Biomedical subjects

Robert L Woolfolk

Publications and source records attributed to Robert L Woolfolk.

6 recordsLinked to original sources

PubMed2006

Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial.

BACKGROUND: Patients diagnosed as having somatization disorder (SD) who present with a lifetime history of multiple, medically unexplained physical symptoms represent a significant challenge to health care providers. To date, no psychotherapeutic or pharmacologic intervention has been found to produce clinically meaningful improvement in symptoms or functioning of patients with SD. We examined the efficacy of cognitive-behavioral therapy (CBT) for SD. METHODS: Eighty-four participants meeting criteria for SD were randomly assigned to 1 of 2 conditions: (1) standard medical care augmented by a psychiatric consultation intervention or (2) a 10-session, manualized, individually administered CBT regimen added to the psychiatric consultation intervention. Assessments were conducted at baseline and 3, 9, and 15 months after baseline. The primary outcome measure was the severity scale of the Clinical Global Impression Scale for Somatization Disorder (CGI-SD). Secondary outcome measures were responder status as determined by clinical ratings, self-reported measures of physical functioning and somatic symptoms, and health care utilization assessed via medical records. RESULTS: Fifteen months after baseline, somatization symptoms were significantly less severe in the group treated with CBT (0.84 points on the CGI-SD 7-point scale) (P<.001). Patients treated with CBT also were significantly more likely to be rated as either very much improved or much improved than patients treated with only augmented standard medical care (40% [n = 17] vs 5% [n = 2]). Cognitive-behavioral therapy was associated with greater improvements in self-reported functioning and somatic symptoms and a greater decrease in health care costs. CONCLUSION: For patients diagnosed as having SD, CBT may produce clinical benefits beyond those that result from the current state-of-the-art treatment.

Adolescent↗

PubMed2006

Cognitive behavior therapy for menopausal hot flashes: two case reports.

Two case reports of women treated with an individual cognitive behavioral treatment (CBT) for menopausal hot flashes are presented. Both women reported substantial improvements in the number of hot flashes experienced as well as in their quality of life as measured by the Menopause Quality of Life Scale (MENQOL), the Hamilton Rating Scale for Depression (HAM-D), and the Hamilton Rating Scale for Anxiety (HAM-A). Improvements in hot flashes and quality of life were maintained 6 months after treatment ended. It is hypothesized that CBT reduces hot flashes by reducing central sympathetic activation, perceptions of stress, and self-critical thoughts. The long-term efficacy of CBT for hot flashes should be examined in large controlled clinical trials.

Cognitive Behavioral Therapy↗

PubMed2005

Identification, situational constraint, and social cognition: studies in the attribution of moral responsibility.

In three experiments we studied lay observers' attributions of responsibility for an antisocial act (homicide). We systematically varied both the degree to which the action was coerced by external circumstances and the degree to which the actor endorsed and accepted ownership of the act, a psychological state that philosophers have termed "identification." Our findings with respect to identification were highly consistent. The more an actor was identified with an action, the more likely observers were to assign responsibility to the actor, even when the action was performed under constraints so powerful that no other behavioral option was available. Our findings indicate that social cognition involving assignment of responsibility for an action is a more complex process than previous research has indicated. It would appear that laypersons' judgments of moral responsibility may, in some circumstances, accord with philosophical views in which freedom and determinism are regarded to be compatible.

Adult↗

PubMed2002

Social cognitive complexity and depression: cognitive complexity moderates the correlation between depression self-ratings and global self-evaluation.

The authors studied the psychometric characteristics of a standardized data-collection method for assessing the complexity of an individual's cognitions about self and other people (social cognitive complexity). A total of 437 college undergraduates were assessed using this method and concurrently assessed for depression, self-deception, impression management, self-esteem, and positive/negative affectivity. It was found that a measure of overall social cognitive complexity was internally consistent and demonstrated concurrent and discriminant validity. In particular, a composite measure of the complexity of both positive and negative cognitions of self and other was associated with greater self-reported depression, after controlling for the other variables studied (, impression management). It was also found that social cognitive complexity moderated the degree of global self-evaluation in self-reported depression, such that global self-evaluation accounted for a considerably higher amount of the variance of depression in low-complex individuals than it did in high-complex individuals.

Cognition↗

PubMed2002

Rationing mental health care: parity, disparity, and justice.

Recent policy debates in the US over access to mental health care have raised several philosophically complex ethical and conceptual issues. The defeat of mental health parity legislation in the US Congress has brought new urgency and relevance to theoretical and empirical investigations into the nature of mental illness and its relation to other forms of sickness and disability. Manifold, nebulous, and often competing conceptions of mental illness make the creation of coherent public policy exceedingly difficult. Referencing a variety of approaches to ethical reflection on health care, and drawing from the empirical literature on therapeutic efficacy and economic efficiency, we argue that differential rationing, 'disparity,' is unjustifiable.

Ethical Analysis↗

PubMedDate not supplied

Psychosocial treatments for multiple unexplained physical symptoms: a review of the literature.

OBJECTIVE: Patients presenting with multiple medically unexplained physical symptoms, termed polysymptomatic somatizers, often incur excessive healthcare charges and fail to respond to standard medical treatment. The present article reviews the literature assessing the efficacy of psychosocial treatments for polysymptomatic somatizers. METHODS: Relevant articles were identified by scanning Medline and PsychLit. Thirty-four randomized, controlled studies were located. Whenever possible results from each study were transformed into effect sizes. An analysis of the efficacy of the psychotherapeutic approaches is provided. RESULTS: Various psychosocial interventions have been investigated with polysymptomatic somatizers. Although the majority of studies suggest psychosocial treatments benefit this population, the literature is tarnished by methodological shortcomings. Effect sizes are modest at best. Long-term improvement has been demonstrated in fewer than one-quarter of the trials. CONCLUSIONS: Although seemingly beneficial, psychosocial treatments have not yet been shown to have a lasting and clinically meaningful influence on the physical complaints of polysymptomatic somatizers.

Humans↗