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Biomedical subjects

D A Shapiro

Publications and source records attributed to D A Shapiro.

At least 19 recordsLinked to original sources
PubMed1990

Correlations of session evaluations with treatment outcome.

Do evaluations of psychotherapy sessions predict treatment outcome? Clients (n = 40) and their therapists rated each session (n = 16 per client) of their brief therapy on the Session Evaluation Questionnaire (SEQ), which yields indices of session Depth (power, value) and Smoothness (comfort, safety). External raters rated tape-recordings of half of the sessions. SEQ ratings by one of two principal therapists were strongly correlated with client improvement on self-report measures; those of the other therapist were not. Clients' SEQ ratings did not show the expected correlations with improvement. External raters' ratings of session Smoothness were significantly correlated with client improvement on some measures.

Female↗
PubMed1990

Coping and help-seeking in the UK adult population.

A large national sample of the UK adult population was surveyed to find out how respondents would cope and whom they would turn to for help if they experienced psychological problems. Overall, the most frequently endorsed coping methods were cognitive or behavioural rather than avoidance- or substance-based. Respondents tended to endorse informal rather than formal helpers, especially partners and close relatives, although the family doctor was given greater endorsement than in corresponding US studies. Individual differences in coping and help seeking were examined with respect to demographic variables and level of reported psychological symptoms. Respondents who reported higher levels of symptoms tended to endorse more coping methods, especially avoidance methods, and to show greater readiness to seek help. The implications of the findings for traditional clinical work and for mental health education and promotion are discussed.

Adaptation, Psychological↗
PubMed1990

The Second Sheffield Psychotherapy Project: rationale, design and preliminary outcome data.

The cost-efficiency of psychotherapy research can be enhanced by (a) dissemination of the rationale and design of large-scale investigations whilst still under way, (b) incorporation of process measures within comparative outcome studies, (c) cumulative development of a series of related studies, and (d) sharing of recordings and other data with other investigators. We present the rationale and design, including full details of process and outcome measures, of the second Sheffield psychotherapy project, in which 120 white-collar, professional and managerial employees presenting with major depressive disorder receive either eight or 16 sessions of either prescriptive (cognitive/behavioural) or exploratory (relationship-oriented) therapy in a 2 x 2 design. Ethical considerations prompted the analysis of preliminary outcome data on 48 clients. Results suggested substantial clinical improvement, of similar magnitude for both methods and both durations of treatment, except that exploratory therapy appeared more effective than prescriptive in relation to interpersonal difficulties. Other workers are invited to build collaboratively on this research by making their own process analyses of recordings available from this study, relating these analyses to the existing impact and outcome data, and developing comparable data sets based on the design and initial results of this project.

Depressive Disorder↗
PubMed1990

Two-year follow-up of the Sheffield Psychotherapy Project.

Of 40 depressed and anxious patients who received treatment during the Sheffield Psychotherapy Project, 31 completed the BDI and SCL-90 at two-year follow-up. At both group and individual levels, outcomes were very similar to those obtained at the completion of treatment. Substantial minorities of patients reported major life events and seeking further help for psychological problems during the two years, but these reports were not reliably associated with symptoms at follow-up. Patients recalled very different elements in prescriptive and exploratory therapies as helpful, with a notable emphasis upon prescriptive therapy's relaxation and anxiety management as a source of problem solution.

Adult↗
PubMed1989

One measure of supervisory effectiveness in speech-language pathology and audiology.

This investigation developed and utilized a methodology for studying the follow-through of student clinicians from supervisory conferences to later activities. Based upon an earlier investigation in which 1,389 commitments made by 64 supervisees were identified and analyzed, completion of each commitment was measured in this investigation to determine if specific behaviors of clinicians occur after making commitments in supervisory conferences. Results indicated that clinicians demonstrate greater completion of commitments when structured accountability (i.e., written agreement) is introduced early into and subsequently faded from supervisory conferences, and that the written agreement is more beneficial for beginning clinicians than for experienced clincians. Of utmost importance was the demonstration that specific behaviors of supervisees can be followed and measured over time, and that certain behaviors of clinicians occur as a direct result of commitments made during conferences with a supervisor.

Audiology↗
PubMed1989

Pitfalls in Tay-Sachs carrier detection: physician referral patterns and patient ignorance.

Tay-Sachs carrier detection testing prior to pregnancy is more desirable than intra-pregnancy testing because it is technically easier, less expensive, and associated with less anxiety and less urgency. However, more than 80% of individuals referred for testing were pregnant women and/or their partners. The literature of the last several years has been silent on these and related issues. A questionnaire designed to determine the factors responsible for these circumstances was sent to 404 physicians (231 obstetrician/gynecologists and 173 internists and family physicians). Of the delivered questionnaires, 49.5% were completed and returned. The majority of obstetrician/gynecologists responding refer patients for Tay-Sachs carrier detection. Internists and family physicians do not, and their responses indicate a lack of pertinent knowledge. In addition, despite physician referral, patients delayed testing until pregnancy. While educational efforts have been targeted to obstetrician/gynecologists, expanded educational activities for internists, family physicians, and patients are required.

Education, Medical, Continuing↗
PubMed1988

An analysis of commitments made by student clinicians in speech-language pathology and audiology.

This study identified and classified commitments made by student clinicians in speech-language pathology and audiology supervisory conferences and provides a methodology for documenting change in supervisees' behavior as a result of supervisory interaction. Five different types of commitments were isolated and served as the basis of the Commitment Classification System. They included clinical procedures, clinical process administration, supervisory procedures, supervisory process administration, and academic information/teaching function. The independent variables were condition (written agreement or no written agreement between supervisee and supervisor), order of conditions, experience level of supervisee, week number within each condition, and type of commitments. Frequency data were collected for 6 consecutive weeks. The resulting 1,389 commitments made by 64 student clinicians in 384 individual conferences at 12 universities were analyzed within a multiple analysis of variance. Significant findings (p less than .05) indicated that the greatest number of commitments made involved planning, analysis, and evaluation of the clinical process with particular attention on client behavior; and the number of commitments made was a function of written accountability and order of conditions.

Audiology↗
PubMed1988

Client perceptions of significant events in prescriptive and exploratory periods of individual therapy.

This study compared the impact of helpful and hindering events, as perceived by 40 clients, in two forms of psychotherapy: an exploratory, relationship-oriented therapy, and a prescriptive, cognitive/behavioural therapy. All clients received eight sessions of each type of treatment in a crossover design. Events were obtained by self-report both during and at the end of each period, and content analysed for type of therapeutic impact by three trained raters. Results showed that during treatment the most commonly occurring helpful impacts across both types of treatments were 'problem solution', 'awareness' and 'reassurance', while the most commonly occurring hindering impact was 'unwanted thoughts'. Similar impacts were reported at the end of each period, with the addition of 'personal contact'. In addition, it was found that 'problem solution' and 'reassurance' impacts were more commonly reported in prescriptive treatment, whereas 'awareness' and 'personal contact' impacts were more prevalent in exploratory treatment. Only the prevalence of 'unwanted thoughts' was correlated (negatively) with outcome. Some possible reasons for the lack of correlation between reported impacts and outcome are suggested.

Anxiety Disorders↗
PubMed1988

Brief Structured Recall: a more efficient method for studying significant therapy events.

Previously, significant therapy events have been studied using a time-consuming form of tape-assisted recall. Brief Structured Recall (BSR) was developed to overcome difficulties with this earlier method. We carried out two case studies of time-limited therapy following the protocol of the Sheffield Psychotherapy Project (eight sessions each of Prescriptive and Exploratory therapies). In the first case study, we developed a more efficient method of identifying significant therapy events. In the second case study we developed structured interview schedules for obtaining client and therapist ratings and descriptions of a broad range of factors involved in significant events. The events identified in the two cases were typically 5-10 min in length, occurred in the second halves of sessions, contained 2-4 'peak' (most helpful) speaking turns, and were most often attributed to the therapist. The most common predominant impact of these events was Problem Clarification, followed by Personal Insight and Problem Solution. Treatment differences were more marked in the therapist's ratings of event impacts than in the clients' ratings.

Adaptation, Psychological↗
PubMed1987

Enalapril and hydrochlorothiazide as antihypertensive agents in the elderly.

This randomized, double blind study compared the antihypertensive effects of enalapril to hydrochlorothiazide (HCTZ) in the elderly. One hundred seventy-four patients with diastolic blood pressures (DBP) of 90-120 mm Hg or isolated systolic hypertension (ISH) (systolic BP greater than 160 mm Hg and diastolic BP less than 90 mm Hg) were studied. After four weeks of placebo, patients received either enalapril 10 mg or HCTZ 12.5 mg once daily. If the BP was uncontrolled (DBP greater than 85 mm Hg or SBP greater than 140 mm Hg) after 4 weeks, the dose was doubled. At 8 weeks, if necessary, the other drug could be added at the lower dose, then doubled 4 weeks later. Two-thirds of the patients had essential hypertension (EH), the rest ISH; 68% were male and 80% Caucasian. The baseline BPs were 167/94 mm Hg in both groups, at 8 weeks the mean BPs were 148/85 mm Hg in both groups (p less than or equal to 0.01), and at the end of the study the BPs with enalapril were 144/83 mm Hg and with HCTZ they were 145/83 mm Hg (p less than or equal to 0.01). The Caucasians showed greater BP falls on enalapril than HCTZ after 4 weeks (p less than or equal to 0.05). The SBP falls for the ISH (-22 mm Hg) and EH (-23 mm Hg) groups were similar at the end of the study. Both drugs were generally well tolerated. Laboratory adverse experiences (AEs) were 9% more common in the HCTZ patients (n.s.). Enalapril and HCTZ both seem to be effective antihypertensive agents in the elderly.

Aged↗
PubMed1987

Expectancy and outcome in prescriptive vs. exploratory psychotherapy.

Client ratings of the credibility of prescriptive and exploratory therapies were compared, and correlated with clinical improvement. Both expectancies and outcomes favoured prescriptive therapy in the first, but not the second, period of a cross-over design, and modest correlations were obtained between credibility and improvement. Regression analysis suggested that the impact of expectancy on outcome was secondary to the treatment effect rather than its cause.

Anxiety Disorders↗
PubMed1987

Comparison of enalapril and thiazide diuretics in the elderly hypertensive patient.

One hundred seventy-four patients, 65 years of age or older, entered a double-blind, seven-center, 16-week, controlled study to compare the effects of enalapril and hydrochlorothiazide (HCTZ) in an elderly hypertensive population. Sixty-eight percent of the patients were men, 32% were women. Thirty-two percent of the patients had isolated systolic hypertension. Approximately 80% of the patients were white. After a 4-week placebo run-in period, patients with sitting diastolic BP (DBP) of 90-120 mm Hg or systolic BP (SBP) greater than or equal to 160 mg Hg and DBP less than 90 mm Hg (isolated systolic hypertension) were randomized to receive 10 mg of enalapril or 12.5 mg of HCTZ once daily. If after 4 weeks their BPs were not controlled (i.e., DBP greater than 85 mm Hg or SBP greater than 140 mm Hg), the dose of the drug was doubled. If after successive 4-week intervals, their BPs were still not controlled, the other drug was added to their regimen and this was then doubled. The initial mean BPs were 167/94 mm Hg in both groups. By the end of the monotherapy phase at 8 weeks, the mean BPs had fallen significantly (p less than or equal to 0.01) to 148/85 mm Hg in both groups. By 16 weeks, the mean BPs had again fallen similarly: in the enalapril group to 144/83 mm Hg, and in the HCTZ group to 145/83 mm Hg. Seventy-nine percent of the enalapril group and 85% of the HCTZ group had controlled BPs at this time (DBP less than or equal to 85 or SBP less than or equal to 140 mm Hg). White and nonwhite patients in both drug groups had similar falls in SBP and DBP both at the end of the monotherapy period and the overall study. The white patients experienced more rapid falls in BP with enalapril, the nonwhite patients with HCTZ. Three serious adverse experiences occurred in the enalapril group, none of which were considered likely to be due to the drug therapy. Overall, 49% of the enalapril group and 61% of the HCTZ group reported an adverse effect during the study (not significant). Laboratory adverse effects occurred 10% more frequently in the HCTZ group: enalapril, 22%; HCTZ, 32% (not significant); none was serious. Both drugs therefore appeared to be equally efficacious antihypertensive agents in these elderly patients.

Aged↗
PubMed1987

Prescriptive v. exploratory psychotherapy. Outcomes of the Sheffield Psychotherapy Project.

Prior research suggests that psychotherapeutic techniques which differ in their contents are quite similar in their outcomes. Outcome data are reported from a study designed to maximise sensitivity to technique effects on outcome in a clinically realistic setting, and to permit detailed analysis of the relations between content, immediate impact, and outcome of therapy. Forty professional and managerial workers with depression or anxiety received eight sessions of Prescriptive (cognitive/behavioural) and eight sessions of Exploratory (relationship-oriented) therapy in a crossover design, with each client seeing the same therapist throughout. Outcome was assessed by standard interview and questionnaire methods. The results favoured Prescriptive therapy, although this difference was of moderate extent. The outcome was largely unaffected by the order in which the two methods were offered.

Anxiety Disorders↗
PubMed1986

Social support and life events in working class women. Stress buffering or independent effects?

Several authors have suggested that social support reduces the risk of psychiatric disorder by providing a "buffer" against the adverse effects of stressful events. Others have proposed, in contrast, that social support is beneficial irrespective of life stress. We addressed this issue in a community survey of 193 working class mothers by measuring social support, threatening life events, psychiatric symptomatology, and psychological well-being via a detailed assessment combining a standardized interview and case-identification procedure with self-report questionnaires yielding continuous measures of distress and well-being. Subject selection minimized confounding between support and events. The effects of life stress and social support were found to be largely independent of one another, although detailed analysis suggested that the conclusions drawn in such studies are affected by the measures and statistics used.

Adult↗