The Role of Acculturation in the Relation Between Intimate Partner Violence and Substance Misuse Among IPV-victimized Hispanic Women in the Community

Hispanic women in the United States are disproportionately affected by intimate partner violence (IPV). One correlate of IPV among Hispanic women with important public health implications is substance misuse. However, limited research has identified culturally relevant factors that may impact the strength of the IPV-substance misuse association in this population. The present study examined the moderating role of acculturation in the relation between IPV types (i.e., physical, psychological, and sexual) and substance (i.e., alcohol and drug) misuse. Participants were 150 IPV-exposed Hispanic women in the community (M age = 35.13). IPV types, substance misuse outcomes, and acculturation were significantly and positively correlated with each other at zero-order. Moderation analyses indicated that the relations between IPV and substance misuse were stronger among Hispanic women with higher (vs. lower) levels of acculturation. These findings suggest the potential utility of considering acculturation when assessing and treating substance misuse among IPV-exposed Hispanic women.

Alcohol Misuse and Women's Use of Aggression in Intimate Relationships: The Mediating Role of Motivations for Using Aggression

The relationship between alcohol misuse and women's use of intimate partner violence (IPV) aggression has been well studied; however, there has been no research to date on women's self-reported motivations for use of IPV aggression (e.g., self-defense, control) as an underlying mechanism explaining this link. Accordingly, this study aims to examine whether the effects of alcohol misuse on IPV aggression vary as a function of women's motivations for using aggression. Participants were 412 ethnically diverse community women, between the ages of 18 and 65, in intimate relationships characterized by bidirectional IPV. The Motives and Reasons for IPV Scale was used to assess women's reasons for using IPV aggression. Results revealed that the tough guise motive (i.e., wanting to appear tough, intimidating, and willing to harm one's partner) explained the relationship between alcohol misuse and physical and sexual IPV aggression. Findings suggest the utility of incorporating the assessment of women's motivations for IPV aggression in an effort to provide better informed intervention addressing the underlying reasons women use IPV aggression.

Women's Use of Aggression and Their Depressive Symptoms: The Mediating Effect of Aggression-Related Shame and Avoidance Coping Among Women Experiencing Bidirectional Intimate Partner Violence

Research is scarce on the consequences of women's use of aggression on their depressive symptoms, particularly in relationships where women use and are victimized by intimate partner violence (IPV). Further, research has yet to identify factors that may mediate the aggression-depressive symptoms link among women who experience bidirectional IPV. The present study examined the potential mediating roles of shame and avoidance coping in the relationship between women's use of intimate partner aggression and their depressive symptoms. Participants were a community sample of 369 women who used and were victimized by physical aggression with a current male partner in the previous 6 months. A serial multiple mediator model was used to examine the mediating roles of aggression-related shame and avoidance coping on the relation between women's use of aggression and depressive symptoms. Results showed a significant indirect effect of women's use of aggression on their depressive symptoms through both aggression-related shame and avoidance coping; indirect effects were not significant through each mediator separately. After controlling for women's IPV victimization, we found a positive association between women's use of aggression and aggression-related shame, which in turn was related to greater avoidance coping, and subsequently, greater depressive symptoms. These findings highlight the importance of examining shame and avoidance coping as consequences of women's use of aggression and its effects on poorer mental health outcomes among women who use and are victimized by IPV.

Racial/ethnic differences moderate associations of coping strategies and posttraumatic stress disorder symptom clusters among women experiencing partner violence: a multigroup path analysis

BACKGROUND

Past research underscores the key role of coping strategies in the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD) symptoms. The goal of the current study was to extend existing literature by examining whether race/ethnicity moderates the relations among coping strategies (social support, problem-solving, avoidance) and PTSD symptom clusters (intrusion, avoidance, numbing, arousal).

METHODS

Participants were 369 community women (134 African Americans, 131 Latinas, 104 Whites) who reported bidirectional aggression with a current male partner. Multigroup path analysis was utilized to test the moderating role of race/ethnicity in a model linking coping strategies to PTSD symptom clusters.

RESULTS

The strength and direction of relations among coping strategies and PTSD symptom clusters varied as a function of race/ethnicity. Greater social support coping was related to more arousal symptoms for Latinas and Whites. Greater problem-solving coping was related to fewer arousal symptoms for Latinas. Greater avoidance coping was related to more symptoms across many of the PTSD clusters for African Americans, Latinas, and Whites, however, these relations were strongest for African Americans.

CONCLUSION

Results provide support for the moderating role of race/ethnicity in the relations among coping strategies and PTSD symptom clusters, and highlight potential targets for culturally informed PTSD treatments.

Intimate partner aggression-related shame and posttraumatic stress disorder symptoms: The moderating role of substance use problems

A dearth of literature has examined the consequences of women's use of aggression in intimate relationships. Women's use of aggression against their intimate partners, regardless of their motivation (e.g., self-defense, retaliation), may elicit shame. Shame, in turn, may contribute to the maintenance and/or exacerbation of posttraumatic stress disorder (PTSD) symptoms, which are commonly experienced in this population. Further, emerging research suggests that emotionally avoidant coping strategies, such as substance use, may strengthen the relation between shame and PTSD symptoms. The goal of the present study was to examine whether women's shame concerning their use of intimate partner aggression is associated with their PTSD symptoms, and whether drug and alcohol use problems moderate this association. Participants were 369 community women who had used and been victimized by physical aggression in an intimate relationship with a male partner in the past six months. The intimate partner aggression-related shame × drug (but not alcohol) use problems interaction on PTSD symptom severity was significant. Analysis of simple slopes revealed that women's intimate partner aggression-related shame was positively associated with their PTSD symptoms when drug use problems were high, but not when drug use problems were low. Findings have implications for the potential utility of PTSD treatments targeting a reduction in shame and maladaptive shame regulation strategies (i.e., drug use) in this population. Aggr. Behav. 42:427-440, 2016. © 2015 Wiley Periodicals, Inc.

Behavioral and Psychological Differences Among Abused Women Who Use Violence in Intimate Relationships

This article examines behavioral and psychological differences among women who used violence in four types of relationships. Nearly all of the women experienced physical abuse from their male partners. Types were compared on the extent of childhood abuse experienced, use of avoidance coping, anger, motivations for using violence, injuries, psychological symptoms, and alcohol use. Women in the Victim type (the partner used more physical violence and coercion against her than she against him) and the Abused Aggressor type (the woman used more violence and coercion against the partner than he against her) had the poorest behavioral and psychological indices. Women in Mixed-Female Coercive relationships (the woman’s use as of coercion was equivalent to or greater than her partner, but the partner used as much or more violence) had the fewest difficulties. Scores for women in Mixed-Male Coercive relationships (the partner was more coercive than the woman, but the woman’s use of violence was equivalent to or greater than the partner’s) generally fell in between the other groups.

The Mediational Role of Relationship Efficacy and Resource Utilization in the Link Between Physical and Psychological Abuse and Relationship Termination

This study examines the roles of physical and emotional abuse and resource utilization, relationship efficacy, and childhood abuse on relationship status (together or separated) in a sample of 69 low-income, nonsheltered battered women. Separate path models were conducted for physical and psychological abuse. Increased physical abuse was related to separated status, increased resource utilization, and decreased efficacy. The effect of physical abuse on status was mediated by resource utilization and efficacy, whereas the effect of psychological abuse on status was partially mediated only by utilization. Increased childhood abuse was associated with together status. Baseline psychological but not physical abuse predicted a longer term separated status thereby suggesting that the effects of psychological abuse may be enduring.

Precursors and Correlates of Women's Violence: Child Abuse Traumatization, Victimization of Women, Avoidance Coping, and Psychological Symptoms

Path modeling assessed (a) the influence of child abuse traumatization on women's use of violence and their experiences of being victimized, (b) the association of these three variables to depressive and posttraumatic stress symptoms, and (c) the indirect pathways from women using violence and their being victimized to psychological symptoms through avoidance coping. Among 108 primarily African American women recruited from the community who used violence with a male partner, women's use of violence, but not their experiences of being victimized, was predicted by child abuse traumatization. Women's use of violence did not directly or indirectly predict symptomatology. In contrast, child abuse traumatization and women's experiences of being victimized were predictive of both depressive and posttraumatic stress symptoms, and being victimized also was related indirectly to depressive symptoms through avoidance coping.

A dangerous boomerang: Injunctive norms, hostile sexist attitudes, and male-to-female sexual aggression

This study examined the interactive effects of injunctive norm exposure and hostile and benevolent sexist attitudes on men's sexually aggressive responses during a behavioral analogue paradigm in which they interacted online with a bogus female partner. Heterosexual adult men (n = 201), recruited from an online sample, read fictional information regarding other men's approval of misogynistic, paternalistic, or egalitarian treatment of women, or non-gender-relevant control information. Through a media preference survey, men then learned that their female partner disliked sexual content in films, after which they had an opportunity to send her up to 120 sec' worth of either a sexually explicit or nonsexual film clip. Validating the online sexual aggression paradigm, men with a 1-year history of sexual assault exhibited more sexually aggressive responding during the film selection paradigm. Moreover, exposure to injunctive norm information produced a boomerang effect, such that men high in hostile sexist attitudes showed an increase in sexual aggression when confronted with paternalism and gender equality norms. Conversely, exposure to paternalism and gender equality norms suppressed the otherwise protective function of high benevolent sexism in reducing men's sexually aggressive tendencies. The implications of these results for social norms interventions are discussed.

A Comparison of the Structural Factors of the Propensity for Abusiveness Scale for Women and Men in a Domestic Violence Treatment Program

Court-mandated domestic violence (DV) treatment programs across the country have seen a marked increase in female clients. These programs use a variety of measurement tools to assess the needs of their clients. Increased numbers of women in treatment for DV reflect a need to address the measurement of intimate partner violence (IPV) for both males and females. Unfortunately, the reliability and validity of many of measures used to assess IPV and related constructs for women remains unknown. The current study focuses on a particular measure, the Propensity for Abusiveness Scale (PAS). The PAS is not a measure of abusive behavior per se; rather, it assesses risk factors for abuse, including affective lability, anger expression, trauma symptoms, and harsh parenting experienced by the respondent. Specifically, the current study compares the factor structure and the measurement properties of the PAS for males and females in a sample of 885 (647 female, 238 male) participants in a DV treatment program. Findings indicate that the PAS demonstrated configural, metric, and scalar invariance between the female and male samples. These results suggest that it is appropriate for researchers and clinicians to make comparisons between women and men based on PAS factor scores.

The mediating role of avoidance coping between intimate partner violence (IPV) victimization, mental health, and substance abuse among women experiencing bidirectional IPV

Avoidance coping is consistently linked with negative mental health outcomes among women experiencing intimate partner violence (IPV). This study extended the literature examining the potentially mediating role of avoidance coping strategies on both mental health and substance use problems to a highly generalizable, yet previously unexamined population (i.e., women experiencing bidirectional IPV) and examined multiple forms of IPV (i.e., psychological, physical, and sexual) simultaneously. Among a sample of 362 women experiencing bidirectional IPV, four separate path models were examined, one for each outcome variable. Avoidance coping mediated the relationships between psychological and sexual IPV victimization and the outcomes of PTSD symptom severity, depression severity, and drug use problems. Findings indicate nuanced associations among IPV victimization, avoidance coping, and mental health and substance use outcomes.

Evaluation of the Green Dot Bystander Intervention to Reduce Interpersonal Violence Among College Students Across Three Campuses

Evidence suggests that interventions to engage bystanders in violence prevention increase bystander intentions and efficacy to intervene, yet the impact of such programs on violence remains unknown. This study compared rates of violence by type among undergraduate students attending a college campus with the Green Dot bystander intervention (n = 2,768) with students at two colleges without bystander programs (n = 4,258). Violent victimization rates were significantly (p < .01) lower among students attending the campus with Green Dot relative to the two comparison campuses. Violence perpetration rates were lower among males attending the intervention campus. Implications of these results for research and practice are discussed.

Elucidating posttraumatic stress symptom profiles and their correlates among women experiencing bidirectional intimate partner violence

OBJECTIVE

This study employed latent class analysis to identify profiles of women experiencing intimate partner violence (IPV) based on the severity of posttraumatic stress disorder (PTSD) symptoms.

METHOD

Self-report data from a sample of 369 women experiencing bidirectional IPV was used.

RESULTS

A 3-class solution comprising low, moderate, and high PTSD severity profiles best fit the data. Profiles were differentially related to whether IPV victimization was considered traumatic (PTSD criterion A); whether functioning was impaired as a result of PTSD symptoms (PTSD criterion F); whether the woman met full diagnostic criteria for PTSD; depression symptom severity; and severity of psychological, physical, and sexual IPV victimization and use of IPV. An extremely high percentage of women in the high (96%) and moderate (88%) severity classes experienced functional impairment, although many did not meet full diagnostic criteria for PTSD.

CONCLUSIONS

Findings support the need for interventions individually tailored to one's treatment needs based on the nature of one's traumatic stressor and the impact of PTSD on daily functioning.

Patterns of resource utilization and mental health symptoms among women exposed to multiple types of victimization: a latent class analysis

Although the value of resources aimed to support women who experience intimate partner violence (IPV) is clear, few studies have investigated how exposure to multiple types of victimization influences women's resource utilization. We applied latent class analysis (LCA) to a sample of 412 women who used IPV in their current relationships to test whether women's resource utilization is associated with different patterns of victimization, including current IPV victimization, past IPV victimization, and childhood victimization. Three classes of women were identified: the Low Cumulative IPV class (n = 121) included women with a low prevalence of past IPV victimization and low severity of current IPV victimization; The High Past/ Low Current IPV class (n = 258) included women with a high prevalence of past IPV victimization but low severity of current IPV victimization; and the High Cumulative IPV class (n = 33) included women with a high prevalence of past IPV victimization and severe current IPV victimization. Multiple types of childhood victimization were highly prevalent among women in all three classes. Women in the High Cumulative IPV class used a greater variety of resources, experienced a greater number of posttraumatic stress and depression symptoms, drug problems, and used more severe IPV aggression compared to women in other classes. These findings highlight the heterogeneity of resource utilization among women in relationships characterized by bidirectional IPV and underscore the potential clinical utility of adapting services to meet the specific needs of women with unique profiles of victimization.

Relationship self-efficacy protects against mental health problems among women in bidirectionally aggressive intimate relationships with men

Research examining predictors or correlates of mental health problems among women who experience or use aggression in intimate relationships typically assesses factors that confer risk. Such research has primarily examined intimate partner violence (IPV) victimization or aggression frequency or severity as central risk factors for mental health problems. In the general population, one factor demonstrating a protective effect on mental health problems is self-efficacy. Research on self-efficacy among women who experience or use aggression in intimate relationships is nearly absent. The purpose of this study was to determine if self-efficacy specific to a woman's ability to manage various relationship problems (i.e., relationship self-efficacy [RSE]) played a protective role against the severity of posttraumatic stress, depression, and anxiety symptoms among 354 community-residing women who were victimized and used aggression (bidirectional IPV). Regression analyses found that RSE uniquely predicted each mental health outcome above and beyond what was accounted for by the frequency of physical, sexual, and psychological victimization and aggression. Further, RSE fully mediated the relationships between psychological victimization and each mental health outcome. If replicated, and in circumstances where it is determined safe to do so, findings suggest RSE as a promising avenue for future research to improve the health and well-being of women in bidirectionally aggressive relationships.

Exploring Rape Myths, Gendered Norms, Group Processing, and the Social Context of Rape Among College Women

The purpose of this research is to explore the negotiation strategies of college women as they interpret ambiguous rape scenarios. In focus groups, 1st- and 4th-year college women were presented with a series of three vignettes depicting incidents that meet the legal criteria for rape yet are ambiguous due to the presence of cultural rape myths, contexts involving alcohol consumption, varying degrees of consent, and a known perpetrator. These contexts are critical in understanding how college women define rape. Key findings indicated many of these college women utilized rape myths and norms within their peer groups to interpret rape scenarios.

Factor structures for aggression and victimization among women who used aggression against male partners

Theories and measures of women's aggression in intimate relationships are only beginning to be developed. This study provides a first step in conceptualizing the measurement of women's aggression by examining how well three widely used measures (i.e., the Revised Conflict Tactics Scales (CTS), the Sexual Experiences Survey [SES], and the Psychological Maltreatment of Women Inventory [PMWI]) perform in assessing women's perpetration of and victimization by aggression in their intimate relationships with men. These constructs were examined in a diverse sample of 412 African American, Latina, and White women who had all recently used physical aggression against a male intimate partner. The factor structures and psychometric properties of perpetration and victimization models using these measures were compared. Results indicate that the factor structure of women's perpetration differs from that of women's victimization in theoretically meaningful ways. In the victimization model, all factors performed well in contributing to the measurement of the latent victimization construct. In contrast, the perpetration model performed well in assessing women's physical and psychological aggression but performed poorly in assessing women's sexual aggression, coercive control, and jealous monitoring. Findings suggest that the power and control model of intimate partner violence (IPV) may apply well to women's victimization but not as well to their perpetration of violence.

Does the inclusion criterion of women's aggression as opposed to their victimization result in samples that differ on key dimensions of intimate partner violence?

This study is among the first attempts to address a frequently articulated, yet unsubstantiated claim that sample inclusion criteria based on women's physical aggression or victimization will yield different distributions of severity and type of partner violence and injury. Independent samples of African American women participated in separate studies based on either inclusion criterion of women's physical aggression or victimization. Between-groups comparisons showed that samples did not differ in physical, sexual, or psychological aggression; physical, sexual, or psychological victimization; inflicted or sustained injury. Therefore, inclusion criterion based on physical aggression or victimization did not yield unique samples of "aggressors" and "victims."

Gender symmetry, sexism, and intimate partner violence

This study of a predominantly Hispanic sample of 92 male and 140 female college students examines both gender symmetry in intimate partner violence (IPV) and inconsistent relationships found in previous studies between sexist attitudes and IPV. Results indicate that although comparable numbers of men and women perpetrate and are victimized in their relationships with intimate partners, the path models suggest that women's violence tends to be in reaction to male violence, whereas men tend to initiate violence and then their partners respond with violence. Benevolent sexism was shown to have a protective effect against men's violence toward partners. Findings highlight the importance of studying women's violence not only in the context of men's violence but also within a broader sociocultural context.

Why I Hit Him: Women's Reasons for Intimate Partner Violence

This study examines motives for intimate partner violence (IPV) among a community sample of 412 women who used IPV against male partners. A "Motives and Reasons for IPV scale" is proposed, and exploratory factor analyses identified five factors: expression of negative emotions, self-defense, control, jealousy, and tough guise. To our knowledge, the study is the first to investigate the relationship between women's motives for IPV and their perpetration of physical, psychological, and sexual aggression, as well as coercive control, toward partners. Hierarchical regression analyses revealed participants' aggression was driven by complex, multiple motives. All five motives were related to a greater frequency of perpetrating IPV. Treatment programs focusing on women's IPV perpetration should address both defensive and proactive motives.

Relationships among Women's Use of Aggression, Their Victimization, and Substance Use Problems: A Test of the Moderating Effects of Race/Ethnicity

This study examined whether relationships among women's aggression, their victimization, and substance use problems were moderated by race/ethnicity. Four hundred and twelve community women (150 African Americans, 150 Latinas, and 112 Whites) who recently were aggressive against a male partner completed a 2-hour computer-assisted interview. ANOVA and path analysis revealed that (a) for all women, victimization and aggression were strongly related; (b) race/ethnicity moderated the relationships between victimization and alcohol and drug use problems; and (c) no groups evidenced a relationship between alcohol or drug use problems and aggression. Findings suggest that it is essential to develop culturally relevant, gender-specific interventions to reduce both women's aggression and victimization, as well as related negative behaviors such as alcohol and drug use.

The resource utilization of women who use violence in intimate relationships

Studies have found high rates of help seeking among domestic violence victims. However, little research has investigated the help-seeking patterns of women who use violence (many of whom are also abused). Understanding the resources utilized by women who are violent toward their partners may aid in designing interventions that will reduce the women's violence, as well as reduce the victimization they may be experiencing. This study examines the resource utilization of 108 women who used violence against a male partner (94% of whom also experienced victimization). Findings revealed that (a) almost all of the women utilized community resources in an attempt to manage the violence in their relationships; (b) victimization was related to resource utilization via self-defense motives, avoidance coping, and posttraumatic stress symptoms; and (c) greater resource utilization was related to lower levels of women's violence against their partners. Findings suggest that community resources may help prevent women's violence.

A review of research on women's use of violence with male intimate partners

This article provides a review of research literature on women who use violence with intimate partners. The central purpose is to inform service providers in the military and civilian communities who work with domestically violent women. The major points of this review are as follows: (a) women's violence usually occurs in the context of violence against them by their male partners; (b) in general, women and men perpetrate equivalent levels of physical and psychological aggression, but evidence suggests that men perpetrate sexual abuse, coercive control, and stalking more frequently than women and that women also are much more frequently injured during domestic violence incidents; (c) women and men are equally likely to initiate physical violence in relationships involving less serious "situational couple violence," and in relationships in which serious and very violent "intimate terrorism" occurs, men are much more likely to be perpetrators and women victims; (d) women's physical violence is more likely than men's violence to be motivated by self-defense and fear, whereas men's physical violence is more likely than women's to be driven by control motives; (e) studies of couples in mutually violent relationships find more negative effects for women than for men; and (f) because of the many differences in behaviors and motivations between women's and men's violence, interventions based on male models of partner violence are likely not effective for many women.

The development of a theory of women's use of violence in intimate relationships

Reports have appeared in the popular press in recent years concluding that women are just as violent as men. These reports stem from acontextual survey studies comparing prevalence rates of women's and men's physical violence. The authors contend that the above conclusion is simplistic and misleading, and that a theoretical framework that embeds women's violence in the context in which it occurs is sorely needed. This article proposes a model that includes women's violence in the context of their victimization by male partners, motivations for violent behavior and how they cope with relationship problems, experiences of childhood trauma, and outcomes of depression, anxiety, posttraumatic stress disorder, and substance use. The model is then examined within the context of gender, race, and class. The cultural context of domestic violence for African American and Latina women is reviewed. This literature reinforces the need to place women's violence in a broader sociocultural context.

The role of coping and problem drinking in men's abuse of female partners: test of a path model

This article examines the relationship of coping and problem drinking to men's abusive behavior towards female partners. While previous research has demonstrated a consistent association between problem drinking and male abuse of intimate partners, virtually no studies have assessed the role of coping in relation to men's violence. Furthermore, multivariate studies have not examined how these factors operate together to increase risk for abusive behavior. An ethnically diverse sample of 147 men in a court-mandated program for domestic violence offenders completed questionnaires at the first session. Path modeling was conducted to test the extent to which coping and problem drinking predicted both physical and psychological abuse. In addition, the relationships of problem drinking and physical abuse to injury of the men's female partners were examined. Results indicated that both the use of avoidance and problem-solving coping to deal with relationship problems were related indirectly to abusive behavior through problem drinking. Greater use of avoidance coping strategies was more likely among problem drinkers. By contrast, men who used higher levels of problem-solving coping were less likely to be problem drinkers. Avoidance, but not problem-solving coping also was directly and positively related to physical and psychological abuse. Men identified as problem drinkers were more likely to use both physical and psychological abuse. Finally, greater use of physical violence was strongly related to higher levels of injury among female partners, and served to mediate the relationship between problem drinking and injury. Results are discussed in terms of their contribution to the identification of risk and protective factors for men's violent behavior toward intimate female partners and implications for developing intervention strategies.

Women who use violence in intimate relationships: the role of anger, victimization, and symptoms of posttraumatic stress and depression

The present study examines the role of anger and victimization in women's use of aggression in heterosexual intimate relationships. The sample was composed of 108 women, primarily African American, urban, and poor, who had used violence against a partner in the previous 6 months. Path modeling was used to examine the interrelationships among anger, women's aggressive behavior, victimization, childhood abuse experiences, and symptoms of posttraumatic stress and depression. Results revealed that almost all of the women experienced violence from their partners. Greater frequency of victimization from partners and experiences of childhood abuse increased the likelihood that women would use aggression against their partners. Victimization from partners and childhood abuse also increased the likelihood that women would experience symptoms of posttraumatic stress and depression. Women with more symptoms of posttraumatic stress were also more likely to express anger outwardly towards others. Expressing anger outwardly toward others, in turn, predicted an increased likelihood of using aggression against partners.

Helping preschool leukemia patients and their parents cope during injections

Taught 4 preschool leukemia patients (ages 3-5) to engage in specific coping behaviors before and during painful intramuscular and intravenous injections. Parents were taught to coach their children in the use of the coping behaviors. Intervention was delivered in a multiple baseline across-subjects design. Parent and child behavior was coded using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R, Blount, Powers, & Sturges) and Observation Scale of Behavioral Distress (OSBD, Elliott, Jay, Woody). Parents and nurses rated child behavior as well. Results indicated that parents learned coping-promoting behaviors, children learned specific coping behaviors, and children displayed less behavioral distress. Maintenance of behavior change was addressed. Contributions of this study to the current literature on children's coping with invasive medical procedures and implications for future research and clinical practice are discussed.