The 'efficacy' of alprazolam in panic disorder and agoraphobia: a critique of recent reports.
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Biomedical subjects
Publications and source records attributed to I Hand.
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Experimental results from a sample of 216 patients with four different "symptom-neuroses" show that 65% to 90% of these patients have different combinations of multiple symptomatology. With a background of these data, we present an Operationalized Multisymptomatic Model of Neuroses (OMMON), based on self-rating assessment of these patients on 4 symptom scales. Individual ratings on each scale are dichotomized into (+) or (-) results with regard to defined cut-off points and the model is derived from their 16 mathematically possible combinations. Subsequent analysis of these data (from a single test application) with our Varying Cut-Off Point Assessment (VACOPA) leads to hypotheses regarding causal symptom interactions and prediction of symptom changes over time, easily evaluated by repeated test application. In treatment research the model seems suitable to: (a) build more homogeneous diagnostic groups; (b) operationalize varying degrees of "neurotic" disturbance, from "normal" via "client" to "patient"--independently of existing illness theories; (c) support prognoses of individual developments within and without treatment; (d) specify treatment aims and optimal sequences of interventions; (e) monitor predicted outcome; (f) reconsider earlier apparently contradictory outcome studies; (g) evaluate theoretical concepts regarding "neurotic" symptom formations in neuroses, psychoses, and psychosomatic disturbances. For treatment purposes, OMMON should only be used together with "clinical" hypotheses; its prognostic potential can be increased by additional application of our Operationalized Multivariate Model of Motivation (OMMOM). All three diagnostic approaches may be used for mutual evaluation.
Obsessive-compulsive phenomena occur in 'normal,' neurotic and psychotic individuals. Operational definition, quantitative assessment, and diagnostic evaluation are still unsatisfactory, particularly with regard to differentiation of obsessive-compulsive phenomena (phenomenology), differentiation of trait and symptom factors, and evaluation of different obsessive-compulsive factors in the various kinds of neuroses. Our investigation of phenomenology differs from previous similar ones in basically two aspects: The newly developed obsessive-compulsive checklist covers the whole range of obsessions and compulsions, and questionnaire items of the checklist are operationally difined without reference to constructs from theories of personality or from psychopathology. Results include: Two-thirds of all patients suffer from combined obsessions and compulsions; factorial analysis reveals five symptom factors which are quite different from factor analytic results of previous studies; depression and phobias constitute a factor by themselves; checklist ratings and factor analytic results show the necessity for and basis of a new self-rating questionnaire to substitute for those currently in use. Implications of these results for future research in psychopathology as well as treatment evaluation are discussed.
Twenty-four volunteer college students, who were regular drug users, were randomly allocated to three training groups of equal size: alpha feedback, EMG feedback and a joked control group. Subjects, who were unaware of which feedback condition they received, were asked to practice at home during a six month follow-up period to achieve a relaxed state similar to that experienced during training. No group was successful in retaining gains made in their alpha levels during each session. The EMG group, however, significantly reduced their muscular activity during training and retained the improvement during follow-up. The alpha and joked groups did not significantly improve their EMG during training but at follow-up achieved the same levels as the EMG group. There was evidence to suggest a reduction in drug use among light and medium users that was maintained during follow-up. Significant and lasting improvements were made by each group in the duration and quality of their sleep. Anxiety levels were also reduced.
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Twenty-four volunteer college students who were regular drug users were randomly allocated to three training groups of equal size: alpha feedback, EMG feedback and a joked control group. The subjects were unaware of which feedback condition they received and were asked to practise at home during a six-month follow-up period in order to achieve a relaxed state similar to that experienced during training. No group was successful in retaining gains made in their alpha levels during each session, but the EMG group significantly reduced their muscular activity during training and retained the improvement during follow-up. The alpha and joked groups did not greatly improve their EMG during training but at follow-up achieved the same levels as the EMG group. There was evidence to suggest that a reduction in drug use among light and medium users was maintained during follow-up. Significant and lasting improvements were made by each group in the duration and quality of their sleep and anxiety levels were reduced.
Short term psychotherapy is increasingly recognized as a socioeconomic necessity. Problem-oriented treatments, particularly if applied in problem-homogenous groups, are one means of economizing and sometimes even improving psychotherapy. They also require a re-evaluation of the nature of the patient-therapist dyad. The "task-oriented small group" as a basic field of human interaction has been studied intensively in experimental social psychology. Nevertheless, group psychotherapy and behavior therapy have largely neglected group-specific aspects of such variables as cohesion, task-orientation, modelling, mutual self-help, risk-taking, motivation and insight. This paper outlines some recent changes in this respect, and discusses in particular the "symptomoriented peer workshop" as a treatment milieu. The general therapeutic potential of the peer workshop is briefly assessed with regard to the application of the above mentioned group variables in peer self-help groups, rehabilitation programs for the chronically hospitalized, symptom or depth-treatment in short-term psychotherapy, and in re-education programs for problem-children. The main concern is with its specific application to the treatment of phobias. Phobias are comparatively easy to define, yet are often connected with other personality problems. This has made them a model-problem in the arguments about symptom-substitution between "psycho"- and "behavior" -therapists, and it has stimulated discussion as to how behavior-focused treatments affect cognition and emotion, and to what extend depth and insight-oriented therapies change behavior. The interaction between treated and non-treated problems, and the behavioral, cognitive and emotional effects of differential treatment ingredients are discussed with special reference to the first controlled study in behavior therapy, that applied behavior-focussed confrontation with reality (flooding in vivo) under the sociodynamics of the small gsoup. Problem-focussed retraining under real-life conditions (reality testing) as group-therapeutic fieldwork can be a means of treatment in its own right may open up the patient for subsequent attempts to tackle more complex problems, or may just be an adjuvant in a multi-level approach. This certainly applies for phobias and can probably be generalized to other problems.
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