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PubMed2004

An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST).

BACKGROUND: Despite considerable interest in early intervention in psychosis, the evidence base for its effectiveness is sparse. We aimed to evaluate a new service in South London, UK, Croydon Outreach and Assertive Support Team (COAST) using a randomised controlled trial (RCT) during its first year. METHOD: Referrals were taken from local adult community mental health teams of those with documented first service contact in the last 5 years and a diagnosis of any functional psychosis. Those who consented (N = 59) were randomised to COAST or treatment as usual (TAU). COAST offered a range of interventions, including optimum atypical medication, psychological interventions (individual cognitive behavioural therapy and family intervention if appropriate) and a range of vocational and welfare help according to need. Whole team training was used to be able to offer these kinds of interventions. RESULTS: Outcomes were evaluated at baseline, 6 months and 9 months on a range of standardised clinical and social measures. Overall both COAST and TAU clients improved over time, but there were no significant improvements for COAST clients; a lack of significant results in the time x treatment interaction. There was a trend for COAST carers' quality of life to increase. Bed days were also less in COAST, but not significantly so. CONCLUSIONS: The lack of clearly demonstrated improvements for COAST is consistent with the published literature so far. The fact that both groups improved in symptoms and functioning over the year suggests that while access to early intervention is helpful, community adult mental health teams should aim to offer high quality input at any stage of psychosis in order to meet client and carer needs.

Adult↗
PubMed1986

Assertiveness training in the treatment of a child's tics.

Tic activity has long been an area for clinical intervention by behavior therapists. Most techniques have involved approaches that require direct focusing on the tic itself (e.g. habit reversal). For some people, however, such a direct focus may not be clinically appropriate. This article describes a child who, in addition to suffering from tics, was also extremely unassertive. It was observed that unassertive behavior often preceded tic activity. Assertiveness training provided the child with a self-control technique with which he was able to control and eventually eliminate his tic activity.

Assertiveness↗
PubMed2004

Assertiveness training to prevent verbal abuse in the OR.

THE HIGH INCIDENCE OF VERBAL ABUSE directed toward perioperative nurses by surgeons has been the subject of recent research studies. REPEATED INCIDENTS of verbal abuse in the OR contribute to increased incidence of errors, low morale, and high turnover among nursing staff members. ASSERTIVENESS TRAINING that focuses on conflict resolution and communication skills is an effective method of coping with verbal abuse. EACH MEMBER is a vital part of the perioperative team. Any disruption to the team, including verbal abuse, can compromise patient safety. Collaboration among team members is critical to ensure safe patient outcomes.

Aggression↗
PubMed2004

Prediction of outcome from the Dartmouth assertive community treatment fidelity scale.

BACKGROUND: Assertive community treatment (ACT) is an intensive and comprehensive treatment for clients with severe mental illness (SMI) who do not readily benefit from clinic-based services. Monitoring the implementation of such programs is critical, because better-implemented programs have been found to be effective in improving client outcomes. OBJECTIVE: We tested the hypothesis that fidelity to the ACT model would be positively correlated with improved client outcomes, as measured by reduction in psychiatric hospital use. METHODS: A scale measuring fidelity of program implementation, the Dartmouth ACT Scale, was examined in 10 newly formed ACT teams. Using the team as the unit of measure, the mean reduction in state hospital days for a 1-year period before and after program admission was calculated. Mean effect size in reduction in hospital days was used as the outcome measure in a correlational design. RESULTS: Pre/post comparisons showed a 43 percent reduction in hospital days for 317 clients (t=8.61, P<.001). The Pearson correlation between DACTS fidelity and reduction of state hospital days was .49, P=.08, one-tailed. CONCLUSION: Several possible reasons are offered for why the study hypothesis was not confirmed. However, even if predictive validity of the Dartmouth ACT Scale is limited, it continues to be a useful tool for program monitoring and for providing corrective feedback.

Assertiveness↗
PubMed1985

Consistency of assertive, aggressive, and submissive behavior for children.

The interpersonal behavior of 50 third- through fifth-grade children was assessed over an 8-month period in a wide variety of naturally occurring school activities. The consistency of the children's behavior was found to vary as a function of the child's sex, the class of behavior examined, and the similarity/dissimilarity of the contexts in which the behaviors occurred. Boys demonstrated remarkable consistency in their aggressive expression; 46 of 105 intercorrelations for the aggressiveness dimensions were statistically significant. In general, the consistency of assertive behavior for both boys and girls was unexpectedly high.

Aggression↗
PubMed2000

Generalization effects of coping-skills training: influence of self-defense training on women's efficacy beliefs, assertiveness, and aggression.

Concern for personal safety is a pervasive stressor for many women. Developing competencies in physical self-defense may empower women to engage more freely in daily activities with less fear. This study assessed the effects of physical self-defense training on multiple aspects of women's perceived self-efficacy and other self-reported personality characteristics. Training powerfully increased task-specific (self-defense) efficacy beliefs as well as physical and global efficacy beliefs. Training increased self-reported assertiveness, and posttraining decreases in hostility and aggression were found on several of the subscales of The Aggression Questionnaire (A. H. Buss & M. Perry, 1992), indicating that training did not have an aggression-disinhibiting effect. In the experimental condition, most of the effects were maintained (and some delayed effects appeared at follow-up.

Adaptation, Psychological↗
PubMed2000

Employment outcomes in family-aided assertive community treatment.

Family-aided assertive community treatment (FACT) was enhanced by adding vocational specialists to help persons with severe mental illness obtain competitive employment. Results were then tested against those of conventional vocational rehabilitation (CVR). The FACT cohort demonstrated significantly better employment rates than did the CVR, while negative symptoms declined in the former and increased in the latter. No evidence was found that competitive work presented a significant risk for relapse.

Adult↗
PubMed2006

Noradrenaline might enhance assertive human social behaviours: an investigation in a flatmate relationship.

OBJECTIVE: The aim of the present study was to explore the role of noradrenaline on the social behaviour of healthy volunteers when they were interacting with a familiar person, their flatmate. Interaction with the flatmate was explored in a cooperative game situation. METHODS: Ten pairs of same-sex healthy volunteer flatmates aged 18-25 years were recruited for the experiment. All volunteers gave written informed consent and the study was approved by the institutional ethical committee. A randomised, double blind, placebo-controlled crossover trial of reboxetine versus placebo was conducted. In each of the 10 pairs of volunteers, one (subject) volunteered to take the tablets and the other (flatmate) received no treatment. Reboxetine (4 mg/bd) and placebo were administered orally as identical capsules for 2 weeks. The subjects were randomly assigned to receive either reboxetine or placebo first and there was a two-week washout period following the first treatment. At baseline and the end of each treatment, they filled in the Beck Depression Inventory (BDI), Social Adapation Self-Evaluation Scale (SASS), and Aggression Questionnaire (AQ). Then, they were instructed to play the Tangrams game. This task elicits face-valid social behaviours such as cooperation, giving commands and unilateral grasps. RESULTS: Analysis of covariance showed that there was a statistical trend for reboxetine treatment to increase commands (p=0.055). CONCLUSION: This study presents preliminary evidence that two weeks' enhancement of noradrenaline transmission induced by reboxetine makes healthy volunteers more self-confident and assertive.

Adolescent↗
PubMed1998

Assertive, offensive, protective, and defensive styles of self-presentation: a taxonomy.

Classifications of self-presentational behavior are reviewed for differences and similarities. Earlier classifications and recent empirical research are used as a basis for a taxonomy of four styles of self-presentation--assertive, offensive, protective, and defensive--according to the relevant self-presentational intentions and the level of activity involved. Each style is illustrated with typical behavioral examples, together with individual differences and possible consequences.

Assertiveness↗
PubMed1981

Castration fantasies and assertiveness in father-absent males.

In a previous report (Shill 1981), father-absence was linked to insecurity in core male gender identity in a nonclinical sample of college males. The present paper describes further aspects of the experimental use of projective techniques, based on psychoanalytic theory and clinical discussions, to assess the effect of father-absence on male personality development. Castration fantasies and sense of competence in the mastery of external reality as an index of masculine self-representation were coded from the projective test responses of 103 father-present and 28 father-absent college males. When given a choice of castrating figure at the human or animal level, all subjects identified the human mother rather than the father as the more frightening castrating figure. Father-absent subjects, however, identified the animal mother as the more frightening castrating figure, compared to the animal father, more frequently than the father-present subjects, suggesting a denial and displacement of castration fear toward the human mother onto the animal substitute. The father-absent subjects also evidence significantly less sense of mastery, suggesting less self-assertiveness and sense of competence than the father-present controls. The importance of identification with the father as the basis for a masculine ego style and of father absence as a developmental interference affecting the appropriate management of aggression in males is discussed.

Adult↗
PubMed2005

An open trial of outpatient group therapy for bulimic disorders: combination program of cognitive behavioral therapy with assertive training and self-esteem enhancement.

The purposes of this study were to examine the therapeutic efficacy of combined group cognitive behavioral therapy (CGCBT) and to explore the characteristics of the patients who failed to complete it. Our group cognitive behavioral therapy combined with assertiveness training for alexithymia and self-esteem enhancement therapy were attended over a 10-week period. Twenty-five participants were enrolled in the study. The clinical symptoms were assessed before and after treatment, using rating scales including the Eating Disorder Inventory-2, the Bulimic Investigatory Test, Edinburgh, the Toronto Alexithymia Scale, the Rosenberg Self-Esteem Scale, and Global Assessment of Functioning. Sixteen participants (64%) completed the CGCBT program. Completion of the CGCBT resulted in significant improvements in reducing binge-eating behavior and improving social functioning. Eight patients (32%) significantly improved using the Clinical Global Impression Change (CGI-C). Stepwise logistic regression analysis of the results indicated that a lower age (P=0.04) and psychiatric comorbidity (P=0.06) were predictors of dropout from the CGCBT program. Our CGCBT program is a promising first-line treatment for bulimic outpatients. Lower age and the presence of comorbidity had effects on dropout rates.

Adult↗
PubMed2004

Client and community services satisfaction with an assertive community treatment subprogram for inner-city clients in Edmonton, Alberta.

OBJECTIVES: To evaluate client and agency satisfaction with a specific assertive community treatment subprogram, known as inner-city support, developed in Edmonton to target the inner-city population, and to determine the demographics and potential needs of this population. METHOD: Clients were administered questionnaires based on the Client Satisfaction Questionnaire and the Satisfaction With Life Scale. We also conducted a face-to-face interview. We contacted and similarly surveyed 18 community agencies. RESULTS: The program was well received, although areas for improvements included dissemination of information and hours of operation. Clients also requested more input regarding the development of activities. Clients were predominantly male with a diagnosis of schizophrenia comorbid with substance abuse and antisocial personality disorders, a history of forensic contact, homeless, and dependent on social assistance. CONCLUSION: Among the population with serious and persistent mental illness, inner-city clients represent a particularly disadvantaged subpopulation that may benefit from specialized community programs.

Adolescent↗
PubMed2005

Difficult-to-engage patients: a specific target for time-limited assertive outreach in a Swiss setting.

OBJECTIVE: Assertive community treatment (ACT) failed to develop in Europe, and its efficacy is debated. In Lausanne, Switzerland, ACT focuses on difficult-to-engage patients and aims to facilitate linkage with outpatient care through time-limited interventions. This study aimed to evaluate the applicability and efficiency of time-limited ACT. METHODS: We retrospectively assessed social, clinical, and functional outcomes and motivation for treatment in 75 consecutively seen subjects treated between 2000 and 2002. RESULTS: With 70% of the interventions lasting less than 6 months, we observed significant improvement in most clinical and social problems, in collaboration, in motivation for treatment, and in social network support, despite high baseline levels of clinical and social problems. The number of hospitalizations decreased significantly. CONCLUSIONS: Time-limited ACT is a useful treatment for difficult-to-engage patients with severe clinical and social problems, and it facilitates linkage to care. This narrower target for ACT may facilitate its implementation in Europe.

Adolescent↗
PubMed2005

Self-defense or assertiveness training and women's responses to sexual attacks.

Self-defense classes aim to prevent violence against women by strengthening women's capacity to defend themselves; however, little research has examined the effects of self-defense training on women's attempts to fight back during actual attacks. This study investigated the relationship of self-defense or assertiveness training and women's physical and psychological responses to subsequent rape attacks (N = 1,623). Multivariate analyses showed that victims with preassault training were more likely to say that their resistance stopped the offender or made him less aggressive than victims without training. Women with training before their assaults were angrier and less scared during the incident than women without training, consistent with the teachings of self-defense training. Preassault training participants rated their degree of non-consent or resistance as lower than did nonparticipants, perhaps because they held themselves to a higher standard. Suggestions for future research on women's self-defense training and rape prevention are offered.

Adult↗
PubMed1999

Test-retest reliability of the Hurlbert Index of Sexual Assertiveness.

This study investigated the test-retest stability of the Hurlbert Index of Sexual Assertiveness. 54 nonclinical and 46 clinical subjects were administered the Index on two occasions 4 wk. apart. Test-retest correlation coefficients were calculated separately and together. The results evidenced high test-retest reliability. Correlation coefficients were .88 for nonclinical subjects and .83 for clinical subjects with an over-all test-retest reliability of .85 for all 100 subjects.

Adult↗
PubMed2004

Participant perspectives on satisfaction with assertive community treatment.

This report explores participants' satisfaction with Assertive Community Treatment Programs in Ontario, Canada through a general satisfaction questionnaire that includes three open-ended questions. Open-ended questions are a simple tool for obtaining more detail about areas of satisfaction and dissatisfaction, and responses seem to be less influenced by social desirability than quantitative ratings. Participants particularly used the opportunity of answering open-ended questions to express feelings about their relationships with the team workers.

Adolescent↗
PubMed2004

Prevalence and characteristics of parenting among people served by Assertive Community Treatment.

This study examines the prevalence and the characteristics of parenting among people served by Assertive Community Treatment (ACT). Four semi-rural ACT teams in southeastern Ontario were surveyed. The findings suggest that a significant minority (38%) of persons receiving ACT services are parents, although most (84%) do not live with their children and many rarely see their children. These findings are surprising considering the lack of discussion in the literature about parenting among recipients of ACT services. The results are discussed in terms of the meaning for ACT services.

Adult↗
PubMed2005

The client experience of assertive community treatment: a qualitative study.

Assertive Community Treatment (ACT) has demonstrated effectiveness in reducing hospital days for persons with schizophrenia. Utilizing depth interviews and Grounded Theory techniques (Strauss & Corbin, 1998), client reactions to this intensive form of treatment delivery were explored. This study illustrates the importance of the relationship between treatment providers and persons with schizophrenia. As providers assisted clients with practical needs, clients began to develop trust, which fostered a sense of belonging and relationship, leading toward a positive motivation regarding treatment.

Anxiety↗