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Results for “Desensitization, Psychologic”

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At least 451 records · Page 25Linked to original sources

PubMed1992

Medication use and the assessment of agoraphobic avoidance.

Many anxiety disorder patients who present for behaviour therapy are already taking anxiolytic medications. The present study added a new subscale to the Mobility Inventory labelled 'Without Medication' to assess possible reliance on medication for coping with phobic situations. 121 Patients with panic-related disorders were administered the scale. The results supported the reliability and validity of the existing Mobility Inventory subscales in general and of the new subscale in particular. It appears to reliably assess a clinically important domain that is not measured in traditional self-report measures of phobic avoidance.

Adult↗

PubMed1992

Fearful distortions.

Clinical observations suggesting that perceptual distortions can take place during episodes of fear are described, and two hypotheses are set out: (1) perceptual distortions occur during episodes of fear, and (2) such distortions decline after reduction of the pertinent fear. An experiment in which fearful subjects were asked to report their perceptions of a feared object during episodes of fear, and then again after fear-reduction, was carried out. Snake-phobic and spider-phobic subjects showed evidence of some distortions in the activity of the pertinent fear object, but no distortions of size. After the reduction of the relevant fear, the subjects reported significant declines in the activity of the pertinent animal. The two hypotheses received partial support.

Adult↗

PubMed1992

Self-monitoring of panic attacks and retrospective estimates of panic: discordant findings.

An event sampling method was used to study the frequency of panic attacks during treatment of agoraphobics. Results revealed a much lower incidence of panic attacks in agoraphobics according to self-monitoring than was expected on account of their retrospective estimation. When more stringent criteria for panic attacks are applied, retrospective overestimation becomes even more apparent. The implication of this finding for the classification of panic disorder patients is discussed.

Agoraphobia↗

PubMed1993

A comparison of in vivo and vicarious exposure in the treatment of childhood water phobia.

The effectiveness of in vivo exposure and vicarious exposure in reducing children's phobic anxiety and avoidance of water was investigated. Forty-eight water phobic children between the ages of 3 and 8 yr were randomly assigned to one of four groups: (1) in vivo exposure plus vicarious exposure (IVVE); (2) vicarious exposure (VE); (3) in vivo exposure (IVE); and (4) assessment only control. All subjects in the treatment groups received three individually administered treatment sessions. At the conclusion of treatment it was found that the IVE condition had produced statistically and clinically significant gains that had generalized to another situation involving water, and were largely maintained over a period of 3 months. In contrast, the VE condition did not lead to statistically greater treatment benefits than those observed in the control subjects. Furthermore, there was no significant difference between the IVVE condition and the IVE condition in their level of improvement from pre- to post-treatment. Hence, by post-treatment, vicarious exposure had not only failed to produce benefits when used on its own, but had also failed to enhance the benefits achieved through in vivo exposure. However, a tendency for the vicarious component to enhance the maintenance of treatment benefits was found at follow-up. The implications of these findings are discussed.

Child↗

PubMed1993

Cognitive and behavioural treatments of fear of blushing, sweating or trembling.

Social phobic patients (n = 30) with fear of blushing, sweating or trembling as the predominant complaint were randomly assigned to three treatment conditions: (1) exposure in vivo followed by cognitive therapy, (2) cognitive therapy followed by exposure in vivo, or (3) a cognitive-behavioural treatment in which both strategies were integrated from the start. Each treatment condition consisted of 16 sessions, given in two treatment blocks of 4 weeks each, separated by a no-treatment phase of 4 weeks. Self-report assessments were held before and after the treatment blocks and at 3-months follow-up. No significant differences were found between effects of the first treatment block vs those of the 4-weeks waiting-list period. After the second block treatment was significantly more effective than waiting-list. The analyses showed significant time effects after both treatment blocks and at follow-up, indicating improvement for the group as a whole. After two treatment blocks and at follow-up no significant differences among the different treatment packages were found on target problems, avoidance of social situations, cognitions and somatic complaints. After discussion of the results recommendations for further research will be given.

Adult↗

PubMed1993

Applied relaxation, exposure in vivo and cognitive methods in the treatment of panic disorder with agoraphobia.

Forty-five psychiatric outpatients with DSM-III-R diagnosis of panic disorder with agoraphobia were assessed with a battery of self-report, behavioral and cognitive measures before and after therapy, and at a 1 yr follow-up. They were randomly assigned to either Applied Relaxation (AR; n = 15), Exposure in vivo (E; n = 15) or Cognitive Treatment (CT; n = 15) and received 12 individual therapy sessions, once weekly. All patients also had self-exposure instructions. The three treatments yielded significant improvements that were maintained at follow-up. One criterion of clinically significant improvement was fulfilled by 87% of the AR-, 80% of the E- and 60% of the CT-patients at the end of treatment, and 85, 79 and 67%, respectively, at follow-up. Between-group differences were observed on two measures only, both showing better results for AR than for CT. The conclusion that can be drawn is that the three treatments, focussed on different anxiety components, are about equally effective, and the results are maintained 1 yr after the end of treatment.

Adult↗

PubMed1993

Exposure with and without cognitive therapy for generalized social phobia: effects of individual and group treatment.

Patients with generalized social phobia (n = 73) were randomly allocated to two treatment modalities: (1) group or (2) individual treatment, and to three treatment packages: (1) two blocks of exposure in vivo (2) a block cognitive therapy followed by a block exposure in vivo, or (3) two blocks cognitive-behavioural treatment in which both strategies were integrated from the start. All treatments consisted of 16 sessions, given in two treatment blocks of 4 weeks each, separated by a no-treatment phase of 4 weeks. Self-report assessments were held before and after the treatment blocks and at 3-months follow-up. Significant differences were found between effects of the first treatment block vs those of the 4-weeks waiting-list period. Repeated measures MANOVA's demonstrated significant time effects after both treatment blocks and at follow-up, indicating improvement for the group as a whole. After the first treatment block the integrated treatment did significantly worse than either exposure in vivo or cognitive therapy in decreasing somatic complaints. On the other variables no differences among the treatments were found. At follow-up a significant interaction was found between treatment package and modality on the variable cognitions: largest progress was found in the group treatment with cognitive therapy followed by exposure in vivo; smallest progress was found in the integrated group treatment. Results are discussed and recommendations for further research are given.

Adolescent↗

PubMed1993

Exposure with response prevention and serotonergic antidepressants in the treatment of obsessive compulsive disorder: a review and implications for interdisciplinary treatment.

A comprehensive review of controlled investigations examining the effectiveness of exposure with response prevention (ERP) and clomipramine (CMI), as well as other serotonergic anti-depressants, in the treatment of Obsessive Compulsive Disorder (OCD) was conducted. Overall, findings suggested that ERP is more effective than CMI, particularly in alleviating rituals, but CMI may be more effective in reducing obsessive compulsive behavior among individuals with concomitant severe depression, obsessions only, and overvalued ideation. In addition, the literature favors ERP in terms of side-effects and risks, dropout, and maintenance, while one advantage of drug therapy is that less time and effort are required by the therapist and patient. Directions for interdisciplinary treatment are discussed.

Antidepressive Agents↗

PubMed1995

The treatment of social phobia: the differential effectiveness of exposure in vivo and an integration of exposure in vivo, rational emotive therapy and social skills training.

Thirty-four social phobic patients were treated with either exposure in vivo or an integrated treatment, consisting of rational emotive therapy, social skills training and exposure in vivo. Comparison with a waiting-list control group showed the effectiveness of both treatments. Contrary to expectations, the integrated approach was not superior over exposure in vivo alone. Also, the long-term effectiveness of both treatments was equally good.

Adult↗

PubMed1995

Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder.

The present study is the first controlled study that evaluates the effects of cognitive therapy along the lines of Beck (1976) [Cognitive therapy and the emotional disorder. New York: International University Press] and Salkovskis (1985) [Behaviour Research and Therapy, 23, 571-583] in obsessive compulsive disorder (OCD) and compares these effects with those of self-controlled exposure in vivo with response prevention. Seventy-one patients were randomly assigned to either cognitive therapy or exposure in vivo. In each treatment condition seven patients dropped out. Both treatments consisted of 16 sessions. Cognitive therapy as well as exposure in vivo led to statistically significant improvement. Multivariate significant differences suggesting a superior efficacy of cognitive therapy in comparison to exposure in vivo on the obsessive compulsive measures and on the measures for associated psychopathology. However, no univariate differences were found. Further, in both treatment conditions a considerable percentage of the patients was rated as "recovered". Significantly more patients were rated as "recovered" in the cognitive therapy. The results show that this form of cognitive therapy is an effective treatment for OCD and suggest that cognitive therapy may be even more effective than exposure in vivo.

Adult↗

PubMed1995

Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia.

The purpose of this study was to determine the efficacy of a structured exposure-based behavior therapy program delivered by telephone to agoraphobic individuals who were isolated from specialized treatment centres. Forty-two individuals with a DSM-III-R diagnosis of panic disorder with agoraphobia who were living in rural areas of Ontario were assigned to either an eight-session telephone behavior therapy program or wait-list control condition. There were significant treatment x time interaction effects on several outcome variables. Patients originally in the wait-list group then received the same type of therapy and they also significantly improved. All treatment gains were maintained at three-month and six-month follow-up. Telephone behavior therapy appears to be a cost-effective and efficacious treatment for agoraphobics living in remote regions where specialized anxiety disorder services are not readily available.

Adult↗

PubMed1995

Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia.

The relationship between adherence to group cognitive-behavioral treatment instructions and outcome was examined for 52 social phobic clients. Less symptomatic clients were no more likely to adhere to treatment instructions than more highly symptomatic clients. Clients were less likely to participate during group treatment sessions if they were higher on avoidant personality traits, and were less likely to complete self-directed exposures if they were more paranoid. Dependent clients tended to complete homework assignments more than less dependant clients. With one exception, adherence to treatment instructions for between session homework was not related to any of the outcome measures at the completion of treatment. However, at the 6-month follow-up, clients who adhered more to homework instructions reported less anxiety during the speech, and also tended to report greater decrements in anxiety and larger changes in their avoidant behavior. These data suggest that homework may be more important in the long-run, when the therapist is no longer present to prompt exposure.

Adult↗

PubMed1994

Exposure reduced agoraphobia but not panic, and cognitive therapy reduced panic but not agoraphobia.

Earlier studies showed that cognitive therapy has anti-panic effects and exposure has anti-agoraphobic effects while other studies suggest that agoraphobia is a secondary complication of panic disorder. It was therefore hypothesized that cognitive therapy not only reduces panic but also agoraphobia and that it potentiates the effects of exposure in vivo. Two groups of 12 severe agoraphobics were treated with 4 sessions of cognitive therapy followed by 8 sessions of cognitive therapy combined with in vivo exposure. The other 12 received 4 sessions of 'associative therapy', a presumably inert treatment that controls for therapist attention, followed by 8 sessions of in vivo exposure that was framed in common behavioral terms. The initial cognitive therapy produced a significant reduction in panic frequency, while associative therapy did not affect panic. Neither cognitive therapy alone, nor associate therapy alone significantly reduced depression, state or trait anxiety, self-rated agoraphobia or behavioral avoidance. After adding exposure however, these parameters were clearly and significantly reduced. Cognitive therapy did not potentiate exposure effects. The results are discussed.

Adult↗

PubMed1994

Does rapid eye movement desensitization facilitate emotional processing?

Recent years have seen considerable interest in rapid eye movement desensitization (REMD), a novel procedure for the treatment of traumatic memories and related conditions. REM is usually administered as a component of a broader therapeutic procedure, now termed eye movement desensitization and reprocessing (EMDR). On the basis of previous and largely uncontrolled work, it is not clear to what degree therapeutic gains can be attributed exclusively to REMD. Following exposure to a contrived trauma, Ss were allocated to one of three conditions: REMD; slow eye movement desensitization (SEMD); and stationary-imagery (SI; i.e. no eye movement). Emotional processing was significantly impaired in the REMD group compared to the SEMD and SI groups. No significant differences were found between the SEMD and SI groups.

Adult↗

PubMed1994

Effects of concurrent diazepam treatment on the outcome of exposure therapy in agoraphobia.

In a study designed to evaluate the impact of benzodiazepine use on the outcome of behaviour therapy, 91, severe, chronic agoraphobics (46 BDZ users and 45 non-users) were randomly allocated on a double-blind basis to in vivo exposure with low-dose diazepam (ED) or placebo (EP). Drug doses were adjusted on the basis of weekly psychiatric assessments over weeks 1-4. Patients had 8 x 2 hr exposure sessions (weeks 5-12) and were then withdrawn from medication (weeks 13-16). Re-assessments were completed at weeks 4, 12 and 16, and follow-up assessments at approx 20, 46 and 72 weeks. In the analysis of the results, the clinical outcome was evaluated in relation to the therapeutic regime (ED vs EP) and prior BDZ use (users vs non-users). The results showed that the ED group had greater changes in anxiety than the EP group during the drug manipulation phases (anxiety increasing during BDZ withdrawal). There were no group differences in agoraphobic symptoms and no evidence that the outcome of the behavior therapy was significantly affected by concurrent BDZ treatment. There were significant improvements in agoraphobic symptoms over the treatment period, with no evidence for relapse of treatment gains on withdrawal from BDZ, nor for differential responses over the one year follow-up. Initial differences between users and non-users were less marked than expected, although there was a trend for more drop-outs among users across both ED and EP groups.

Adult↗

PubMed1995

Heartbeat perception and panic disorder: possible explanations for discrepant findings.

Results on cardiac awareness in panic disorder are inconsistent. The present study attempted to clarify whether differences in instructions or the inclusion of patients taking antidepressant medication could account for these inconsistencies. 112 patients with panic disorder with agoraphobia were compared to 40 normal controls on the heartbeat perception task developed by Schandry (1981) [Schandry, R., Psychophysiology, 18, 483-488] using a standard instruction ("count all heartbeats you feel in your body") and a strict instruction ("count only those heartbeats about which you are sure"). Superior heartbeat perception for patients was only found with the standard instruction. Similarly, only with the standard instruction, patients taking medication affecting the cardiovascular system performed worse than patients without medication, as expected based on the relationship between stroke volume and heartbeat perception. The pattern of group differences indicates that agoraphobic patients have a better feeling for how fast their heart is beating than controls although these differences may be due to a tendency to interpret weak sensations as heartbeats. Furthermore, we tested in a subgroup of 40 patients whether cardiac awareness changes with exposure treatment. No changes in heartbeat perception were observed.

Adrenergic beta-Antagonists↗

PubMed1995

Treatment of claustrophobias and snake/spider phobias: fear of arousal and fear of context.

Forty-nine individuals with fears of snakes or spiders, and 21 individuals with claustrophobic fear were assigned randomly to two sessions of either in vivo exposure plus relaxation or in vivo exposure plus disconfirmation of misappraisals of bodily sensations. Behavioral, subjective and physiological assessments were conducted pre and post treatment, and 4 weeks later. As hypothesized, disconfirmation of misappraisals of bodily sensations benefited claustrophobic fear reduction, but had little effect on fears of snakes or spiders. However, differential treatment effects failed to generalize to nontargetted phobic situations, or generalize over time. In addition, the two treatments affected basic beliefs about arousal sensations equally.

Adolescent↗

PubMed1995

Exposure with response prevention treatment of anorexia nervosa-bulimic subtype and bulimia nervosa.

Binge exposure with response-prevention of bingeing (ERP-B) was evaluated in 20 female Ss within an inpatient eating disorders unit over 9 sessions as an adjunct to standard milieu therapy. Subjects met DSM-III-R criteria for either bulimia nervosa (BN) (n = 13) or the bulimic subtype of anorexia nervosa (AN-B) (n = 7). The average age of the Ss in each group was 26.5 (+/- 8.8) and 24.1 +/- 6.0) yr, respectively. Results indicate significant within-session and pre-post treatment effects in self-report measures 'urge to binge', 'lack of control', 'feelings of guilt' and 'tension'. Further analysis revealed that the AN-B subgroup had significantly greater reduction in 'depression' and 'urge to vomit' compared to the BN group. This study provides preliminary evidence that ERP-B deserves further investigation with long-term follow-up in both BN and AN-B patients and may be particularly advantageous in the AN-B subpopulation.

Adolescent↗