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PubMed1983

The effects of instructional set on the outcome of a stress management program.

A multicomponent stress management program, consisting of education about stress, various sorts of relaxation training, and cognitive coping strategies, was administered under two different instructional sets: In the positive demand set the program was touted to have previously been shown to be very effective, while in the neutral demand set the program was described as experimental. The two conditions were compared to a waiting list control. Results showed higher expectations of benefit in the positive demand group. Moreover, this group rated themselves as more able to cope with stress than the other two groups. Finally, the positive demand group showed significantly greater reductions in systolic blood pressure reactivity to laboratory stress tests (mental arithmetic and cold pressor) than the other two groups. The posttest advantages seemed to be mediated by a significantly higher level of home practice in the positive demand group.

Arousal↗
PubMed2002

Timing of psychoeducational psychotherapeutic interventions in schizophrenic patients.

Psychoeducational interventions for schizophrenic outpatients and their key-persons have shown impressive long-term effects on the course of illness. Psychoeducation is suggested to be offered as early as possible to be most effective. This prospective randomized study examines the influence of pre-therapy duration of illness on the effects of a psychoeducative training. The controlled study covered a total of 191 schizophrenic outpatients and comprised psychoeducational training and cognitive psychotherapy. Pre-therapy duration of illness was divided at 4 and 7 years resulting in groups of short, medium, and long duration of psychosis. Study patients were examined for rehospitalization at a five year interval. In patients with long duration of illness, attendance at psychoeducation did not modify rehospitalization rate. This was true for patients with very short duration of psychosis. Only patients with medium duration of illness after psychoeducative intervention showed a reduced rehospitalization rate. In general, results do recommend psychoeducative intervention at early psychosis. However, psychoeducation was not optimally located in patients with a very short duration of illness. Psychoeducation showed a most preventive effect in patients with a medium duration of illness who already accept their illness but are not yet adhering to fatalistic assumptions often established to explain the manifestation of illness.

Adult↗
PubMed1991

Meige's disease misdiagnosed as anxiety disorder.

A woman in her late 40s with a 5 year history of anxiety was treated with relaxation training and cognitive restructuring. Her anxiety was manifested by facial twitching, hand fidgeting, vocal tremor, loss of self-esteem, and depression. Therapy seemed to reduce motor symptoms and improve her self-esteem, confidence, and mood. Six months after the start of therapy the client was found to have Meige's Disease. Following treatment with botulinum toxin, motor symptoms disappeared. This case highlights the need for psychotherapists to be more aware of neurological and medical problems which may mimic psychological ones.

Anxiety Disorders↗
PubMed1993

Learning to cope with asthma: a behavioural self-management program for children.

An educational training program for children with asthma, aged between 8 and 13 years, was evaluated in an 18-month randomized, controlled experiment, including three follow-up evaluations. The objective of the program is to improve coping with asthma in daily life. The program, ten 1-hour sessions, is a combination of self-management training and cognitive behaviour therapy in a group, using games and learning materials specifically designed for this age group. From 195 asthmatic children, 112 with inadequate self-management abilities were selected; these children were randomly divided into an experimental group and two control groups. The results indicated highly significant differences in favor of the experimental group on the psychological and medical variables. There were no drop-outs during the program. The conclusion is that this multi-faceted program is an effective method of teaching children how to cope with their asthma and helping them to achieve a less anxious and more realistic attitude towards their illness.

Activities of Daily Living↗
PubMed2004

Psychological treatment of three urban fire fighters with post-traumatic stress disorder using eye movement desensitisation reprocessing (EMDR) therapy.

Fire fighters are at increased risk of developing mental health problems due to the nature of their work, which can sometimes be extremely traumatic. Arranging for immediate access to mental health specialists can often take a protracted time to arrange, leading to the individual remaining disabled and off work. The South Wales fire and rescue service have responded to this challenge and formed a partnership with their local NHS traumatic stress service. This has enabled fire fighters to receive early psychological assessment and treatment from a nurse therapist trained in cognitive behaviour therapy or referred to a consultant liaison psychiatrist. This paper will describe 3 cases which all suffered with PTSD and were treated via the partnership with a controversial therapy EMDR.

Adult↗
PubMed2001

Strategic management simulations is a novel way to measure resident competencies.

BACKGROUND: The Strategic Management Simulation (SMS) has been used extensively to test and train higher cognitive functions in persons who occupy professional and leadership positions (i.e., skills like those needed by a surgeon). METHODS: The SMS was used to predict surgical residents' competency in decision making. Skills required for integrative surgical decision making including critical thinking, crisis management, flexibility, factual knowledge, and team building were assessed. Surgical residents with at least 2 years of experience participated. In additional, attending faculty familiar with the residents' work evaluated each resident with a standard comprehensive rating scale. Simulation performance on multiple measures was compared with faculty ratings. RESULTS: A number of measures obtained on simulation performance (eg, activity level, response speed, initiative, adequate usage of and appropriate search for relevant information) generated high correlations with comprehensive faculty assessment (eg, measures of crisis management, team interactions, flexibility of approach). CONCLUSION: The simulation technique is able to accurately assess performance of surgical residents (on a number of parameters) in a relatively brief time period. Simulation data were highly similar to faculty ratings that were based on at least 2 years of experience with the resident.

Clinical Competence↗
PubMed2003

An educational program for parents of asthmatic preschool children: short- and medium-term effects.

Parent education has proven to be effective in improving parents coping with their child's asthma. Little is known about its effectiveness neither during inpatient rehabilitation nor about the different effectiveness of different approaches. A controlled clinical trial was conducted with 242 parents of asthmatic children aged less than 8 years. The aims were to develop a cognitive-behavioral training program for parents and compare its differential effectiveness with an information-centered standard-program as part of rehabilitation. Both groups reported a highly significant increase in their knowledge, self-efficacy and quality of life over time in a follow-up just after the end of their inpatient stay. There was a further increase from discharge to the 6-month follow-up for self-efficacy and quality of life. In respect to the functional severity of asthma, children of both groups showed a significant improvement. Whether these effects have long-term stability and which parents benefit from which type of intervention will be the objective of an ongoing 12-month follow-up.

Adult↗
PubMed1998

Unlocking orthodontic malocclusions: an interplay between form and function.

It is possible to unlock dental malocclusions in a functional or mechanical manner, or in a combination of these two processes. Functional unlocking starts with an in-depth diagnosis of all aspects of a specific malocclusion including a recognition of those craniofacial dysfunctions that may be present. Craniofacial dysfunctions that may require treatment include those that involve the vegetative processes of breathing and swallowing and all aspects of cranial posture. This form of unlocking deals with the working environment of the oral cavity, that here, is also referred to as the oral functional matrix. Functional unlocking encompasses cognitive awareness training that involves patients in the treatment of their dysfunction. The early resolution of oral dysfunctions is not only an essential part of orthodontic treatment but it is also a vital component of the stability of the treatment results obtained. Mechanical unlocking, in contrast to functional unlocking, removes occlusal interferences that could interfere with the development and function of the entire stomatognathic system. Both functional and mechanical unlocking are often overlooked in orthodontic diagnosis and treatment planning. This article uses clinical examples, where possible, to illustrate how malocclusions may be unlocked to provide better and more stable treatment results.

Cephalometry↗
PubMed2001

Out-patient behaviour therapy in alcoholism: relapse rates after 6 months.

OBJECTIVE: In spite of the increasing interest in out-patient treatment programmes for alcoholics, there still exist only a few experimental studies on this issue. In this still ongoing study the efficacy of different behaviour therapy strategies is to be examined. METHOD: One hundred and twenty patients were assigned randomly to non-specific supportive therapy or to two forms of behavioural therapy (coping skills training and cognitive therapy). Behavioural treatment comprised 26 weekly sessions; follow-up examinations will take place every 6 months over 2 years. RESULTS: Patients undergoing behavioural therapy showed less drop-outs and significantly higher rates of abstinence compared with supportive treatment. Nevertheless, statistically significant differences between the two behavioural therapy strategies could not be established so far. CONCLUSION: Preliminary results demonstrate the feasibility and efficacy of behaviour therapy programmes in the out-patient treatment of alcoholism. Furthermore, they stress the importance of professional psychiatric and psychotherapeutic engagement in the field of addiction.

Adult↗
PubMed2002

Out-patient behaviour therapy in alcoholism: treatment outcome after 2 years.

OBJECTIVE: The main aim of the study was the evaluation of out-patient behavioural approaches in alcohol dependence. Additionally, the persistence of treatment effects and the impact of psychiatric comorbidity in long-term follow-up was examined. METHOD: A total of 120 patients were randomly assigned to non-specific supportive therapy or to two different behavioural therapy programmes (coping skills training and cognitive therapy) each comprising 26 weekly sessions; the follow-up period lasted 2 years. RESULTS: Patients undergoing behavioural therapy showed a consistent trend towards higher abstinence rates; significant differences between the two behavioural strategies could not be established. Moreover, the results indicate a reduced ability of cognitive impaired patients to cope with short-time abstinence violations and at a reduced benefit from behavioural techniques for patients with severe personality disorders. CONCLUSION: Behavioural treatment yielded long-lasting effects and met high acceptance; yet, still in need of improvement is the development of specific programmes for high-risk patients.

Adult↗
PubMed2001

What do physicians think about evidence-based antibiotic use in critical care? A survey of Australian intensivists and infectious disease practitioners.

BACKGROUND: The analysis of factors that influence prescribing decisions is increasingly important. Antibiotic use is often based on limited evidence and lack of information about clinical decision-making processes is an important obstacle to improving antibiotic utilization. AIMS: To compare the attitudes of intensive care unit practitioners (ICUP) and infectious disease practitioners (IDP) to antibiotic use and to the evidence-based information support. METHOD: A postal survey conducted between March and July 2000 of ICUP and IDP representing all States and Territories in Australia. RESULTS: One hundred and fifty-three of 224 clinicians returned the questionnaire (68.3% response rate). In choosing an antibiotic, IDP placed significantly more weight than ICUP on the in vitro susceptibility of the pathogen (P = 0.001), antibiotic cost (P = 0.05) and possible development of antibiotic resistance (P = 0.007). More than 95% of both groups believed that unit-specific antibiotic susceptibility of endemic pathogens was an essential factor in rational prescribing, but only 68.5% of IDP and 38.7% of ICUP use microbiology laboratory databases. When in doubt about appropriate antibiotic use, 63.8% of ICUP seek and 76.3% usually follow the advice of IDP. Both groups agree that published antibiotic guidelines are useful, but IDP were more likely to consult them. ICUP were more likely to believe that guidelines are used to control clinicians rather than to improve quality of care (P = 0.001). A greater proportion of IDP (71.2%) than ICUP (52.5%) believed that antibiotic prescribing in their intensive care unit (ICU) was evidence based but most (91.8% and 86.9%, respectively) agreed that it should be. CONCLUSIONS: Australian clinicians have positive views about evidence-based prescribing and antibiotic guidelines. However, there are clinically significant differences in prescribing behaviour between ICUP and IDP. These may be explained by different disease spectra managed by each group or different cultures, training and/or cognitive styles. Improvements in the understanding of physicians' information and decision support needs are required to strengthen evidence-based prescribing.

Anti-Bacterial Agents↗
PubMed2001

[Outpatient behavioural treatment in alcoholism: alcohol consumption and sociodemographic factors].

In spite of the increasing interest in outpatient treatment programmes for alcohol dependents, there still exist only a few experimental studies on this issue. Moreover, the interaction between abstinence and sociodemographic factors has been only rarely explored. In this study, the efficiency of different behaviour therapy strategies was examined: 120 patients were randomly assigned to nonspecific supportive therapy or to 2 forms of behavioural therapy (coping skills training and cognitive therapy). Behavioural treatment comprised 26 weekly sessions; follow-up examinations took place every 6 months over 2 years. Patients undergoing behavioural therapy showed less drop outs and significantly higher rates of abstinence and also of reemployment and satisfaction with their job situation compared to those under supportive treatment. At the same time, the employment status proved to be a valid predictor of treatment success, whereas there was only a weak (negative) impact of an existing partnership on abstinence. Statistically significant differences between the 2 behavioural therapy strategies could be established in neither respect.

Adult↗
PubMed1990

A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints.

This randomized, prospective study investigated the effectiveness of two group behavioral medicine interventions for primary care patients experiencing physical symptoms with a psychosocial component (eg, palpitations, gastrointestinal disturbances, headaches, malaise, sleep disorders). The subjects were 80 volunteers at a health maintenance organization (HMO) in the greater Boston area. Both interventions focused on the mind/body relationship and used didactic material, relaxation-response training, awareness training, and cognitive restructuring. The two behavioral medicine intervention groups were compared with a group that focused exclusively on information about stress management and its relation to illness. Measures of visits to the HMO and of distress from physical and psychological symptoms were obtained before the interventions and again 6 months afterward. At the 6-month follow-up, patients in the behavioral medicine groups showed significantly greater reductions in visits to the HMO and in discomfort from physical and psychological symptoms than did the patients in the information group. The results suggest that when the relationship among thoughts and behaviors and symptoms of patients with psychosomatic dysfunction is actively addressed, the patients' discomfort level and the cost of medical care can be reduced.

Adaptation, Psychological↗
PubMed1988

Testing as a teaching tool.

More than four years ago, the authors initiated testing as a means of obtaining data for evaluating residents. The testing process has evolved now and is used for its teaching value and as a means of objective resident self-evaluation. Testing is designed to provide 10 cases an hour, with characteristics allowing a single diagnosis as a unique answer. No history is provided because a common topic and anatomic area provide a context for each examination. Answers are given during the examination after each question, and discussion follows. All answers are written, and answer sheets are collected. Attendance is high. Test scores are routinely lower than in other forms of evaluation. Testing integrates all aspects of radiology training from cognitive through deductive, simulates written consultations, and provides a means of self-evaluation through rapid feedback. Testing is a viable form of teaching that blends self-evaluation with faculty and peer feedback.

Educational Measurement↗
PubMed1983

Behavioral treatment of psychogenic vomiting in the context of social phobia.

A case of psychogenic vomiting in the context of social phobia was treated by a combination of exposure in vivo, social skills training, and cognitive modification. The intervention was not directly aimed at the vomiting, but at aspects of the patient's behavior hypothesized to be instrumental in maintaining it; deficits in prosocial behaviors and associated anxiety. Change was assessed on the basis of patient's records of daily frequency of: vomiting; performance of treated behaviors; and associated anxiety within a single-case multiple baseline design. Change occurred only with the introduction of treatment and not before it, ruling out effects of time or mere contact. Clinically, the vomiting was virtually eliminated after 7 weeks, and the anxiety was substantially reduced in most previously feared (and avoided) social situations; except for a 2-week depressive spell, this outcome has been maintained for an available 2-year follow-up. A general improvement in the patient's personal, social, and vocational life has also occurred.

Adult↗
PubMed2005

The role of psychological well-being in retaining rural general practitioners.

OBJECTIVE: Retention of rural GPs is an increasing area of concern and is receiving considerable attention from the government, medical authorities and the media. This study aimed to examine the potential for psychological interventions to assist in the retention of rural GPs through targeting their psychological well-being. DESIGN: GPs completed a questionnaire, including questions about their level of support in rural practice, psychological health (work-related morale and distress, distress related specifically to working in rural general practice, quality of work life) and intentions to leave rural practice. SETTING: Rural general practices in South Australia. PARTICIPANTS: One hundred and eighty-seven rural GPs. RESULTS: Results indicated that rural GPs who were seriously considering leaving rural practice had higher work-related distress, higher distress related specifically to working in a rural general practice and lower quality of work life. GPs who considered leaving rural practice also reported having fewer colleagues with whom to discuss professional issues. CONCLUSION: Results indicated that psychological interventions (such as cognitive behavioural training), assistance with stress reduction and coping mechanisms (such as more interaction with colleagues) may be of benefit to GPs who are considering leaving rural practice. Such training may increase the number of GPs who ultimately stay in rural practice.

Adult↗
PubMed1993

Practitioner review: problems in children's peer relations: what can the clinician do?

This paper describes the assessment and treatment of children with peer relationship problems. The first part of the paper is organized around five topics: peer rejection, peer neglect, the absence of friendships, reputation in the peer group, and peer group affiliations. Next, a series of assessment methods is delineated, including peer, teacher, parent and self reports, as well as direct observational procedures. Finally, we suggest a number of treatment options, including social skills training, social cognitive interventions, and co-operative group interventions.

Behavior Therapy↗