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Biomedical subjects

R M Goisman

Publications and source records attributed to R M Goisman.

11 recordsLinked to original sources
PubMed1995

DSM-IV and the disappearance of agoraphobia without a history of panic disorder: new data on a controversial diagnosis.

OBJECTIVE: This analysis describes subjects who met rigorous criteria for DSM-III-R agoraphobia without a history of panic disorder and makes inferences from these data regarding relationships among agoraphobia without a history of panic disorder, panic disorder, and panic disorder with agoraphobia. METHOD: Twenty-six subjects (seven men and 19 women) with agoraphobia without a history of panic disorder were identified from among 711 subjects recruited for a multicenter, longitudinal anxiety disorder study. Narrative transcripts prepared by raters from study evaluations were coded for limited symptom attacks, situational panic, catastrophic cognitions, and possible precipitants and stressors, course, and somatic and psychosocial treatments received. RESULTS: Sixty-five percent of the subjects reported experiences consistent with situational panic attacks, and 57% had definite or probable limited symptom attacks; these attacks usually preceded or appeared at the same time as avoidance behavior. Eighty-one percent had catastrophic cognitions associated with agoraphobia. Twenty-six percent reported a likely precipitating factor for symptom onset, and 30% reported a definite or probable major life stressor within 6 months before symptom onset. Cognitive-behavioral treatments were relatively infrequently used. Course was relatively unchanged across the follow-up period. CONCLUSIONS: These data support a view of agoraphobia without a history of panic disorder on a continuum with uncomplicated panic disorder and with panic disorder and agoraphobia, rather than as a separate diagnosis.

Adult↗
PubMed1994

Comparison of personality disorders in different anxiety disorder diagnoses: panic, agoraphobia, generalized anxiety, and social phobia.

Recently there has been increasing interest in the relationship of the personality and the anxiety disorders. This paper presents comorbidity findings between DSM-III-R personality pathology and several DSM-III-R anxiety disorders and makes direct comparisons between anxiety groups. This is the most extensive comparison of this kind reported thus far. This report is on the first 475 anxiety patients who were recruited from multiple sites to take part in a naturalistic study of anxiety. All had a DSM-III-R diagnosis of panic, agoraphobia, social phobia, or generalized anxiety disorder (GAD). Previous studies which found a high comorbidity between the anxiety and the personality pathology were confirmed, with a significantly higher prevalence of personality pathology occurring with social phobia and GAD. Among our patients, all of whom had anxiety disorders, the presence of comorbid major depression is associated with an increase in the levels of comorbid personality pathology--as previously described in the literature. The relationship between low social functioning and the presence of personality pathology was confirmed, however, the relationship appears to be specific to certain areas of functioning, a new finding. There is a clinically important relationship between Personality Diagnostic Questionnaire--Revised personality pathology and the anxiety disorders characterized by different prevalences of personality disorders in different anxiety disorders and specific areas of social dysfunction.

Adult↗
PubMed1992

Risk management in the practice of behavior therapy: boundaries and behavior.

Behavior therapy represents a treatment modality widely utilized by clinicians but to date insufficiently examined from the risk-management standpoint. Given that the determination of negligence is dependent on the role of the therapist as proximate cause of the adverse outcome and on the availability of an accepted standard of care from which deviations can be specified, a number of general characteristics of behavior therapy may render its practitioners potentially vulnerable to litigation. These may include its directiveness, its replicability, and its methodologic rigor. Similarly, certain specific behavioral techniques may carry some medicolegal risks, including the use of aversion methods, utilization of family members or other lay cotherapists, response cost, and exposure therapies. In addition, therapeutic boundaries in behavioral treatment may be different from those in psychoanalytic therapy, allowing for therapist practices that might otherwise be considered unusual or in themselves negligent, but the therapist may have a heavier burden of justification in such cases. The authors suggest that recognition of the possibility of adverse results, ongoing and competent informed consent, adequate documentation, willingness to consult, and careful monitoring of treatment outcome may help mitigate the medicolegal risks of these procedures.

Behavior Therapy↗
PubMed1991

AIDS education for patients with chronic mental illness.

Despite the AIDS epidemic's impact, development of prevention and risk-reduction programs has been slow, especially for patients with chronic mental illness. These patients may be at particular risk for HIV transmission and acquisition due to characteristics of their illness. Despite a paucity of such program descriptions in the literature and widespread concern that exposure of such patients to educational material related to sexuality or AIDS would be overstimulating, an effective and safe curriculum to teach risk-reduction can be designed. This paper describes such a program at the Massachusetts Mental Health Center, in Boston.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Relaxation and merging in the treatment of personality disorders.

A behavioral intervention specifically designed to merge split self-representations was found helpful as an adjunct to the psychotherapy of personality-disordered patients. The method, which is introduced only after signs of split self-representation have been identified through exploratory psychotherapy, consists of a series of steps. Patients are first taught a relaxation technique and are asked to practice at home. Once they are able to relax in the session, they are asked for visual images of first one and then another of the conflicting self-representations. After clear images have been elicited and discussed, they are encouraged to merge them. Finally, they are asked "Who's watching" or some similar question designed to elicit a statement about a unified self. Twenty-four of 27 patients meeting criteria for personality disorders in Clusters B and C of DSM-III-R responded with greater compliance, reduced resistance, and improved relationships at work and elsewhere. Comparison is made to the merging intervention commonly used in the treatment of Multiple Personality Disorder.

Adult↗
PubMed1988

Resistances to learning behavior therapy.

Resistance to learning about behavior therapy, due to role conflict, model conflict, and disparagement, remains high in the mental-health field despite growing interest in behavioral methods and mounting evidence of their efficacy. Effects of these resistances on training and factors that may mitigate their influence are discussed.

Behavior Therapy↗
PubMed1985

The psychodynamics of prescribing in behavior therapy.

The assignment of therapeutic tasks derived from learning theory to the patient by the therapist constitutes behavioral prescribing. After discussing some issues involved in comparing schools of psychotherapy and briefly examining some behavioral aspects of the psychotherapist-patient relationship, the author considers psychodynamic implications of a number of behavioral prescriptions, including homework, relaxation training, systematic desensitization, flooding, assertiveness training, sexual therapy, and self-control procedures. The author then examines possible meanings of behaviorally prescribed change itself, briefly discusses countertransference in behavior therapy, and advocates a multitheoretical perspective for psychotherapists.

Assertiveness↗
PubMed1983

Therapeutic approaches to phobia: a comparison.

The DSM-III is an atheoretical diagnostic scheme within which comparisons of differing treatment approaches for the same disorder, here phobias, is facilitated. After describing current and historically important definitions of phobia and reviewing pertinent epidemiologic data we have traced the development of psychoanalytic and behavioral treatment approaches for this disorder. For each of the two schools we have looked at the classic formulation, an important early case, and latter-day variations on the earlier descriptions of etiology and pathogenesis. Similarly we have described both the basic treatment method dictated by the early formulations and also some more modern therapy approaches springing from the recent variations. Finally, we have compared and contrasted these two approaches along a variety of theoretical and clinical variables and have offered some thoughts regarding model-building in psychiatric diagnosis and treatment.

Behavior Therapy↗
PubMedDate not supplied

Comorbidity of anxiety disorders in a multicenter anxiety study.

From 11 sites in New England and Missouri, 711 patients with > or = one of five index anxiety disorders were recruited onto a longitudinal study in which they were interviewed every 6 months regarding symptoms, course, and treatments received. Of the five disorders studied, panic disorder without agoraphobia was the disorder most often found as a sole diagnosis and generalized anxiety disorder (GAD) was least often found alone, both as lifetime diagnoses or when restricted to cases active at intake. Panic disorder with agoraphobia and agoraphobia without history of panic disorder (AWOPD) had three specific diagnoses with which they were frequently comorbid: social phobia, simple phobia, and GAD. AWOPD, social phobia, and GAD were frequently found in the presence of each other. It is possible that the experience of anxiety due to any syndromal cause may decrease the threshold for an individual to experience other anxiety symptoms or disorders. Clinicians should be aware of these patterns of comorbidity in order to formulate accurate differential diagnoses and prescribe treatments in a rational manner.

Adult↗
PubMedDate not supplied

Specificity of substance use in anxiety-disordered subjects.

The current research (1) examines empirical evidence to substantiate the relationship between substance choice and chronology of onset of anxiety and substance use disorders, and (2) provides information on the specificity of substance choice among anxiety disorders. A study group of 181 subjects in the Harvard Anxiety Research Project (HARP) who had a history of substance use disorder were the focus of this examination. Subjects whose anxiety disorder had an onset before their substance use disorder (primary anxiety) were compared with those whose substance use preceded onset of an anxiety disorder (secondary anxiety) for differences in distribution of subjects among categories of substance of abuse. Primary and secondary anxiety groups do not have different ages of onset for substance use disorder, nor was there greater likelihood for choosing alcohol for any of the anxiety disorders. However, there is a decreased risk of alcohol use in the small group of generalized anxiety subjects and an increased risk of opioid use in the small group of posttraumatic stress disorder subjects. There was no indirect support for the self-medication hypothesis. Neither age of onset data, specific substance association, nor proximal diagnosis association support a simple interaction. The strongest finding supported an "avoidance" of CNS stimulants.

Adult↗