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Biomedical subjects

H Lubin

Publications and source records attributed to H Lubin.

At least 19 recordsLinked to original sources
PubMed2000

Interactive psychoeducational group therapy in the treatment of authority problems in combat-related posttraumatic stress disorder.

The use of Interactive Psychoeducational Group Therapy to ameliorate authority problems of veterans with combat-related posttraumatic stress disorder is described. Despite the common occurrence of authority problems in this population, and the degree of damage they have caused in family, work, and legal domains, they are rarely specifically targeted by treatment interventions. A conceptual framework linking psychological trauma with distortions in authority relations is presented, followed by the format, procedures, and case examples of this form of group therapy. By uncovering the distorted beliefs associated with traumatic schemas as they emerge in the group interaction, the group therapist can first help the clients question their assumptions about authority, and then explore more adaptive behaviors. The need to examine in greater detail the causes and impact of authority problems among clients with posttraumatic stress disorder is emphasized.

Adult↗
PubMed1999

Comparison of outcome between homogeneous and heterogeneous treatment environments in combat-related posttraumatic stress disorder.

This study compared treatment outcome at discharge, and 4, 8, and 12 month follow-up between an inpatient program consisting of a mixture of Vietnam combat veterans with posttraumatic stress disorder (PTSD) and general psychiatric patients (N = 42), and the same program at a later period, consisting of only Vietnam combat veterans with PTSD (N = 33). Veterans rated the homogeneous environment higher in satisfaction, support, order, clarity, and amount of discussion of combat, and lower in hostility, than the heterogeneous condition. However, veterans showed no improvement in condition at 12 month follow-up, with the exception of decreased violence, replicating earlier studies. No differences in outcome were found between homogeneous or heterogeneous treatment environments. This study underscores the enduring nature of chronic posttraumatic stress disorder in the veteran population.

Adult↗
PubMed1998

Efficacy of Psychoeducational Group Therapy in reducing symptoms of posttraumatic stress disorder among multiply traumatized women.

OBJECTIVE: The role of group therapy in treatment of posttraumatic stress disorder (PTSD) has been traditionally restricted to issues of self-esteem and interpersonal relationships, rather than primary symptoms of the disorder. In this study, the authors examined the effectiveness of a 16-week trauma-focused, cognitive-behavioral group therapy, named Interactive Psychoeducational Group Therapy, in reducing primary symptoms of PTSD in five groups (N=29) of multiply traumatized women diagnosed with chronic PTSD. METHOD: The authors made assessments at baseline, at 1-month intervals during treatment, at termination, and at 6-month follow-up by using self-report and structured interview measures of PTSD and psychiatric symptoms. The absence of a control group limits the conclusions drawn from the study. RESULTS: At termination, subjects showed significant reductions in all three clusters of PTSD symptoms (i.e., reexperiencing, avoidance, and hyperarousal) and in depressive symptoms; they showed near-significant reductions in general psychiatric and dissociative symptoms, at termination. These improvements were sustained at 6-month follow-up. CONCLUSIONS: The role of group therapy in PTSD treatment should not be prematurely restricted to addressing self-esteem and interpersonal dimensions only. The use of structured, cognitive-behavioral elements within the group format may allow for more targeted treatment of core symptoms of the disorder.

Adult↗
PubMed1997

The impact of the homecoming reception on the development of posttraumatic stress disorder. The West Haven Homecoming Stress Scale (WHHSS).

This study reports on the development of a self-report measure of the homecoming experience among Vietnam veterans with posttraumatic stress disorder (PTSD). The West Haven Homecoming Stress Scale (WHHSS), measuring Frequency of Events, Intensity of Feelings, and Level of Support during the first 6 months after return from overseas, and within the past 6 months, was collected from 247 veterans who were receiving inpatient treatment for PTSD. Homecoming Stress was the most significant predictor of current PTSD symptomatology superseding combat exposure, childhood and civilian traumas, and stressful life events. A factor analysis resulted in four orthogonal factors: Shame, Negative Interpersonal Interaction, Social Withdrawal, and Resentment. Homecoming Stress was unchanged over the course of a 4 month inpatient program.

Adult↗
PubMed1997

Single session effects of treatment components within a specialized inpatient posttraumatic stress disorder program.

This study examined the potential contributions of individual treatment components within one inpatient posttraumatic stress disorders (PTSD) program. Fifteen treatment components were assessed by a self-report instrument administered to a cohort of veterans just before and immediately after each session approximately halfway through the program. Components with an external focus, action modality, and, secondarily, little Vietnam content were associated with more improvement than components with an internal focus, verbal modality, or high Vietnam content. Improvement was greatest in veterans with fewer PTSD symptoms. Short-term improvement was not correlated with veterans' ratings at discharge of component effectiveness. These results were later confirmed on a second cohort. This study supports the potential roles of distraction and physical release, as opposed to exploratory verbal discussion, in the treatment of chronic combat-related PTSD.

Adult↗
PubMed1997

Treatment preferences of Vietnam veterans with posttraumatic stress disorder.

This study attempted to examine patterns over time in treatment preferences of 65 veterans who completed a 4 month inpatient posttraumatic stress disorders (PTSD) program in order to reveal potentially more beneficial types of treatment. Veterans rated the severity of their symptoms and degree of benefit of 35 different treatment components at discharge, and at 4 and 12 months follow-up. Veterans rated their symptoms as having not changed at discharge, and worsening by 4 months. Veterans initially perceived components that were high in Vietnam content, exploratory in purpose, verbal in modality, and personally focused as most effective, but by 12-month follow-up they perceived these as less effective than components that were low in Vietnam content, educative, action oriented, and externally focused. These effects were strongest among veterans with higher levels of PTSD symptomatology. Combat exposure, childhood abuse, and race were generally not significant predictors of response. These results underscore the importance of further inquiry into the relative value of rehabilitative-oriented and psychotherapeutic-oriented treatments for veterans with severe and chronic PTSD.

Adult↗
PubMed1997

Interactive psychoeducational group therapy for traumatized women.

A specialized form of outpatient group therapy with traumatized women is described. Interactive psychoeducational group therapy (IPGT) aims to help the survivor differentiate her self-representations from traumatic schemata that she may have assimilated since the traumatic event. Such assimilation is viewed as leading to a number of negative effects, including shame, social isolation, distorted body image, and sense of meaninglessness. Using a membership with heterogeneous trauma, cognitive-distancing techniques, corrective interpersonal enactments, and specifically designed ceremonies, IPGT attempts to encourage survivors to alter their relationship to the traumatic event and the illness of posttraumatic stress disorder. Clinical examples demonstrate members' improvement in self-image, interpersonal relationships, and sense of belonging to the community at large.

Adult↗
PubMed1997

Startle reflex abnormalities in women with sexual assault-related posttraumatic stress disorder.

OBJECTIVE: This investigation was designed to assess the acoustic startle response in treatment-seeking women with sexual assault-related posttraumatic stress disorder (PTSD). METHOD: Thirteen patients with sexual assault-related PTSD and 16 healthy female comparison subjects were recruited for participation in the study. Each patient met the full criteria for PTSD according to the Structured Clinical Interview for DSM-III-R. All subjects in the study were right-handed. The acoustic stimuli were bursts of white noise (92 dB and 102 dB) with a nearly instantaneous onset delivered binaurally through headphones. RESULTS: The magnitude of the startle response (eye blink) to the first stimulus was asymmetrically distributed in the PTSD patients but not in the comparison subjects: it was greater for the left eye than the right eye in the PTSD patients only. There was a differential asymmetry of startle response in the two subgroups of patients (recent PTSD and long-standing PTSD): the startle reflex was larger for the left eye than the right in the subgroup with recent PTSD but not in the group with long-standing PTSD. CONCLUSIONS: This study provides the first objective evidence of startle abnormalities in women with PTSD. The significantly greater startle responses for the left eye compared with the right in the PTSD subjects suggest a laterality effect. As suggested by the preclinical model of shock sensitization, it is possible that in a subgroup of individuals with PTSD, trauma may sensitize the startle reflex. This model may hold true in humans and is supported by the findings of greater startle response in the patients with recent-onset PTSD.

Acoustic Stimulation↗
PubMed1996

Outcome of intensive inpatient treatment for combat-related posttraumatic stress disorder.

OBJECTIVE: This study analyzed the outcome of a 4-month intensive inpatient program for combat-related posttraumatic stress disorder (PTSD) among Vietnam veterans. METHOD: The subjects were 51 male veterans with PTSD who completed the inpatient treatment program. Comprehensive measures of PTSD and psychiatric symptoms, as well as social functioning, were assessed at admission, discharge, and 6, 12, and 18 months after discharge. RESULTS: The overall study group showed an increase in symptoms from admission to follow-up and a decrease in violent actions and thoughts and legal problems. Family and interpersonal relationships and overall morale were improved at discharge but then returned to pretreatment levels at 18 months. Patient evaluations also indicated that the program affected morale and interpersonal relationships but not symptoms. CONCLUSIONS: The chronic nature of combat-related PTSD among Vietnam veterans is evident. The study raises the possibility that long-term intensive inpatient treatment is not effective, and other forms of treatment should be considered after rigorous study of such variables as length of stay, trauma versus rehabilitation focus, and patient characteristics.

Adaptation, Psychological↗
PubMed1995

The therapeutic use of ritual and ceremony in the treatment of post-traumatic stress disorder.

The therapeutic purposes and effects of specially designed ceremonies in the treatment of persons with post-traumatic stress disorder are described. Ceremonies compartmentalize the review of the trauma, provide symbolic enactments of transformation of previously shattered relationships, and reestablish connections among family and with society in general. Four ceremonies used with Vietnam combat veterans are described which focus on the themes of separation from and return to the family, forgiveness of the living, and releasing the dead. Ritual and ceremony are highly efficient vehicles for accessing and containing intense emotions evoked by traumatic experience. Evaluation by family and veterans judge these ceremonies to be the most effective components of treatment.

Drama↗
PubMed1995

Critical interaction therapy: couples therapy in combat-related posttraumatic stress disorder.

There is a need for family therapy interventions that are specific to the conditions found in families of traumatized people such as combat veterans. In these families, the historically "real" event of the trauma often continues to exert influence on the family system despite collusive arrangements that serve to keep it hidden. In families of combat veterans, a situation develops whereby the veteran becomes triangulated with a dead buddy without the spouse's knowledge. The discrepancy between past and present emerges in what we call the critical interaction between the spouses. This article outlines a method of couples therapy that attempts to demystify this critical interaction, and begins to integrate the discrepant narratives of each spouse. The establishment of a nascent mutuality of perspective within the couple releases energies that can be directed toward support rather than symptom-formation in the family system.

Combat Disorders↗
PubMed1994

Elevation of serum free triiodothyronine, total triiodothyronine, thyroxine-binding globulin, and total thyroxine levels in combat-related posttraumatic stress disorder.

BACKGROUND: This study was designed to assess both central and peripheral aspects of thyroid function in combat-related posttraumatic stress disorder (PTSD), with the particular purpose of finding a mechanistic explanation for an imbalance between serum levels of free thyroxine (T4) and total T4 previously observed in pilot work. METHODS: A total of 96 male combat veterans with PTSD diagnosed by DSM-III-R (72 from the West Haven, Conn, Veterans Affairs Medical Center and 24 from the Menlo Park, Calif, Veterans Affairs Medical Center) were compared with 24 male control subjects. One or more serum samples were analyzed by radioimmunoassays for levels of total T4, free T4, total triiodothyronine (T3), free T3, T4-binding globulin, and thyrotropin. RESULTS: The pilot observation of moderately elevated total T4 levels with no elevation in free T4 levels in patients with PTSD was confirmed, suggesting the hypotheses that (1) there may be an increased peripheral conversion of free T4 by deiodination to T3 or (2) there may be an increased binding of T4 secondary to elevated T4-binding globulin levels. Our findings support both hypotheses. The PTSD groups all showed a marked and sustained elevation in levels of both total T3 and free T3, as well as elevated T3/T4 ratios, supporting the increased T3 conversion hypothesis. The PTSD groups also showed a marked and sustained increase in T4-binding globulin levels, supporting the increased binding hypothesis. Thyrotropin levels did not differ between PTSD and control groups. CONCLUSIONS: These findings demonstrate an unusual pattern of thyroid alterations, featuring substantial elevations in total T3, free T3, and T4-binding globulin levels, in combat-related PTSD that differs from established endocrinopathies, such as classic hyperthyroidism, T3 thyrotoxicosis, or chronic T4-binding globulin elevation.

Adult↗
PubMed1988

A comparison of data from dental charts, client interview, and client mail survey.

Dental records and client survey reports were compared as sources of data for dental research. Further, two forms of the client survey were completed, a mail survey and telephone interview. A random sample of 271 clients of a dental group practice based within a university health service was selected. The Kappa values indicated a reasonable level of agreement of client survey and dental record with regard to the types of services received but no with regard to actual number of visits. Responses to the mail and the telephone versions of the client survey were compared for service satisfaction, hygiene behavior, and attitude and belief variables. Two potential sources of bias: nonrespondent/respondent bias and other response biases, such as acquiescent responses, were detected. The study illustrates the importance of weighing which source of response bias is more crucial to the general validity of a study based on the research questions to be addressed.

Dental Health Surveys↗
PubMed1980

Consumer perceptions of dental care in the health services program of an educational institution.

A consumer survey was used to evaluate the University of Massachusetts dental service, a program emphasizing an educational and preventive approach, comprehensive care, and consideration of some prepayment. Attitude and courtesy of staff, explanation of treatment, and the educational approach of the services were favorably assessed by the patients. Those who attended the dental education sessions reported higher levels of satisfaction with the service than those who did not. Mechanisms for financing and the philosophical emphasis on health education seem to have resulted in an extremely successful service.

Age Factors↗