PubMed Health⌕ Search

Biomedical subjects

Isaac Marks

Publications and source records attributed to Isaac Marks.

8 recordsLinked to original sources
PubMed2006

Self-exposure treatment of recurrent nightmares: waiting-list-controlled trial and 4-year follow-up.

BACKGROUND: In open and randomized controlled trials self-exposure therapy reduced the frequency of nightmares but follow-up ceased at 7 months post-entry. METHOD: Ten adults who attended an outpatient clinic and had DSM-IV nightmare disorder were put on a 3-month waiting-list. After 3 months they were given a self-exposure manual and were asked to follow its instructions for 4 weeks and were then followed up for 4 years. They were rated at 0, 3, 4, 5, 7, 10, 16, 28 and 52 months. At month 0 only, a matched control group of 10 subjects from the same clinic who had no axis I or II disorder was also rated. RESULTS: At month 0, the nightmare sufferers had more nightmares, anxiety, depression, hostility and somatic symptoms than the matched control group. All 10 nightmare sufferers completed the 3-month waiting-list, 4-week self-exposure therapy and 4-year follow-up without any dropouts. The recurrent nightmares and most associated symptoms did not improve while on the waiting-list but improved markedly after self-exposure therapy and remained improved over the 4-year follow-up. CONCLUSIONS: Adults' recurrent nightmares and associated symptoms failed to improve over a 3-month waiting-list period but reduced greatly after subsequent self-exposure therapy with minimal therapist contact over 1 month, and these gains continued over the next 4 years.

Adult↗
PubMed2005

Brief scheduled phone support from a clinician to enhance computer-aided self-help for obsessive-compulsive disorder: randomized controlled trial.

Treatment-resistant obsessive-compulsive disorder (OCD) patients from around the United Kingdom who employed computer-guided self-help by using BTSteps over 17 weeks were randomized to have brief live phone support from a clinician either (1) in nine Scheduled clinician-initiated calls or (2) only in calls Requested by the patient (n=22 per condition). Call content and mean duration were similar across conditions. Scheduled-support patients dropped out significantly less often, did more homework of self-exposure and self-imposed ritual prevention (95% vs. 57%), and showed more improvement in OCD symptoms and disability. Mean total support time per patient over 17 weeks was 76 minutes for Scheduled and 16 minutes for Requested patients. Giving brief support proactively by phone enhanced OCD patients' completion of and improvement with computer-aided self-help.

Humans↗
PubMed2004

Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions.

This article describes a broad-spectrum, computer-aided self-help clinic that raised the throughput of anxious/depressed patients per clinician and lowered per-patient time with a clinician without impairing effectiveness. Many sufferers improved by using one of four computer-aided systems of cognitive behavior therapy (CBT) self-help for phobia/panic, depression, obsessive-compulsive disorder, and general anxiety. The systems are accessible at home, two by phone and two by the Web. Initial brief screening by a clinician can be done by phone, and if patients get stuck they can obtain brief live advice from a therapist on a phone helpline. Such clinician-extender systems offer hope for enhancing the convenience and confidentiality of guided self-help, reducing the per-patient cost of CBT, and lessening stigma. The case examples illustrate the clinical process and outcomes of the computer-aided system.

Adult↗
PubMed2004

Computer-aided self-help for phobia/panic via internet at home: a pilot study.

In an open study, ten people with phobia or panic disorder who could not travel repeatedly to a therapist accessed a computer-aided exposure self-help system (FearFighter) at home on the internet with brief therapist support by telephone. They improved significantly, and their outcome and satisfaction resembled those in patients with similar disorders who used FearFighter in clinics with brief face-to-face therapist support.

Adult↗
PubMed2004

Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial.

BACKGROUND: Preliminary results have demonstrated the clinical efficacy of computerised cognitive-behavioural therapy (CBT) in the treatment of anxiety and depression in primary care. AIMS: To determine, in an expanded sample, the dependence of the efficacy of this therapy upon clinical and demographic variables. METHOD: A sample of 274 patients with anxiety and/or depression were randomly allocated to receive, with or without medication, computerised CBT or treatment as usual, with follow-up assessment at 6 months. RESULTS: The computerised therapy improved depression, negative attributional style, work and social adjustment, without interaction with drug treatment, duration of preexisting illness or severity of existing illness. For anxiety and positive attributional style, treatment interacted with severity such that computerised therapy did better than usual treatment for more disturbed patients. Computerised therapy also led to greater satisfaction with treatment. CONCLUSIONS: Computer-delivered CBT is a widely applicable treatment for anxiety and/or depression in general practice.

Adult↗
PubMed2004

Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial.

BACKGROUND: Cognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative. AIMS: To assess the cost-effectiveness of computer-delivered CBT. METHOD: A sample of people with depression or anxiety were randomised to usual care (n=128) or computer-delivered CBT (n=146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach. RESULTS: Service costs were 40 British pounds (90% CI - 28 British pounds to 148 British pounds) higher over 8 months for computer-delivered CBT. Lost-employment costs were 407 British pounds (90% CI 196 British pounds to 586 British pounds) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at 40 British pounds, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year. CONCLUSIONS: Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.

Adult↗
PubMedDate not supplied

Routine monitoring of outcome over 11 years in a residential behavioural psychotherapy unit.

BACKGROUND: Though research trials have to rate clinical outcome, few units monitor outcome of their routine care over many years. We report such monitoring to evaluate therapy over time and under changing operating and economic conditions. METHOD: Clinical outcome data were collected routinely over 11 years in a behavioural psychotherapy unit whose residential patients mostly had severe, chronic obsessive-compulsive disorder (OCD) treated by self-exposure therapy. Data were from 218 referrals during 4 of the 11 available years. RESULTS: In each of the 4 time periods, the patients improved consistently and highly significantly by 30-50% on symptoms and disability, which resembled outcome in a multi-centre controlled trial. There were almost no significant differences in pre-treatment ratings between patients who attended follow-up, patients who completed residential treatment but not follow-up and those who did not complete residential treatment. When the unit became a hostel and the UK government introduced an internal market, more chronic patients were admitted who often lived far away. CONCLUSIONS: The fact that successive OCD cohorts had improved comparably by discharge suggests there was no 'burn-out' in staff standards of care over 11 years, and no loss of gains when the unit became a more cost-effective hostel.

Behavior Therapy↗