2000). Celano, Geller, Phillips, and Ziman
(1998) did examine adherence
in a predominantly African American sample of low-income children with asthma.
However, this important information is rarely integrated into the treatment
trials used to support ESTs.
Many of the issues described here reflect general methodological problems
as well as problems specific to culture or diversity. For example, we discuss
here the failure to take into account moderating cultural variables. Many
process and outcome studies fail to take into account any moderating variables
(Bergin & Garfield, 1994)
other than diversity-related variables. In this case, individual difference
variables such as illness severity and duration may also be important and are
often overlooked in treatment research. Consequently, the concerns and issues
raised here are within the larger context of weaknesses and problems in
process and outcome research in general.
Another example of the potential for lack of applicability to minority populations is the ESTs for obesity. Several studies utilize a strategy of contingency contracting in which money deposited by participants and participant families was refunded contingent on success or participation in the program. Because minority families tend to have lower SES and higher rates of poverty, the feasibility and utility of this approach may differ for such families. Nine articles out of 41 (19%) report SES of participant families in the ESTs for obesity. Of those nine, the middle class is disproportionately represented.
Recommendations/Future Directions
It is clear that the current ESTs for common pediatric disorders requiring
psychological intervention lack data supporting their use with diverse
populations. Likewise, data on cultural variables that may be related to
disease onset and course, treatment acceptability, adherence, and outcome are
lacking. The failure to understand cultural influences on illness, its
prevention, and moderators of treatment effectiveness have limited our ability
to provide the most effective, culturally competent care to all children who
may benefit from psychological interventions.
Several theorists and researchers have made recommendations to address
these issues in general, and we present recommendations specific to pediatric
psychology. For example, Sue
(1999) states that external
validity of treatment studies can be improved by including more diverse
samples that represent those for whom the treatment will be used. A conscious
effort must be made to incorporate underrepresented groups despite the added
difficulties and cost. Likewise, he suggested the use of a wider use of
research methodologies and going beyond simply comparing ethnic or racial
groups. Consideration of cultural variables likely to vary within the cultural
group, such as level of acculturation and SES, may prove more beneficial to
expanding our knowledge than research designs that assume group
homogeneity.
Walders and Drotar (2000)
thoroughly examine the issue of conducting research with diverse pediatric and
child clinical populations. They discuss in detail issues such as sampling,
use of qualitative methodologies, use of within-group and between-group
designs, subject recruitment, measurement issues, use of appropriate norms,
and training professionals for research with diverse pediatric populations.
These authors provide specific recommendations in these areas that may help
the researcher develop research studies that more adequately incorporate
issues of diversity. Bernal and Scharron-Del-Rio
(2001) discuss many of these
issues as well. They also emphasize the need for discovery-oriented research
that prioritizes the therapy process more than simply the outcome.
Hall (2001) discusses
culturally sensitive therapy (CST) in relation to ESTs. He makes a case for
the importance of CSTs, which allow for tailoring psychological services to
specific cultural contexts. This flexibility of tailoring a treatment is in
direct contrast to the notion of ESTs, which focus on using the inflexible
manualized treatment across ethnic groups. Hall also states that the
constructs of interdependence, spirituality, and discrimination fundamentally
are what differentiate minority persons from majority persons. He suggests
that incorporating these constructs into EST research through collaborative
efforts of EST and CST researchers is necessary to further this body of
literature.
Anderson (1995b) summarizes
numerous recommendations made by panels as part of the National Conference on
Behavioral and Sociocultural Perspectives on Ethnicity and Health. These
recommendations are comprehensive and useful, although many are oriented to
systems changes (i.e., increase money for minority health research, increase
the number of minority researchers). Below are recommendations that
incorporate some ideas from the task groups applied to pediatric psychology in
addition to our recommendations.
- Examine family factors associated with culture and their relationship to
treatments including adherence, treatment acceptability, and outcome. Parents
and families are important because children with chronic illness depend on the
parents and family for facilitation and delivery of treatment. Family roles in
the child's treatment are likely to vary by culture.
- Explore how culture influences health care beliefs, practices, health care
utilization, and adherence. Culture influences beliefs about the causes and
remedies for illness. Incongruence between such beliefs and assumptions of
ESTs can result in disengagement from the medical treatment team and poor
adherence. Additionally, these beliefs likely influence choices about use of
alternative treatments for children with health concerns. For example,
American Indian beliefs and traditional practices related to health may play
an important role in the treatment process. Research examining the impact of
including "traditional" practices into the treatment plan on
adherence and outcome may prove useful.
- Develop treatments that address the unique barriers faced by families with
low SES status. Current ESTs require a commitment of family resources (time,
money, travel) beyond what many low SES families can afford. Development of
treatments that are flexible in their mode of delivery (e.g., use of telephone
or web-based), time of utilization (when family needs it vs. once per week),
and can be applied in less structured and controlled environments may make
such treatments more acceptable and effective.
- Examine the independent and interactional effects of health and minority
status on development and health. Illness in children can affect peer
relationships and social development. Additionally, children from minority or
low SES groups can experience racism, teasing, and social isolation. Without a
better understanding of the interaction of these influences, the ability to
intervene at the individual and system level will be limited.
- Identify cultural variables that may serve as protective factors or as
strengths that enhance treatment effects and outcome. Some cultural beliefs or
characteristics may provide a unique strength. For example, collectivist
cultures emphasizing social networks such as a tribe or extended family may
improve the effectiveness of treatments that utilize social support. Research
examining the extent to which choosing and modifying treatments to capitalize
on cultural strengths may prove useful in determining which ESTs are
efficacious with specific groups.
- Include a discussion of cultural assumptions or biases where appropriate
when reporting treatments used in efficacy research with minority populations.
A discussion of cultural assumptions and biases of treatments should be
included in all outcome studies of diverse populations as an issue relating to
external validity, because many of the existing treatments were derived from a
middle-class white perspective.
- Address the cultural appropriateness of measures and methodologies when
examining variables related to culture. Many of the measures used to examine
constructs in health psychology were developed with middle-class white
persons. It is essential to discuss the extent to which the measures reflect
those values. Norms for the measures should be included in cases where
relative scores are interpreted and psychometric properties should be reported
when used with culturally diverse samples.
- Consider the influence of culture when evaluating and interpreting results.
Make specific recommendations for incorporating cultural issues into further
research. Even in cases where cultural issues were not included, a discussion
of such issues and how they may have influenced the results of the study would
be helpful. Specific hypotheses about such cultural variables and
recommendations for testing them in future research would help the profession
to move forward.
- Develop ESTs for specific populations. Although some studies include small
numbers of minority participants proportional to the general population,
generalizations cannot be made to those minority populations. Rather, studies
are needed that examine empirically supported treatment approaches with larger
samples of such groups. For example, studies examining a treatment approach
with Asian American or Native American samples would provide much more
evidence on the applicability of such treatments to those populations.
Likewise, this approach is more likely to reveal specific cultural factors
that may influence the efficacy of the treatments. Now that the first
generation of efficacy studies has supported the use of treatments with
middle-class and mainly white populations, application (with appropriate
modifications) of these treatments to different cultures is necessary to
ensure that the treatment works for people in such cultures.
Although no exemplary studies incorporate all of the aforementioned
recommendations, Wadden and colleagues
(1990) conducted a study that
incorporates many of the recommendations made here. In their examination of
obesity in African American adolescents, within-group and between-group
cultural issues were carefully considered. The treatment was adapted to more
closely fit the needs and interests of the adolescents, although specific
adaptations are not articulated. Likewise, cultural influences (ethnic and
SES) on views of body type or thinness were discussed. This study can serve as
an example of the effort to include important cultural variables into a
research design with the goal of demonstrating the efficacy of a specific
treatment for a specific minority population.
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Conclusions |
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Much more work is needed in researching cultural issues in the assessment and treatment of pediatric populations. Though the results of these analyses are sobering, they also underscore the enormous responsibilities and opportunities for pediatric psychologists to advance the field through programmatic research. Careful consideration must be given to how future research can incorporate cultural diversity and lead to more effective treatment for children and families from diverse backgrounds.
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Acknowledgments |
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We thank Kenneth W. Merrell, William M. Liu, and the reviewers for their helpful comments on drafts of this manuscript.
Received May 22, 2001; revision received August 28, 2001; accepted December 15, 2001
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Appendix: Articles Included in Review: Asthma |
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Alexander, A. B. (1972). Systematic relaxation and flow rates in asthmatic children: Relationship to emotional precipitants and anxiety. Journal of Psychosomatic Research, 16, 405-410.[Web of Science][Medline]
Alexander, A. B., Miklich, D. R., & Hershkoff, H.
(1972). The immediate effects of systematic relaxation training
on peak expiratory flow rates in asthmatic children. Psychosomatic
Medicine, 34(5),
388-394.
Davis, M. H., Saunders, D. R., Creer, T. L., & Chai, H. (1973). Relaxation training facilitated by biofeedback apparatus as a supplemental treatment in bronchial asthma. Journal of Psychosomatic Research, 17, 121-128.[Web of Science][Medline]
Feldman, G. M. (1976). The effect of biofeedback
training on respiratory resistance of asthmatic children.
Psychosomatic Medicine, 38(1),
27-34.
Gustafsson, P. A., Kjellman, N. I. M., & Cederblad, M. (1986). Family therapy in the treatment of severe childhood asthma. Journal of Psychosomatic Research, 30(3), 369-374.[Web of Science][Medline]
Kotses, H., Glaus, K. D., Bricel, S. K., Edwards, J. E., & Crawford, P. L. (1978). Operant muscular relaxation and peak expiratory flow rate in asthmatic children. Journal of Psychosomatic Research, 22, 17-23.[Web of Science][Medline]
Kotses, H., Glaus, K. D., Crawford, P. L., Edwards, J. E., & Scherr, M. S. (1976). Operant reduction of frontalis EMG activity in the treatment of asthma in children. Journal of Psychosomatic Research, 20, 453-459.[Web of Science][Medline]
Kotses, H., Harver, A., Segreto, J., Glaus, K. D., Creer, T. L., & Young, G. A. (1991). Long-term effects of biofeedback-induced facial relaxation on measures of asthma severity in children. Biofeedback and Self-Regulation, 16(1), 1-21.[Web of Science][Medline]
Lask, B., & Matthew, D. (1979). Childhood asthma:
A controlled trial of family psychotherapy. Archives of Disease in
Childhood, 54,
116-119.
Miklich, D. R., Renne, C. M., Creer, T. L., Alexander, A. B., Chai, H., Davis, M. H., Hoffman, A., & Danker-Brown, P. (1977). The clinical utility of behavior therapy as an adjunctive treatment for asthma. Journal of Allergy & Clinical Immunology, 60, 285-294.
Scherr, M. S., Crawford, P. L., Sergent, C. B., & Scherr, C. A. (1975). Effect of bio-feedback techniques on chronic asthma in a summer camp environment. Annals of Allergy, 35, 289-295.[Web of Science][Medline]
Vazquez, I., & Buceta, J. M. (1993a). Effectiveness of self-management programmes and relaxation training in the treatment of bronchial asthma: Relationships with trait anxiety and emotional attack triggers. Journal of Psychosomatic Research, 37(1), 71-81.[Web of Science][Medline]
Vazquez, I., & Buceta, J. M. (1993b). Psychological treatment of asthma: Effectiveness of a self-management program with and without relaxation training. Journal of Asthma, 30(3), 171-183.[Web of Science][Medline]
Vazquez, I., & Buceta, J. M. (1993c). Relaxation therapy in the treatment of bronchial asthma: Effects on basal spirometric values. Psychotherapy & Psychsomatics, 60, 106-112.
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Appendix: Articles Included in Review: Cancer |
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Cotanch, P., Hockenberry, M., & Herman, S. (1985). Self-hypnosis as antiemetic therapy in children receiving chemotherapy. Oncology Nursing Forum, 12, 41-46.
Ellenberg, L., Kellerman, J., Dash, J., Higgins, G., & Zeltzer, L. (1980). Use of hypnosis for multiple symptoms in an adolescent girl with leukemia. Society for Adolescent Health Care, 1, 132-136.
Kaufman, K. L., Tarnowski, K. J., & Olson, R. (1989). Self-regulation treatment to reduce the aversiveness of cancer chemotherapy. Journal of Adolescent Health Care, 10, 323-327.[Medline]
Kolko, D. J., & Rickard-Figueroa, J. L. (1985). Effects of video games on the adverse corollaries of chemotherapy in pediatric oncology patients: A single-case analysis. Journal of Consulting and Clinical Psychology, 53(2), 223-228.[Web of Science][Medline]
LeBaron, S., & Zeltzer, L. (1984). Behavioral intervention for reducing chemotherapy-related nausea and vomiting in adolescents with cancer. Journal of Adolescent Health Care, 5, 178-182.[Medline]
Redd, W. H., Jacobsen, P. B., Die-Trill, M., Dermatis, H., McEvoy, M., & Holland, J. C. (1987). Cognitive/attentional distraction in the control of conditioned nausea in pediatric cancer patients receiving chemotherapy. Journal of Consulting and Clinical Psychology, 55(3), 391-395.[Web of Science][Medline]
Zeltzer, L. K., Dolgin, M. J., LeBaron, S., & LeBaron, C.
(1991). A randomized, controlled study of behavioral intervention
for chemotherapy distress in children with cancer.
Pediatrics, 88(1),
34-42.
Zeltzer, L., Kellerman, J., Ellenberg, L., & Dash, J. (1983). Hypnosis for reduction of vomiting associated with chemotherapy and disease in adolescents with cancer. Journal of Adolescent Health Care, 4, 77-84.[Medline]
Zeltzer, L., LeBaron, S., & Zeltzer, P. M. (1984). The effectiveness of behavioral intervention for reduction of nausea and vomiting in children and adolescents receiving chemotherapy. Journal of Clinical Oncology, 2(6), 683-690.[Abstract]
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Appendix: Articles Included in Review: Diabetes |
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Boardway, R. H., Delamater, A. M., Tomakowsky, J., & Gutai, J. P. (1993). Stress management training for adolescents with diabetes. Journal of Pediatric Psychology, 18(1), 29-45.
Gross, A. M., Heimann, L., Shapiro, R., & Schultz, R. M.
(1983). Children with diabetes: Social skills training and
hemoglobin A1c levels. Behavior Modification,
7(2),
151-164.
Kaplan, R. M., Chadwick, M. W., & Schimmel, L. E. (1985). Social learning intervention to promote metabolic control in Type I diabetes mellitus: Pilot experiment results. Diabetes Care, 8(2), 152-155.[Abstract]
Moran, G. S., & Fonagy, P. (1987). Psychoanalysis and diabetic control: A single-case study. British Journal of Medical Psychology, 60, 357-372.
Moran, G., Fonagy, P., Kurtz, A., Bolton, A., & Brook, C. (1991). A controlled study of the psychoanalytic treatment of brittle diabetes. Journal of the American Academy of Child and Adolescent Psychiatry, 30(6), 926-935.[Web of Science][Medline]
Rose, M. I., Firestone, P., Heick, H. M. C., & Faught, A. K. (1983). The effects of anxiety management training on the control of juvenile diabetes mellitus. Journal of Behavioral Medicine, 6(4), 381-395.[Web of Science][Medline]
|
Appendix: Articles Included in Review: Obesity |
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|---|
Amador, M., Ramounths, L. T., Morono, M., & Hermelo, M. P. (1990). Growth rate reduction during energy restriction in obese adolescents. Experimental and Clinical Endocrinology, 96, 73-82.[Web of Science][Medline]
Aragona, J., Cassady, J., & Drabman, R. S. (1975). Treating overweight children through parental training and contingency contracting. Journal of Applied Behavioral Analysis, 8, 269-278.[Web of Science][Medline]
Becque, M. D., Katch, V. L., Rocchini, A. P., Marks, C. R., &
Moorehead, C. (1988). Coronary risk incidence of obese
adolescents: Reduction by exercise plus diet intervention.
Pediatrics, 81,
605-612.
Blomquist, B., Börjeson, M., Larsson, Y., Persson, B., & Sterky, G. (1965). The effect of physical activity on the body measurements and work capacity of overweight boys. Acta Paediatrica Scandinavica, 54, 566-572.[Web of Science][Medline]
Brownell, K. D., Kelman, J. H., & Stunkard, A. J.
(1983). Treatment of obese children with and without their
mothers: Changes in weight and blood pressure. Pediatrics,
71, 515-523.
Coates, T. J., Jeffery, R. W., Slinkard, L. A., Killen, J. D., & Danaher, B. G. (1982). Frequency of contact and monetary reward in weight loss, lipid change, and blood pressure reduction with adolescents. Behavior Therapy, 13, 175-185.[Web of Science]
Coates, T. J., Killen, J. D., & Slinkard, L. A. (1982). Parent participation in a treatment program for overweight adolescents. International Journal of Eating Disorders, 1(3), 37-48.
Duffy, G., & Spence, S. H. (1993). The effectiveness of cognitive self-management as an adjunct to a behavioral intervention for childhood obesity: A research note. Journal of Child Psychology and Psychiatry, 34, 1043-1050.[Web of Science][Medline]
Emes, C., Velde, B., Moreau, M., Murdoch, D. D., & Trussell, R. (1990). An activity based weight control program. Adapted Physical Activity Quarterly, 7, 314-324.
Epstein, L. H., McKenzie, S. J., Valoski, A., Klein, K. R., & Wing, R. R. (1994). Effects of mastery criteria and contingent reinforcement for family-based child weight control. Addictive Behaviors, 19, 135-145.[Web of Science][Medline]
Epstein, L. H., Valoski, A., Vara, L., McCurley, J., Wisniewski, L., Kalarchian, M. A., Klein, K. R., & Shrager, L. R. (1995). Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychology, 14, 109-115.[Web of Science][Medline]
Epstein, L. H., Wing, R. R., Koeske, R., Andrasik, F., & Ossip, D. J. (1981). Child and parent weight loss in family-based behavior modification programs. Journal of Consulting and Clinical Psychology, 49(5), 674-685.[Web of Science][Medline]
Epstein, L. H., Wing, R. R., Koeske, R., Ossip, D., & Beck, S. (1982). A comparison of life-style change and programmed aerobic exercise on weight and fitness changes in obese children. Behavior Therapy, 13, 651-665.[Web of Science]
Epstein, L. H., Wing, R. R., Koeske, R., & Valoski, A. (1984). Effects of diet plus exercise on weight change in parents and children. Journal of Consulting and Clinical Psychology, 52(3), 429-437.[Web of Science][Medline]
Epstein, L. H., Wing, R. R., Koeske, R., & Valoski, A. (1985). A comparison of life-style exercise, aerobic exercise, and calisthenics on weight loss in obese children. Behavior Therapy, 16, 345-356.[Web of Science]
Epstein, L. H., Wing, R. R., Koeske, R., & Valoski, A. (1986). Effects of parent weight on weight loss in obese children. Journal of Consulting and Clinical Psychology, 54, 400-401.[Web of Science][Medline]
Epstein, L. H., Wing, R. R., Penner, B. C., & Kress, M. J. (1985). The effect of diet and controlled exercise on weight loss in obese children. Journal of Pediatrics, 107, 358-361.[Web of Science][Medline]
Epstein, L. H., Wing, R. R., Steranchak, L., Dickson, B., &
Michelson, J. (1980). Comparison of family-based behavior
modification and nutrition education for childhood obesity. Journal
of Pediatric Psychology, 5,
25-36.
Epstein, L. H., Wing, R. R., Valoski, A., & Gooding, W.
(1987). Stability of food preferences during weight control: A
study with 8- to 12-year-old children and their parents. Behavior
Modification, 11,
87-101.
Epstein, L. H., Wing, R. R., Woodall, K., Penner, B. C., Kress, M. J., & Koeske, R. (1985). Effects of family-based behavioral treatment on obese 5- to 8-year-old children. Behavior Therapy, 16, 205-212.[Web of Science]
Epstein, L. H., Woodall, K., Goreczny, A. J., Wing, R. R., & Robertson, R. J. (1984). The modification of activity patterns and energy expenditure in obese young girls. Behavior Therapy, 15, 101-108.
Figueroa-Colon, R., von Almen, T. K., Franklin, F. A., Schuftan,
C., & Suskind, R. M. (1993). Comparison of two hypocoloric
diets in obese children. American Journal of Diseases in
Children, 147,
160-166.
Flodmark, C., Ohlsson, T., Rydén, O., & Sveger, T.
(1993). Prevention of progression to severe obesity in a group of
obese schoolchildren treated with family therapy.
Pediatrics, 91,
880-884.
Graves, T., Meyers, A. W., & Clark, L. (1988). An evaluation of parental problem-solving training in the behavioral treatment of childhood obesity. Journal of Consulting and Clinical Psychology, 56, 246-250.[Web of Science][Medline]
Hills, A. P., & Parker, A. W. (1988). Obesity management via diet and exercise intervention. Child Care, Health and Development, 14, 409-416.[Web of Science][Medline]
Ikeda, J. P., Fujii, M., Fong, K. A., & Hanson, M. (1982). Two approaches to adolescent weight loss. Journal of Nutritional Education, 14, 90-92.
Israel, A. C., Guile, C. A., Baker, J. E., & Silverman, W. K.
(1994). An evaluation of enhanced self-regulation training in the
treatment of childhood obesity. Journal of Pediatric
Psychology, 19,
737-749.
Israel, A. C., Stolmaker, L., & Andrian, C. A. G. (1985). The effects of training parents in general child management skills on a behavioral weight weight loss program for children. Behavior Therapy, 16, 169-180.
Israel, A. C., Stolmaker, L., Sharp, J. P., Silverman, W. K., & Simon, L. G. (1984). An evaluation of two methods of parental involvement in treating obese children. Behavior Therapy, 15, 266-272.
Johnson, W. G., Hinkle, L. K., Carr, R. E., Anderson, D. A., Lemmon, C. R., Engler, L. B., & Bergeron, K. C. (1997). Dietary and exercise interventions for juvenile obesity: Long-term effect of behavioral and public health models. Obesity Research, 5, 257-261.[Web of Science][Medline]
Kingsley, R. G., & Shapiro, J. (1977). A comparison of three behavioral programs for the control of obesity in children. Behavior Therapy, 8, 30-36.[Web of Science]
Kirschenbaum, D. S., Harris, E. S., & Tomarken, A. J. (1984). Effects of parental involvement in behavioral weight loss therapy for preadolescents. Behavior Therapy, 15, 485-500.
Mellin, L. M., Slinkard, L. A., & Irwin, C. E. (1987). Adolescent obesity intervention: Validation of the SHAPE-DOWN program. Journal of the American Dietetic Association, 87, 333-338.[Web of Science][Medline]
Mendonca, P. J., & Brehm, S. S. (1983). Effects of choice on behavioral treatment of overweight children. Journal of Social and Clinical Psychology, 1, 343-358.
Peña, M., Bacallao, J., Barta, L., Amador, M., & Johnston, F. E. (1989). Fiber and exercise in the treatment of obese adolescents. Journal of Adolescent Health Care, 10, 30-34.[Medline]
Rocchini, A. P., Katch, V., Anderson, J., Hinderliter, J., Becque,
D., Martin, M., & Marks, C. (1988). Blood pressure in obese
adolescents: Effect of weight loss. Pediatrics,
82, 16-23.
Rocchini, A. P., Katch, V., Schork, A., & Kelch, R. P.
(1987). Insulin and blood pressure during weight loss in obese
adolescents. Hypertension, 10,
267-273.
Senediak, S., & Spence, S. H. (1985). Rapid versus gradual scheduling of therapeutic contact in a family-based behavioral weight control program for children. Behavioral Psychotherapy, 13, 265-287.
Wadden, T. A., Stunkard, A. J., Rich, L., Rubin, C. J., Sweidel,
G., & McKinney, S. (1990). Obesity in black adolescent girls:
A controlled clinical trial of treatment by diet, behavior modification, and
parental support. Pediatrics,
85, 345-352.
Weiss, A. R. (1977). A behavioral approach to the treatment of adolescent obesity. Behavior Therapy, 8, 720-726.[Web of Science]
Wheeler, M., & Hess, K. W. (1976). Treatment of juvenile obesity by successive approximation control of eating. Journal of Behavioral Therapy & Experiential Psychiatry, 7, 235-241.
Anderson, N. B. (1995a). Behavioral and sociocultural perspectives on ethnicity and health: Introduction to the special issue. Health Psychology, 14(7), 589-591.[Web of Science][Medline]
Anderson, N. B. (1995b). Summary task group research recommendations. Health Psychology, 14(7), 649-653.[Web of Science]
Bagley, S. P., Angel, R., Dilworth-Anderson, P., Liu, W., & Schinke, W. (1995). Panel V: Adaptive health behaviors among ethnic minorities. Health Psychology, 14(7), 632-640.[Web of Science][Medline]
Bergin, A. E., & Garfield, S. L. (1994). Handbook of psychotherapy and behavior change (4th ed.). New York: Wiley.
Bernal, G., & Scharron-Del-Rio, M. R. (2001). Are empirically supported treatments valid for ethnic minorities? Toward an alternative approach for treatment research. Cultural Diversity and Ethnic Minority Psychology, 7, 328-342.
Celano, M., Geller, R. J., Phillips, K. M., & Ziman, R.
(1998). Treatment adherence among low-income children with
asthma. Journal of Pediatric Psychology,
23, 345-349.
Chambless, D., & Hollon, S. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(2), 7-18.[Web of Science][Medline]
Christopherson, E. R., & Mortweet, S. L. (2001). Treatments that work with children: Empirically supported strategies for managing childhood problems. Washington, DC: American Psychological Association.
Clay, D. L. (2000). Commentary: Rethinking our
interventions in pediatric chronic pain and treatment research.
Journal of Pediatric Psychology,
25, 53-55.
Drotar, D., & Riekert, K. A. (2000). Understanding and managing sampling issues in research with children. In D. Drotar (Ed.), Handbook of research in pediatric and child clinical psychology: Practical strategies and methods. New York: Plenum.
Flack, J. M., Amaro, H., Jenkins, W., Kunitz, S., Levy, J., Mixon, M., & Yu, E. (1995). Panel I: Epidemiology of minority health. Health Psychology, 14(7), 592-600.[Web of Science][Medline]
Hall, G. C. N. (2001). Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues. Journal of Consulting and Clinical Psychology, 69, 502-510.[Web of Science][Medline]
Jelalian, E., & Saelens, B. E. (1999). Empirically
supported treatments in pediatric psychology: Pediatric obesity.
Journal of Pediatric Psychology,
24, 223-248.
Johnson, K. W., Andersons, N. B., Bastida, E., Kramer, B. J., Williams, D., & Wong, M. (1995). Panel II: Macrosocial and environmental influences on minority health. Health Psychology, 14(7), 601-612.[Web of Science][Medline]
Kiesler, D. J. (1995). Research classic: "Some myths of psychotherapy research and the search for a paradigm": Revisited. Psychotherapy Research, 5, 91-101.
McQuaid, E. L., & Nassau, J. H. (1999).
Empirically supported treatments of disease-related symptoms in pediatric
psychology: Asthma, diabetes, and cancer. Journal of Pediatric
Psychology, 24(4),
305-328.
Meyers, H. F., Kagawa-Singer, M., Kumanyika, S. K., Lex, B. W., & Markides, K. S. (1995). Panel III: Behavioral risk factors related to chronic diseases in ethnic minorities. Health Psychology, 14(7), 613-621.[Web of Science][Medline]
Nathan, P. E., & Gorman, J. M. (Eds.). (1998). A guide to treatments that work. New York: Oxford University Press.
National Institutes of Health. (2001). Overcoming barriers to treatment adherence in minorities and persons living in poverty. Available http://grants.nih.gov/grants/guide/rfa-files/rfa-hl-01-005.html .
Penn, N. E., Kar, S., Kramer, J., Skinner, J., & Zambrana, R. E. (1995). Panel VI: Ethnic minorities, health care systems, and behavior. Health Psychology, 14(7), 641-646.[Web of Science][Medline]
Sue, D. W., Bingham, R. P., Porche-Burke, L., & Vazquez, M. (1999). The diversification of psychology: A multicultural revolution. American Psychologist, 54, 1061-1069.[Medline]
Sue, D. W., & Sue, D. (1990). Counseling the culturally different (2nd ed.). New York: Wiley.
Sue, S. (1999). Science, ethnicity, and bias: Where have we gone wrong? American Psychologist, 54, 1070-1077.[Medline]
Wadden, T. A., Stunkard, A. J., Rich, L., Rubin, C. J., Sweidel, G., & McKinney, S. (1990). Obesity in black adolescent girls: A controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics, 85, 345-352.
Walders, N., & Drotar, D. (2000). Understanding cultural and ethnic influences in research with child clinical and pediatric psychology populations. In D. Drotar (Ed.), Handbook of research in pediatric and child clinical psychology: Practical strategies and methods. New York: Plenum.
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