Dentist-Perceived Barriers and Attractors to Cognitive-Behavioral Treatment Provided by Mental Health Providers in Dental Practices.

Over 1 in 5 dental patients report moderate to severe dental fear. Although the efficacy of cognitive-behavioral treatment (CBT) for dental fear has been examined in over 20 randomized controlled trials-with 2 meta-analyses finding strong average effect sizes ( d > 1)-CBT has received almost no dissemination beyond the specialty clinics that tested it. The challenge, then, is not how to treat dental fear but how to disseminate and implement such an evidence-based treatment in a way that recognizes the rewards and barriers in the US health care system. This mixed-method study investigated the potential of disseminating CBT through care from a mental health provider from within the dental home, a practice known as evidence-based collaborative care (EBCC). Two preadoption studies were conducted with practicing dentists drawn from a self-organized Practice-Based Research Network in the New York City metropolitan area. The first comprised 3 focus groups ( N = 17), and the second involved the administration of a survey ( N = 46). Focus group participants agreed that CBT for dental fear is worthy of consideration but identified several concerns regarding its appeal, feasibility, and application in community dental practices. Survey participants indicated endorsement of factors promoting the use of EBCC as a mechanism for CBT dissemination, with no factors receiving less than 50% support. Taken together, these findings indicate that EBCC may be a useful framework through which an evidence-based treatment for dental fear treatment can be delivered.

Mechanisms Linking Interparental Aggression to Child Dental Caries.

Research has garnered support for a systemic view of factors affecting child dental caries that accounts for the influence of social factors such as the family environment. Our previous work has demonstrated the association between mother-to-father emotional aggression and child caries. The present study builds on these results by evaluating pathways that might explain this relation. Families (n = 135) completed a multimethod assessment of mother-to-father emotional aggression, child caries, and several hypothesized mediators (i.e., child cariogenic snack and drink intake, child internalizing behaviors, child salivary cortisol and α-amylase reactivity, parental laxness, child oral hygiene maintenance, and parental socialization of child oral hygiene maintenance). Mediation analyses partially supported the role of the child's diet as a mechanism linking mother-to-father emotional aggression and child caries. However, children's neglect of oral hygiene, parental laxness, and child emotional and biological disturbances failed to stand as conduits for this association. Future investigations should expand upon these results to better establish the causal links that could only be suggested by the present cross-sectional findings.

A comparison of spousal aggression prevalence rates in U.S. Army and civilian representative samples.

This study compared prevalence rates from reasonably representative U.S. Army (N = 33,762) and civilian (N = 3,044) samples. Age and race were controlled by weighting each sample to 1990 U.S. Census characteristics for married, full-time employed persons. Men's reports of moderate husband-to-wife spousal aggression were not significantly higher, but reports of severe aggression were significantly higher in the standardized Army sample than in the comparable civilian sample (adjusted rates of 2.5% vs. 0.7%, respectively). Thus, controlling for age and race results in reasonably similar prevalence rates. Future studies that more carefully control for any background differences in military and civilian respondents could discern whether military service adds any increased risk for partner violence.

Categorizing partner-violent men within the reactive-proactive typology model.

A system for categorizing partner-violent men as either reactive or proactive aggressors was developed and evaluated in the present study. Sixty partner-violent men were reliably categorized, and the distribution (62% reactive, 38% proactive) fell within the expected range. Some construct validity was demonstrated, as several significant predicted group differences were found on factors of theoretical relevance to the typology model (affectivity, personality, and violence in the family-of-origin). Proactively versus reactively categorized participants were (a) more dominant and less angry during a 10-min interpartner interaction, (b) more antisocial and aggressive-sadistic and less dependent, and (c) more frequently classified as psychopathic (17% vs. 0%). Research and clinical implications of the system are discussed, as is the potential overlap between the reactively and proactively categorized partner-violent men in this study with previously identified types.

Couples' shared participation in novel and arousing activities and experienced relationship quality.

Using a newspaper questionnaire, a door-to-door survey, and 3 laboratory experiments, the authors examined a proposed effect of shared participation in novel and arousing activities on experienced relationship quality. The questionnaire and survey studies found predicted correlations of reported shared "exciting" activities and relationship satisfaction plus their predicted mediation by relationship boredom. In all 3 experiments, the authors found predicted greater increases in experienced relationship quality from before to after participating together in a 7-min novel and arousing (vs. a more mundane) task. Comparison with a no-activity control showed the effect was due to the novel-arousing task. The same effect was found on ratings of videotaped discussions before and after the experimental task. Finally, all results remained after controlling for relationship social desirability. Results bear on general issues of boredom and excitement in relationships and the role of such processes in understanding the typical early decline of relationship quality after the honeymoon period.

Marital interaction coding system: revision and empirical evaluation.

Given the vast amount of codeable information in marital interactions, observational coding systems must emphasize particular classes of behavior. The most widely used marital coding scheme, the Marital Interaction Coding System (MICS), like many older behavioral coding systems, emphasizes verbal content over affect. Changes made to the MICS between versions III and IV are described; they were intended to increase the system's use of coded affect and to decrease autodependence in sequential analysis. We used an archival data set of 994 couples' videotaped conflict negotiations coded with the MICS. As intended, the MICS-IV, relative to the MICS-III, was found to have the advantage of capturing more non-verbal affect expressed during marital interactions, which resulted in stronger interactional contingencies (e.g. Wife Blame-->Husband Blame, Husband Facilitation-->Wife Facilitation). The MICS-IV also yielded significantly lower levels of spurious autodependence.

Observation of couple conflicts: clinical assessment applications, stubborn truths, and shaky foundations.

The purpose of this review is to provide a balanced examination of the published research involving the observation of couples, with special attention toward the use of observation for clinical assessment. All published articles that (a) used an observational coding system and (b) relate to the validity of the coding system are summarized in a table. The psychometric properties of observational systems and the use of observation in clinical practice are discussed. Although advances have been made in understanding couple conflict through the use of observation, the review concludes with an appeal to the field to develop constructs in a psychometrically and theoretically sound manner.

Evaluating domestic partner abuse in a family practice clinic.

BACKGROUND AND OBJECTIVES: Although national surveys indicate that approximately 2 million women are victims of severe physical aggression by their partners each year, these women are underidentified by physicians. The assessment by medical personnel of partner abuse is hampered by lack of a simple and reliable instrument that systematically and quickly determines the occurrence and effect of abuse among patients. METHODS: Ninety (58% of an eligible pool) consecutive, consenting, eligible female patients at a suburban family practice clinic at a tertiary university hospital completed the Partner Abuse Interview to evaluate the 1-year prevalence and effect of abuse. RESULTS: The Partner Abuse Interview required as little as 3 minutes to administer. Results obtained with the interview instrument were internally consistent. Interrater reliability was high for the diagnosis of partner relationship problems with physical abuse by males, as reported by females. Approximately 15% of the women reported having sustained injury or being fearful of their partners as a result of their partners' physical aggression in the past year. CONCLUSIONS: The Partner Abuse Interview is a simple and reliable instrument that could be adapted for use by medical personnel to assess incidents of abuse among patients.

PIP: Physicians' assessment of domestic partner abuse is hindered by the lack of a simple, quick, reliable instrument that determines the occurrence and effect of abuse among female patients. The Partner Abuse Interview, a modified version of the Conflict Tactics Scale, has the potential to meet this need. This instrument was tested in 90 consecutive female patients who presented to a suburban family practice clinic at a US university hospital in 1993. The interview took 3 minutes to complete when there was no domestic violence and 10-15 minutes when violence was detected. Inter-rater reliability was above 90% for all three definitions of partner abuse: any physical aggression, severe violence, and partner abuse. 32%, 16%, and 13% of respondents, respectively, fell into these categories. Pushing, grabbing, and shoving were the most frequently reported abusive behaviors. Compared with women in nonabusive relationships, women in relationships characterized by fear/injury had a lower family income, lower marital satisfaction scores, and less education. More widespread use of this interview is recommended by physicians to identify women in need of treatment and counseling.

Can questionnaire reports correctly classify relationship distress and partner physical abuse?

Relationship adjustment (e.g., Dyadic Adjustment Scale; DAS) and physical aggression (e.g., Conflict Tactics Scale) measures are used both as screening tools and as the sole criterion for classification. This study created face valid diagnostic interviews for relationship distress and physical abuse, through which one could compare preliminarily the classification properties of questionnaire reports. The DAS (and a global measure of relationship satisfaction) had modest agreement with a structured diagnostic interview; both questionnaires tended to overdiagnose distress compared with the interview. Results for partner abuse reiterated the need to go beyond occurrence of aggression as the sole diagnostic criterion, because men's aggression was more likely than women's to rise to the level of "abuse" when diagnostic criteria (injury or substantial fear) were applied.

How much observational data is enough? An empirical test using marital interaction coding.

Using three different samples of couples (clinic, nondistressed community, and engaged), we found that 15 minutes was sufficient to witness enough behavior to make reliable (i.e., internally consistent) estimations of most Rapid Marital Interaction Coding System (Heyman & Vivian, 1993) code frequencies. Ten minutes is sufficient for many codes of interest. The ease in which "how much time is necessary" calculations can be made should entice behavioral investigators from a variety of content areas to publish such figures. By empirically investigating a factor that in most fields becomes reified through convention, investigators can conduct observational research that is both maximally efficient and maximally scientifically defensible.

Major depressive disorder and depressive symptomatology as predictors of husband to wife physical aggression.

This study investigated the association between a husband's depressive symptomatology and the frequency of physical aggression toward his wife, as well as a husband's Major Depressive Disorder (MDD) and the frequency of physical aggression toward his wife. We assessed physically aggressive men who volunteered for treatment with their wives (N = 89). Almost one third had moderate levels of depressive symptomatology (Beck Depression Inventory [BDI > or = 14]), but only 11% met criteria for MDD (based on a structured interview [SCID]). Although the rate of MDD was not absolutely high, it was higher than that reported in a community sample (i.e., 3%). A significant relationship between increased depressive symptomatology and frequency of physical aggression was found, but the association was most likely accounted for by self-reported anger. Related contextual factors including marital discord and psychological aggression are addressed. Theoretical and treatment implications are discussed, including the severity of the treatment population (volunteer vs. court mandated), and severity of the depression (symptomatology vs. clinical diagnosis).