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PubMed1984

Dimensions of psychotherapy session impact across sessions and across clients.

The Session Evaluation Questionnaire measures two dimensions of participants' perceptions of psychotherapy sessions, depth and smoothness, and two dimensions of post-session mood, positivity and arousal. In ratings by therapists and in ratings by clients, the same dimensions were identified as underlying variation across sessions and variation across clients. Thus these 'impact' dimensions can be used for session-level comparisons with process variables and for client-level comparisons with outcome variables, possibly permitting two-stage inferences from process to impact to outcome.

Adolescent↗

PubMed1985

Short-term dynamic psychotherapy. I. The Oslo group's form to score outcome, the reliability testing of this form and observer characteristics.

The aim of short-term dynamic psychotherapy is, through working with a central conflict and transference reactions, to obtain lasting changes based on cognitive and emotional understanding of the main dynamics of the central conflict, called insight. The aim of the present study was to construct a follow-up form that was easy to handle, could score different outcome of short-term dynamic psychotherapy, as for instance symptom relief, change in social functioning and better insight, and was reliable. Sufficient reliability was established with a reliability coefficient between 0.756 and 0.564 for eight result variables. Percentage agreement was estimated in addition. As a total only 10% of the scores differed more than +/- 1 from a consensus score on a scale from zero, no change, to 7, recovered. The therapist was a reliable observer of his/her own patients. The sex of the observer did not influence percentage agreement. High-formal training in psychotherapy tended to give higher percentage of agreement compared to low-formal training.

Adaptation, Psychological↗

PubMed2003

Virtual rehabilitation--benefits and challenges.

OBJECTIVES: To discuss the advantages and disadvantages of rehabilitation applications of virtual reality. METHODS: VR can be used as an enhancement to conventional therapy for patients with conditions ranging from musculoskeletal problems, to stroke-induced paralysis, to cognitive deficits. This approach is called "VR-augmented rehabilitation." Alternately, VR can replace conventional interventions altogether, in which case the rehabilitation is "VR-based." If the intervention is done at a distance, then it is called "telerehabilitation." Simulation exercises for post-stroke patients have been developed using a "teacher object" approach or a video game approach. Simulations for musculo-skeletal patients use virtual replicas of rehabilitation devices (such as rubber ball, power putty, peg board). Phobia-inducing virtual environments are prescribed for patients with cognitive deficits. RESULTS: VR-augmented rehabilitation has been shown effective for stroke patients in the chronic phase of the disease. VR-based rehabilitation has been improving patients with fear of flying, Vietnam syndrome, fear of heights, and chronic stroke patients. Telerehabilitation interventions using VR have improved musculo-skeletal and post-stroke patients, however less data is available at this time. CONCLUSIONS: Virtual reality presents significant advantages when applied to rehabilitation of patients with varied conditions. These advantages include patient motivation, adaptability and variability based on patient baseline, transparent data storage, online remote data access, economy of scale, reduced medical costs. Challenges in VR use for rehabilitation relate to lack of computer skills on the part of therapists, lack of support infrastructure, expensive equipment (initially), inadequate communication infrastructure (for telerehabilitation in rural areas), and patient safety concerns.

Cognition Disorders↗

PubMedDate not supplied

Quality of life and care in Parkinson's disease.

Seventy-two parkinsonian patients attending a subregional movement disorder clinic completed a novel questionnaire designed to examine their quality of life and care. Significant problems with housing, travel, holidays and hobbies were identified. Financial difficulties due to premature retirement and the complex benefit system were found. Many carers were ill but, even when hospitalised, patients were cared for in the community by friends and relatives. Few patients had been referred for paramedical therapies, in spite of considerable disability in some cases. Aids and adaptations were commonly in use without advice from an occupational therapist. The specialised clinic and Parkinson's disease nurse advisor were welcomed by many patients. Most were satisfied with their hospital care and general practitioner, but follow-up arrangements with general practitioners were variable. It is suggested that further research concentrates on the roles of physiotherapy, speech therapy, nurse advisors and social workers in the management of Parkinson's disease, and on the value of increased carer support, including respite care.

Aged↗

PubMed1986

Patient requests: correlates and therapeutic implications for Hispanic, black, and Caucasian patients.

A patient's reason for coming to a psychiatric outpatient clinic (his/her request for service) should be the focal point as a therapist develops an appropriate therapeutic plan for that patient. Data have been collected on 173 Hispanic, Black and Caucasian patients with regard to their reasons for coming to the clinic and selected demographic and process/outcome variables. A factor analysis of the patient request data generated three conceptual factors, which account for 13 reasons for coming to the clinic. The relationship of these factors with selected demographic and therapy outcome variables was tested statistically, and implications for therapy with low income and minority patients are discussed.

Adult↗

PubMed1990

Supplementing behavioral marital therapy with cognitive restructuring and emotional expressiveness training: an outcome investigation.

The current study investigated whether the effectiveness of behavioral marital therapy (BMT) would be increased by the addition of cognitive restructuring (CR) and/or emotional expressiveness training (EET) for maritally distressed couples. Sixty such couples were randomly assigned to 1 of 3 therapists and 1 of 5 treatment conditions (BMT Alone, CR + BMT, BMT + EET, CR + BMT + EET, or waiting list) for 12 weeks of conjoint marital therapy. Within each treatment condition, couples typically improved on the variables focused on in treatment. However, comparisons among active treatment conditions showed few significant differences among treatments; the treatments were equally effective in increasing marital adjustment. Thus, the addition of CR and EET did not appear to increase the overall effectiveness of treatment. Possible reasons for the current findings are provided, and suggestions for future marital outcome investigations are outlined.

Adaptation, Psychological↗

PubMed2006

Communication in young children with fragile X syndrome: a qualitative study of mothers' perspectives.

PURPOSE: To provide descriptive and qualitative information about communication in young children with fragile X syndrome (FXS) and about how families react to and accommodate communication differences in their children. METHOD: In-depth interviews were conducted with 55 mothers of young children with FXS. Interviewers asked mothers to describe their children's communication, strategies they used to help promote their children's communication, communication-related frustrations, their expectations for their children, and the roles that they perceive for themselves. RESULTS: Over half the children were nonverbal and learning to communicate with augmentative and alternative communication. Mothers reported using strategies that were developmentally appropriate and recommended by early childhood experts, such as reading and talking to their children. Many mothers identified challenges faced in helping their child to communicate, and some cited difficulty obtaining speech-language services as a challenge. Mothers identified their roles as caregiver, teacher, therapist, and advocate. CONCLUSIONS: The perspectives offered by mothers are valuable because they indicate how children with FXS communicate in natural contexts. Information about mothers' expectations and roles may help clinicians to be sensitive to variables that will affect working with young children and their families.

Adult↗

PubMed1984

Effects of four treatment methods on social phobic patients not suitable for insight-oriented psychotherapy.

Forty-two social phobic men and women, rated unsuitable for insight-oriented psychotherapy, received one of four randomly assigned types of treatment for 3 months. All patients received basal therapy (B) in the form of standardized information, self-exposure instructions, and anxiolytic medication. One group received this treatment only, with monthly appointments. The others, in addition, received either therapist-directed prolonged exposure in vivo, in some cases supplemented with exposure in imagination (PE), dynamically oriented supportive therapy (ST) or relaxation therapy (R). There was a 9 months' follow-up period. The phobia variables were more improved in the PE and ST groups than in the R and B groups at the termination of treatment. Although improvement had deteriorated somewhat in the PE group during follow-up, the improvement in target phobia was better than in the other groups. There were almost no improvements in the R and B groups. ST and PE groups also showed improved social function while the global rating showed most improvement in the PE group. The B group was not improved at all and the R group only showed a short-lived drop in muscular tension.

Adolescent↗

PubMed1990

Therapeutic techniques vs therapeutic relationships in child behavior therapy.

The parents of 56 children who had received behavior therapy rated a number of variables, including the degree to which they viewed the therapeutic relationship versus the specific techniques used in treatment as important, the extent to which the child improved in therapy, and the child's present functioning. Therapists also provided ratings of clinical improvement. Even though parents gave the highest ratings for the importance of the relationship in therapy, the correlation between technique and clinical outcome was statistically significant while the correlations between the relationship and outcome was not. These statistical associations also held when therapists rated improvement. Also, therapists saw greater improvement in children than did the parents. Over-all, the results support the view that the relationship and techniques are interwoven and are both perceived as important factors in treatment.

Adolescent↗

PubMed1996

How forearm position affects grip strength.

OBJECTIVE: Several studies have indicated that changing body positions results in altered grip strengths. Although one might expect that grip strength would be influenced by the position of the forearm during gripping due to the biomechanical properties of the forearm and hand muscles, no investigations of this variable have been undertaken. METHOD: This study examined the effect on grip strength of moving the forearm among supinated, neutral, and pronated positions while maintaining the standard position recommended by the American Society of Hand Therapists. The mean of three grip trials in each position was recorded for each of 106 subjects. RESULTS: Grips in forearm supination were the strongest, followed by grips in the neutral position. Grips in pronation were the weakest. CONCLUSIONS: The changes in grip strength observed with variations in forearm position further support the necessity of a standard position for testing grip strength. The knowledge of how changes in body position affect the strength of the grip can be used to design environments and tools to maximize biomechanical abilities.

Adolescent↗

PubMed2003

Awareness of disabilities in stroke rehabilitation--a clinical trial.

PURPOSE: To investigate the frequency of unawareness of disabilities after stroke during the rehabilitation stage, the relationship of unawareness with neuroanatomical variables, and the impact of unawareness on functional outcomes. METHOD: Sixty consecutive patients (36 with right, 24 with left hemisphere damage) admitted to rehabilitation hospital with a first, single, unilateral stroke were evaluated at admission, discharge and at 1-year post onset of stroke. Unawareness of disabilities was operationally defined as the discrepancy between therapist and patient's rating on the motor scale of the functional independence measure (FIM). Functional outcomes included FIM, instrumental activities of daily living (IADL) scale, activity card sort (ACS) and safety rating scale. RESULTS: Unawareness of disabilities was found in 44/60 patients at admission and 24/57 at discharge. There was no significant difference between the hemisphere groups in the frequency of unawareness at both times. Discharge unawareness in the right hemisphere group was significantly associated with lesions in the frontal and temporal lobes, and with lesion size. Unawareness in the left hemisphere damaged group was not associated with any neuroanatomical variables. A negative impact of unawareness at admission on functional outcomes was not found, but it was found that unawareness at discharge was a negative predictor of activity level (ACS score) at follow up, after controlling for the severity of initial disability level. CONCLUSIONS: Unawareness of disabilities is a significant issue in stroke rehabilitation. Unawareness that persists to discharge from rehabilitation correlates with neuroanatomical variables in right hemisphere damaged patients, and is a negative predictor for some rehabilitation outcomes at follow-up.

Activities of Daily Living↗

PubMed1998

Interpretive and supportive forms of psychotherapy and patient personality variables.

A randomized clinical trial investigated the efficacy of interpretive and supportive forms of short-term individual psychotherapy and the interaction of each form with the patient's quality of object relations (QOR) and psychological mindedness (PM). The psychiatric outpatient sample included 144 therapy completers and 27 dropouts. Eight experienced therapists provided distinct forms of manual-guided therapy. Outcome was assessed by a comprehensive battery. The dropout rate was higher for interpretive therapy than for supportive therapy. Patients in both forms improved, but they did not differ on outcome from each other. A multivariate interaction effect indicated a direct relation between QOR and outcome for interpretive therapy and almost no relation for supportive therapy. A multivariate main effect indicated a direct relation between PM and outcome for both forms. The relevance of patient personality to outcome in different forms of therapy is addressed.

Adolescent↗

PubMed1997

Biofeedback treatment for pediatric migraine: prediction of treatment outcome.

Despite a growing number of studies showing good effectiveness of nonpharmacological treatments such as thermal biofeedback (TBF) for pediatric migraine, little is known about psychosocial variables that might be predictive of treatment outcome. The identification of predictors appears especially important when children are treated in a home-based treatment format that tends to be somewhat less effective than a therapist-administered treatment. A total of 32 children between the ages 8 and 16 years completed a home-based TBF treatment program with treatment outcome being of similar magnitude as previously reported in the literature. Multiple regression analysis revealed externalizing behavior tendencies, initial level of psychosomatic complaints, and the child's age to be highly predictive of outcome, whereas dimensions of family functioning failed to exert a direct influence. The implications of these findings for the development and evaluation of future treatment programs are discussed.

Adolescent↗

PubMed1981

Music therapy-assisted labor and delivery.

This article describes a new clinical music therapy program for application in the labor and delivery setting, and presents results of a preliminary study to evaluate effectiveness of the treatment. Over 50 women participated in the project; however, inclusion of patients in the data collection portion of the project was limited by criteria designed to minimize the effects of spurious variables. An experimental group of 13 patients participated in six individual predelivery music therapy training sessions during the third trimester of pregnancy. Experimental patients listened to preselected musical works throughout labor and delivery, with the music therapist in attendance. A control group of seven subjects participated in labor and delivery according to regular hospital routines. Data consisted of patients' responses to questionnaire items reflecting subjective perceptions and recollections of the labor/delivery experience and reports of frequency and duration of home practice. Experimental subjects achieved significantly higher "success" scores than did control subjects on five of seven indices (p less than .05). A moderate correlation between music home practice and successful childbirth outcome was demonstrated, with frequency/length of music home practice revealed as a significant predictor of success in the childbirth experience.

Female↗

PubMed1988

Mental imagery and its potential for physical therapy.

The purposes of this article are 1) to review the sports and motor-learning literature regarding the effects of mental imagery and mental practice on physical skills and 2) to explore the feasibility of using them as adjunctive techniques in physical therapy. In the area of sports, evidence exists that mental practice can improve motor skills. Research that supports a mind-body relationship is cited, in addition to research using mental imagery from the areas of medicine, biofeedback, psychoneuroimmunology, and physical therapy. Variables that influence the outcome of mental practice such as vividness, kinesthetic imagery, and combining physical and mental practice are examined, and two major variables associated with ineffective results are identified. The advantages and disadvantages of using mental imagery for physical therapy patients are discussed with the conclusion that mental imagery has the potential to be a viable technique for physical therapists.

Biofeedback, Psychology↗

PubMed1975

The role of cognitive process in social interaction.

This paper reports on a series of studies designed to investigate the hypothesis that the success of a social interaction is function of the compatibility among the participants in complexity or degree of differentiation of their cognitive structure. Patient-therapist cognitive compatibility is shown to predict the success of treatment outcome. Its role in the teacher-student relationship in mental health training is more complex: the teacher's cognitive structure appearing to be a primary variable. In community action groups, cognitive compatibility determines the nature and type of decisions or behaviors carried out by the group. The resarch emphasizes the need for increased familiarity with cognitive research among social psychiatrists.

Cognition↗

PubMed2002

Physical outcome measurements via the Internet: reliability at two Internet speeds.

We have developed a software application to enable interactive rehabilitation via the Internet. The reliability of the telemedicine application was examined by comparing it with face-to-face assessment. The physical outcome measures assessed were knee range of motion, quadriceps muscle strength, limb girth and an assessment of gait. One therapist performed both in-person and Internet-based measurements of all outcome measures on 20 normal subjects. There was good agreement between the two techniques (the 95% limits of agreement included zero for all the variables studied). Internet assessments were conducted at two bandwidths: ISDN at 128 kbit/s and the telephone network at 17 kbit/s. Bandwidth had no significant influence on any of the measures. This study suggests that Internet-based physiotherapy interventions delivered to the home are suitable for further development.

Journal Article↗

PubMedDate not supplied

Differentiation of self and attachment among adult daughters.

The relation among the variables differentiation of self, attachment to mother, and two indicators of mental health were studied in 83 nonclinical adult daughters from a Southern community. An a priori causal model was proposed and tested. Bowen's (1976) theory of differentiation of self and Bowlby's (1969) attachment theory provided the conceptual framework. An operational Daughter Model was tested using the statistical program LISREL. Compared to mothers, daughters scored significantly lower on differentiation of self. Daughter's attachment to mother and daughter's level of self-differentiation were not causally related, supporting the view that differentiation of self and attachment are separate variables in personality development. The daughters' levels of differentiation of self were positively related to positive energy, thus supporting Bowen's theory. These findings affirm the value of attachment behaviors and differentiation of self in adulthood, challenge therapists' bias against attachment behaviors of women, and provide a focus for mental health promotion among women.

Adult↗