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Results for “Desensitization, Psychologic”

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PubMed2005

The role of cognitions in OCD treatment: toward rapprochement.

The authors of the papers in this special issue have underscored the efficacy of both psychological and pharmacological treatments for OCD. Despite the potency of these interventions, complete symptom remission rarely occurs. Furthermore, problems related to treatment drop-out, the persistence of residual symptoms despite adequate therapy, patients' vulnerability to relapse and recurrence, and the lack of a clear method for managing co-morbidity or treating OCD subtypes remain incompletely addressed. This response to the authors' papers evaluates their positions and extends their papers by examining issues such as how cognitive therapy and exposure and response prevention can best be integrated, the role of medication in OCD treatment, factors that impact treatment readiness and/or resistance, and the need for effectiveness research.

Adult↗

PubMed1996

Treatment of bulimia nervosa: when CBT fails.

Controlled studies have established manual-based cognitive-behavioral therapy (CBT) is the first-line treatment of choice for bulimia nervosa. Nevertheless, its effectiveness is limited. On average, only 50% of patients cease being eating and purging. Of the remainder, some show partial improvement, whereas a small number derive no benefit at all. In treating nonresponders to CBT one option would be to use antidepressant medication. A second would be to adopt interpersonal psychotherapy (IPT), an alternative psychological therapy with empirical support. However, both options have failed to reduce binge eating following unsuccessful CBT. Treating nonresponders is hampered by the lack of treatment-specific predictor variables. Comorbid personality disorder is associated with a poorer response not only to CBT but also alternative therapies. There is no evidence that psychodynamic therapy is effective with complex cases with associated psychopathology. A third option is to use more expanded or intensive CBT. An example of the latter would be concentrated exposure within an inpatient setting. The relative merits of adhering to manual-based treatment versus allowing therapists free reign in individual case formulation are discussed.

Bulimia↗

PubMed2001

Short- and long-term effectiveness of an empirically supported treatment for agoraphobia.

This study examined the effectiveness of individual high-density exposure (2-3 weeks, all day) for panic disorder with agoraphobia (PDAG). Participants were 416 unselected patients with a primary diagnosis of PDAG who were treated by 52 therapists in 3 outpatient clinics of the Christoph-Dornier Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy and at the 1-year follow-up showed highly significant reductions in anxiety symptoms, anxious cognition, agoraphobic avoidance, general symptomatology, and depressive symptoms. Results did not differ significantly between the 3 outpatient clinics and are comparable with the average effect sizes reported by meta-analytic studies of controlled efficacy research, using selected patients and specifically trained therapists. Effectiveness was not dependent on duration of disorder, number of treatment sessions, and therapist experience. The study suggests that high-density exposure can be transported from research settings to the mental health field.

Adolescent↗

PubMed2000

Using EMDR to treat post-traumatic stress disorder in a prison setting.

This article describes the treatment of a young man who developed post-traumatic stress disorder (PTSD) following the sudden unexpected miscarriage of his unborn child. He was diagnosed with this anxiety disorder while serving a term of imprisonment. He was treated with a controversial psychological treatment for PTSD, eye movement desensitisation reprocessing (EMDR) therapy, during one, 1-hour session. After this session, his progress was monitored by a further three follow-up appointments at 1 week, 1 month and 3 months, where the self-report questionnaires were repeated and compared with pre-treatment scores. These demonstrated improvement post-treatment and at a 3-month follow-up session. The discussion arising from the treatment will concentrate on EMDR as an effective treatment for PTSD, particularly within a prison setting. Data from recent research highlight the potential risks of PTSD within a community population and the implications for midwives and nurses who treat and care for traumatized patients are discussed.

Abortion, Spontaneous↗

PubMed2006

An experimental study on fear of public speaking using a virtual environment.

This paper examines a necessary condition for successful exploitation of a virtual environment (VE) in therapeutic intervention for fear of public speaking. The condition is that clients experience a degree of anxiety in the VE that is similar to what they would have been expected to experience in a similar real world setting. We refer to this as a "presence" response. The experimental study involved 20 people who were confident public speakers and 16 who were phobic, assessed on a standard psychological scale. Half of each group spoke within a VE depicting an empty seminar room, and the other half within the same room but populated by a neutrally behaving virtual audience of five people. Three responses were measured--a questionnaire-based measure of anxiety, a measure of self-focused attention on somatic responses, and actual heart rate. On all responses, the people with phobia showed a significant increase in signs of anxiety when speaking to the virtual audience compared to the empty room, whereas the confident people did not. The result was strong in spite of the relatively low representational and behavioral fidelity of the virtual characters.

Adult↗

PubMed1997

Psychological treatment of chronic posttraumatic stress disorder in victims of sexual aggression.

The aim of this research was to test the comparative effectiveness of two therapeutic modalities in the treatment of chronic posttraumatic stress disorder in victims of sexual aggression: (a) self-exposure and cognitive restructuring and (b) progressive relaxation training. The sample consisted of 20 patients (victims of rape in adulthood or adult victims of childhood sexual abuse) selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures (pretreatment, posttreatment, and 1-, 3-, 6-, and 12-month follow-up) was used. Most treated patients improved, but the success rate was higher in all measures in the exposure and cognitive restructuring group immediately on posttreatment and at follow-up. Implications of this study for clinical practice and future research in this field are commented on.

Adolescent↗

PubMed1992

Blood phobics and nonphobics: psychological differences and affect during exposure.

This study compared psychological dimensions of blood phobics and nonphobic controls, examined affect in response to phobic and neutral stimuli, and investigated the relationship between reported feelings of faintness and blood pressure. Blood phobics (24 adults with extreme Mutilation Questionnaire scores) and 24 nonphobics completed several psychological measures and viewed one of two 60 sec surgery scenes and a 60 sec neutral scene in counterbalanced order. Subjective, psychophysiologic, and motoric measures of affect were assessed. On questionnaires, phobics reported greater anxiety sensitivity, empathic distress, fear and insecurity, and nightmares, but no difference in autonomic arousal, muscle tension, motion sickness, or other empathy domains. During surgery scenes, phobics had more negative affect than controls; however, phobics were more anxious during only one of the two surgeries, and often only when the surgery was presented prior to the neutral scene. Fainting did not occur, and self-reported feelings of faintness were unrelated to blood pressure changes. The findings highlight the lack of information on blood phobic stimulus properties, fainting's relationship to self-reports and blood pressure, and the specific emotion experienced in blood phobia.

Adolescent↗

PubMed1983

Behaviour therapy in phobic and obsessional disorders.

Behaviour therapy consisting of specific exposure in vivo is reviewed in terms of its clinical usefulness for the treatment of agoraphobia, obsessive compulsive neurosis and related conditions. A combined behavioural and psychological formulation of individual target problems is advocated. These can be rated in terms of discomfort, disability, and physiological indices of anxiety. Although discomfort and disability have been found to correlate, their relationship with anxiety measures is questioned. Variables affecting the outcome of exposure are reviewed, including: duration--best results with prolonged, frequent sessions over a short period; arousal--experience of high anxiety not essential; adjunctive cognitive therapy--considered to add nothing to effectiveness during exposure treatment. The author goes on to argue that simple response prevention is effective in reducing ritualising activities in obsessive compulsive neurosis, without effecting concomitant anxiety. Whereas anxiety responds independently to exposure therapy, and hence that the anxiety reduction model of obsessive compulsive neurosis is inadequate. The putative anti-obsessional properties of clomipramine are questioned, and the utility of imipramine in agoraphobia is disputed.

Agoraphobia↗

PubMed2002

Virtual reality treatment of flying phobia.

Flying phobia (FP) might become a very incapacitating and disturbing problem in a person's social, working, and private areas. Psychological interventions based on exposure therapy have proved to be effective, but given the particular nature of this disorder they bear important limitations. Exposure therapy for FP might be excessively costly in terms of time, money, and efforts. Virtual reality (VR) overcomes these difficulties as different significant environments might be created, where the patient can interact with what he or she fears while in a totally safe and protected environment-the therapist's consulting room. This paper intends, on one hand, to show the different scenarios designed by our team for the VR treatment of FP, and on the other, to present the first results supporting the effectiveness of this new tool for the treatment of FP in a multiple baseline study.

Adult↗

PubMed1976

Exposure in vivo of agoraphobics: contributions of diazepam, group exposure, and anxiety evocation.

Fifty-seven chronic agoraphobic outpatients were treated by 12 hours of exposure in vivo on four days over two weeks to check the effects of oral diazepam versus placebo during group exposure, group versus individual exposure, and high versus medium anxiety arousal during individual exposure. The controlled parallel design allowed comparative evaluation of each treatment condition to six months follow-up. Assessment was blind with respect to drug and psychological treatment. Patients in all treatment conditions improved significantly in phobias and in related life areas. Outcome to group exposure on phobias and other measures was similar in all three drug conditions (placebo, waning diazepam, peak diazepam) with no significant differences between them. Diazepam patients had significantly less discomfort than placebo patients during group exposure treatment. Group exposure patients improved slightly but significantly more than individual exposure patients on non-phobic measures, though group exposure was accompanied by more panics during treatment yet was easier to run by the therapist. Individual exposure under high anxiety arousal was no more therapeutic than with lower anxiety. Diazepam is a mild palliative during group exposure but does not facilitate outcome to treatment. Group exposure in vivo is mildly facilitatory for outcome compared with individual exposure. Anxiety evocation during treatment was not therapeutically helpful.

Administration, Oral↗

PubMed1977

Cognitive processes mediating behavioral change.

The present experiment was designed to test the theory that psychological procedures achieve changes in behavior by altering the level and strength of self-efficacy. In this formulation, perceived self-efficacy. In this formulation, perceived self-efficacy influences level of performance by enhancing intensity and persistence of effort. Adult phobics were administered treatments based upon either performance mastery experiences, vicarious experiences., or they received no treatment. Their efficacy expectations and approach behavior toward threats differing on a similarity dimension were measured before and after treatment. In accord with our prediction, the mastery-based treatment produced higher, stronger, and more generalized expectations of personal efficacy than did the treatment relying solely upon vicarious experiences. Results of a microanalysis further confirm the hypothesized relationship between self-efficacy and behavioral change. Self-efficacy was a uniformly accurate predictor of performance on tasks of varying difficulty with different threats regardless of whether the changes in self-efficacy were produced through enactive mastery or by vicarious experience alone.

Adolescent↗

PubMedDate not supplied

Recommendations and illustrations for combining hypnosis and EMDR in the treatment of psychological trauma.

Three experienced therapists, trained in hypnosis and EMDR, distilled some tentative hypotheses about the use of hypnosis in EMDR from fifteen cases, two presented here. When a therapist uses hypnosis with EMDR, it seems that the client is having difficulty or the therapist anticipates that the client will have difficulty managing the experiences processed with EMDR. Hypnosis initiated either during the introduction to EMDR or within a therapy session prior to the initiation of EMDR seems to have served two functions. The first function is to activate inner work that prepares the client to use EMDR successfully, and the second function is to facilitate overtly the processing of the traumatic experience. Clients might have two kinds of difficulties in managing affect or distress: (1) they may have a long-standing, irrational and strongly held belief that interferes with managing affect or distress, and (2) they may never have developed the capacity to tolerate intense affect, distress or pain. Should a therapist use hypnosis during the closing down phase of a session without preparing the client with hypnosis during the introduction to EMDR, the therapist should seriously reconsider the pace and focus of EMDR and the client's resources to manage affect and distress.

Adolescent↗

PubMed1995

A comparison of two psychological treatments for bulimia nervosa: implications for models of maintenance.

In an effort to elucidate the role of cognitive factors in the maintenance of bulimia nervosa, the efficacy of two psychological treatments was examined in a randomised control trial: cognitive behaviour therapy in the absence of explicit exposure instructions was compared with exposure and response prevention treatment in the absence of cognitive restructuring procedures. In the short term both treatments were successful at effecting substantial improvement in both the specific and the non-specific psychopathology of the disorder. However, at a one year follow up, whilst improvements were well maintained for those who had received the cognitive-behavioural treatment, virtually all of those who had responded to the purely behavioural treatment had relapsed. This provides some support for the cognitive model of the maintenance of bulimia nervosa. Nevertheless, the two treatment groups could not be distinguished on post-treatment measures of cognitive disturbance and neither was it the case that residual levels of cognitive disturbance, as assessed, predicted relapse. This may suggest that the level at which the necessary cognitive change takes place may not be accessible by conventional assessment procedures.

Adolescent↗

PubMed1994

Alprazolam and exposure for panic disorder with agoraphobia. Attribution of improvement to medication predicts subsequent relapse.

Patients with panic disorder plus agoraphobia had 8 weeks of drug treatment (alprazolam or placebo) plus psychological treatment (exposure or relaxation). At the end of treatment at week 8, 40 patients who had become much/very much improved rated how much their gains were attributable to medication or to their own efforts. During the tapering-off to week 16, and treatment-free follow-up to week 43, patients who at week 8 had attributed their gains to medication and felt less confident in coping without tablets had more severe withdrawal symptoms and greater loss of gains than did patients who at week 8 had attributed their gains to their own efforts during treatment. Baseline illness severity, greater age, higher expectations from drug treatment, and more side-effects of drugs during treatment all predicted more external attributions (i.e. to the effect of drugs) but did not independently predict relapse. Patients on alprazolam compared with placebo had more drug attributions. Though drug attributions predicted relapse in both alprazolam and placebo groups, predictions were stronger in the alprazolam group.

Adult↗

PubMed2003

A comparison of delivery methods of cognitive-behavioral therapy for panic disorder: an international multicenter trial.

Cognitive-behavioral therapy (CBT) is the psychological treatment of choice for panic disorder (PD). However, given limited access to CBT, it must be delivered with maximal cost-effectiveness. Previous researchers have found that a brief computer-augmented CBT was as effective as extended therapist-delivered CBT. To test this finding, this study randomly allocated 186 patients with PD across 2 sites in Scotland and Australia to 12 sessions of therapist-delivered CBT (CBT12), 6 sessions of therapist-delivered (CBT6) or computer-augmented CBT (CBT6-CA), or a waitlist control. On a composite measure, at posttreatment, the outcome for CBT 12 was statistically better than the outcome for CBT6. The outcome for CBT6-CA fell between CBT12 and CBT6, but could not be statistically distinguished from either treatment. The active treatments did not differ statistically at 6-month follow-up. The study provided some support for the use of computers as an innovative adjunctive-therapy tool and merits further investigation.

Adult↗

PubMed1993

Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto.

A cross-national randomised trial of alprazolam for chronic panic disorder with agoraphobia was run. Compared with previous trials it had three new features: an exposure therapy contrast group, a six-month treatment-free follow-up, and a low rate of early placebo drop-outs ('non-evaluables'). The dose of alprazolam was high (5 mg/day). The 154 patients had eight weeks of: alprazolam and exposure (combined treatment); or alprazolam and relaxation (a psychological placebo); or placebo and exposure; or placebo and relaxation (double placebo). Drug taper was from weeks 8 to 16. Follow-up was to week 43. Results were similar at both sites. Treatment integrity was good. All four treatment groups, including double placebo, improved well on panic throughout. On non-panic measures, by the end of treatment, both alprazolam and exposure were effective, but exposure had twice the effect size of alprazolam. During taper and follow-up, gains after alprazolam were lost, while gains after exposure were maintained. Combining alprazolam with exposure marginally enhanced gains during treatment, but impaired improvement thereafter. The new features put previous trails in a fresh light. By the end of treatment, though gains on alprazolam were largely as in previous studies, on phobias and disability they were half those with exposure. Relapse was usual after alprazolam was stopped, whereas gains persisted to six-month follow-up after exposure ceased. Panic improved as much with placebo as with alprazolam or exposure.

Adolescent↗

PubMed1994

A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder.

Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (mean 233 mg/day), or a 3-month wait followed by allocation to treatment. During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months. Imipramine was gradually withdrawn after 6 months. Each treatment included self-exposure homework assignments. Cognitive therapy and applied relaxation sessions lasted one hour. Imipramine sessions lasted 25 minutes. Assessments were before treatment/wait and at 3, 6, and 15 months. Comparisons with waiting-list showed all three treatments were effective. Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures. At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures. Between 6 and 15 months a number of imipramine patients relapsed. At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months. Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up.

Adolescent↗

PubMed1997

Overcoming resistance to exposure in panic disorder with agoraphobia.

The issue of panic disorder resistant to treatment (whether pharmacological or psychological) has attracted little research attention, despite its clinical frequency and importance. The aim of this study was to compare three treatment modalities, namely exposure alone (E), exposure associated with imipramine (EI) and cognitive therapy supplementing exposure (EC), in a sample of 21 patients with DSM-IV panic disorder and agoraphobia, who failed to respond to a first standard course of individual behavioural treatment based on exposure in vivo. Treatments were administered according to a cross-over, controlled design (E-EI-EC, EI-EC-E, EC-E-EI). Twelve of the 21 patients achieved remission (panic-free status) during the trial. In 8 cases this occurred after exposure alone (E) and in two cases each after the other treatments (EI and EC). The results revealed a significant effect of the factor time on a number of variables, and the superiority of exposure alone compared to other treatment modalities with regard to some variables. These findings suggest that long-term behavioural treatment based on exposure may be necessary in some patients, and may induce clinical remission. However, patients who do not respond to exposure show poor tolerance of and compliance with pharmacological treatment, and are unlikely to achieve remission with imipramine or cognitive therapy, even though this may occur in individual cases.

Adult↗