SSD for R in the Classroom: One of our final projects!

Now that the semester has ended, we thought we might show you some of our students’ final projects.  This first project was done by Catherine Faro.

The client that Catherine worked with was CW, a 21-year-old white male. CW was recently released from jail and was in treatment at a local mental health clinic with a recovery program for those dually diagnosed.  Catherine noticed that CW was not participating in his therapeutic group and sought to increase his participation.

After some research, Catherine chose to use Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual (Reilly & Shopshire, 2002) to intervene with this client.  It was hoped that this intervention would help CW verbalize his anger, learn adaptive coping skills, and connect better to group treatment.

To measure CW’s progress, Catherine assessed his participation at each group session.  A session was coded as 0 if CW did not participate at all, as 1 if he participated but in a non-substantive manner, and as 2 if he participated fully and constructively.

Baseline measures were taken for 11 sessions prior to beginning the intervention and for 26 sessions after the intervention was introduced.

Catherine produced the following line graph comparing the baseline to the intervention:

She also produced descriptive statistics and a box plot for each phase:         

Catherine noted that both the mean and median levels of participation rose with the intervention.

In further analyzing her data, Catherine did a trend analysis for both baseline and intervention and noted no significant trend in either phase.  Additionally, she noted no potential issues with autocorrelation in either phase.

To statistically  compare the two phases, Catherine used the binomial test to compare baseline successes with intervention phase successes in two ways.  First, “success” was defined as ANY type of group participation.  Looking at it this way, CW was successful 27.2% of the time during the baseline and 67.8% of the time during the intervention (p=0.00).  To evaluate this intervention more rigorously, Catherine then defined success as only productive group participation.  Under this more stringent definition, CW was successful during baseline 18% of the time.  During the intervention, he was successful 39.3% of the time (p=0.01).

Catherine then examined the size of the effect of the intervention using the d-index.  She found that that, with the intervention, CWs group participation improved 27.25%, a small to moderate effect.

BUT HOW DOES THIS IMPACT CATHERINE’S PRACTICE WITH CW?

Catherine concluded that the CBT techniques employed in the intervention may be having an impact on his self-reflection in group.  In her own words:

“CW became better able to discuss situations that made him angry, and examine the cognitive processes behind them and discuss his anger responses in a group setting. These two components assisted him in participating in group both in general, and in a self-reflective manner.”

Catherine said that this analysis “provides support for continued use of CBT techniques to help CW become more aware of his anger responses, and modulate them to more appropriate and constructive ways.”