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Training programme in techniques of self-control and communication skills to improve nurses' relationships with relatives of seriously ill patients: a randomized controlled study.

The interpersonal relationships with relatives of seriously ill patients may cause anxiety on the part of nurses and the need for adequate communication and self-control skills. To assess the efficacy of training nurses in self-control techniques and communication skills when they interact with relatives of seriously ill patients we planned a randomized, controlled trial in two parallel groups: an experimental group, with immediate training, and a control group, with training delayed for 6 months. We recruited 61 nurses from the nursing staff of a university hospital of 500 beds. The intervention consisted of training in relaxation, cognitive restructuring and some communication skills. The outcome variables were communication skills measured under simulated conditions using an observation instrument of our own, administered by observers masked with respect to the study groups, and the levels of state-anxiety measured with the self-assessment questionnaire the State-Trait Anxiety Inventory, under imaginary conditions. The two groups initially had similar scores in the scales of communication skills, and state and trait-anxiety. After intervention, compared with the control group, the experimental group showed significant improvements in the skills of listening, emphasizing, interrupting and coping with emotions (P < 0.05). State-anxiety levels did not show any changes. In conclusion, the joint training in self-control and communication improves some communication skills in nurses when they interact with relatives of seriously ill patients under simulated conditions.

Adaptation, Psychological↗

Cognitive-behavioral therapy for social anxiety disorder: supporting evidence and future directions.

The present paper examines the role of cognitive-behavioral therapy (CBT) in the treatment of social anxiety disorder (SAD). A cognitive-behavioral model of SAD is first presented. Different modalities of CBT for SAD are then described, including exposure, cognitive restructuring, relaxation training, and social skills training, and evidence supporting their efficacy is reviewed. The comparative and combined impact of CBT and pharmacotherapeutic interventions is also explored. CBT appears to be an efficacious treatment for SAD. However, the overall efficacy CBT may be increased by closer examination of the active ingredients of treatment. Such analyses may also enable more successful integration of the different CBT techniques and of CBT and pharmacotherapy in the treatment of SAD.

Cognitive Behavioral Therapy↗

Decreased depression up to one year following CBSM+ intervention in depressed women with AIDS: the smart/EST women's project.

This prospective multisite Phase III clinical trial (Miami, New York, New Jersey) investigated the long-term (one year) effects of a 10-week group cognitive-behavioral stress management/expressive supportive therapy (CBSM+) intervention on disadvantaged minority women living with AIDS. The CBSM+ intervention consisted of 10-weekly group session of stress management, cognitive-behavioral skill training, relaxation techniques and expressive-supportive therapeutic strategies. The primary study outcome was self-reported depression scores as measured by the BDI. The CBSM+ Group intervention significantly decreased depression scores on the BDI for women following the intervention and maintained the decreased level at one-year follow-up.

Acquired Immunodeficiency Syndrome↗

The effects of Dynavision rehabilitation on behind-the-wheel driving ability and selected psychomotor abilities of persons after stroke.

OBJECTIVE: Many conventional rehabilitation exercises, such as pencil-and-paper and computer tasks, may not train perceptual and motor skills as applied to a complex, multiskill activity such as driving. The present study examined the usefulness of the Dynavision apparatus for driving-related rehabilitation. The Dynavision was designed to train visual scanning, peripheral visual awareness, visual attention, and visual-motor reaction time across a broad, active visual field. METHOD: Ten persons with a cerebrovascular accident participated in the study. All had failed behind-the-wheel driving assessments. Subjects participated in a 6-week Dynavision training program using exercises designed to impose various motor, perceptual, and cognitive demands. RESULTS: Dynavision training resulted in significantly improved behind-the-wheel driving assessments as compared to expected outcomes. Comparisons between pretests, posttests, and follow-up tests on a number of Dynavision, response, and reaction time variables showed significant improvements and maintenance effects. Dynavision performance, and, to a lesser extent, choice visual reaction and response times, were found to differentiate between persons assessed as safe and unsafe to drive, and between older and younger drivers. Subject self-reports suggested that a variety of training-related improvements had occurred in everyday functioning. CONCLUSION: Dynavision training shows some rehabilitative promise for improving driving and basic psychomotor skills. Future research on the benefits and limitations of this apparatus should use finer laboratory skill measures and more comprehensive tests of driving and daily functioning to assess more thoroughly skill improvements in persons after stroke.

Aged↗

Assessment and management of urinary incontinence among homebound older adults: a clinical trial protocol.

Urinary incontinence is a common and costly problem among homebound older adults. This article describes the assessment and management protocols utilized in a clinical trial examining the effectiveness of behavioral interventions in treating urinary incontinence in homebound older adults. Individuals with urinary incontinence were identified and referred to the study by home care nurses from two large home health agencies. Following in-home assessment, eligible subjects were randomized to an immediate treatment group or a delayed treatment group (control group). Subjects who were cognitively intact were treated with biofeedback-assisted pelvic floor muscle training, while subjects with cognitive impairments were treated with a program of prompted voiding. Two nurse practitioners assessed and treated subjects participating in the study.

Aged↗

Reinterpretative cognitive strategies in chronic pain management.

This preliminary study was conducted to test the effectiveness of cognitive treatment of clinical pain. Chronic pain patients were trained in a self-control cognitive strategy procedure. Specifically, they were provided with a conceptualization of their pain, instructed in an awareness of their thoughts prior to and during their experience of pain, and trained in the use of several cognitive strategies to replace these thoughts and relabel their pain experience. Training was provided in a group setting to further consolidate the use of the instructions by enabling patients to roleplay the instructions to one another. Patients were also encouraged to verbally reinforce themselves each time they used the procedure. The experience of pain was measured by the McGill pain questionnaire, a behavioral checklist and staff reports. Results suggest that cognitive strategies can effectively alter the experience of clinical pain. Moreover, pain as a cognitive label for a nonspecific state of arousal is suggested.

Cognition↗

Cognitive-behavioral treatment of recurrent nonspecific abdominal pain in children: an analysis of generalization, maintenance, and side effects.

From 10% to 15% of school-aged children experience recurring abdominal pain. This study evaluated the efficacy of a cognitive-behavioral program for the treatment of nonspecific recurrent abdominal pain (RAP) using a controlled group design. The multicomponent treatment program consisted of differential reinforcement of well behavior, cognitive coping skills training, and various generalization enhancement procedures. Multiple measures of pain intensity and pain behavior were conducted, including children's self-monitoring, parent observation, teacher observation, and observation by independent observers. Results showed that both the experimental and the control groups reduced their levels of pain. However, the treated group improved more quickly, the effects generalized to the school setting, and a larger proportion of subjects were completely pain-free by 3-months follow-up (87.5% vs. 37.5%). There was no evidence for any negative side effects of treatment.

Abdomen↗

The Italian Air Force rehabilitation programme for air-sickness.

Motion Sickness, or kinetosis, is a complex clinical syndrome usually classified according to the environmental situation evoking the symptoms. Among the various forms of motion sickness, air sickness has a significant impact on aircrew readiness and is often a cause for the grounding of aircrew. Unfortunately, standards for clinical testing to accurately predict the sensitivity of each individual to air-sickness are currently lacking. Furthermore, pharmacological prevention is contraindicated for aircrews, whose cognitive tasks involve a high level of vigilance. Therefore, a number of Air Forces have developed their own rehabilitation programmes to counteract air-sickness effects on flight personnel. These programmes may differ in several aspects, such as their duration, instruments used, costs and the technical characteristics of the rehabilitation team. However, reports in the specialized literature, refer to high rates of success, despite the above-mentioned differences. In the autumn of 2000, the Italian Air Force (ITAF) also began its own rehabilitation programme for air-sickness desensitisation. The programme was developed at the Aerospace Medicine Department of the ITAF Flight Test Centre, at the Pratica di Mare Air Force Base, Italy. The ITAF rehabilitation course lasts two weeks, and candidates are first classified according to their clinical history and to their reaction to the Coriolis Stress Test. Thereafter, subjects undergo a personalized desensitisation programme, involving increasingly more intense nauseogenic stimuli by means of various devices. At the same time, a psychological approach, based on autogenous training and cognitive-behavioural therapy, is adopted. The present report refers to data from 17 subjects treated from January 2001. The current clinical outcome is extremely encouraging, with a success rate of 88%. Nevertheless, several aspects of motion sickness rehabilitation are still under investigation, and further research programmes, aimed at improving the final clinical outcome and prolonging the benefits of rehabilitation, are needed.

Adolescent↗

Tyrosine improves cognitive performance and reduces blood pressure in cadets after one week of a combat training course.

The effects of the amino acid tyrosine on cognitive task performance were studied on a group of 21 cadets during a demanding military combat training course. In addition, the effects on mood, blood pressure and the norepinephrine metabolite MHPG were determined. Ten subjects received five daily doses of a protein-rich drink containing 2 g tyrosine, and 11 subjects received a carbohydrate rich drink with the same amount of calories (255 kcal). Assessments were made both immediately prior to the combat course and on the 6th day of the course. The group supplied with the tyrosine-rich drink performed better on a memory and a tracking task than the group supplied with the carbohydrate-rich drink. In addition, the supplementation of tyrosine decreased systolic blood pressure. No effects on mood were found. These findings suggest that supplementation with tyrosine may, under operational circumstances characterized by psychosocial and physical stress, reduce the effects of stress and fatigue on cognitive task performance.

Adolescent↗

The relative efficacy of three cognitive-behavioral treatment approaches to temporomandibular disorders.

The purpose of this study was to evaluate the relative efficacy of different biopsychosocial treatment conditions on patients with chronic temporomandibular disorder. Ninety-four patients with chronic temporomandibular disorder were assigned to either a biofeedback treatment group, a cognitive-behavioral skills training (CBST) treatment group, a combined (combination of biofeedback/CBST) treatment group, or a no-treatment control group. Pain scores were analyzed pretreatment and posttreatment to determine group and within-subjects treatment effects. Results demonstrated that, in terms of a self-reported pain score, all three treatment groups had significantly decreased pain scores from pretreatment to posttreatment, while the no-treatment group did not. Moreover, patients in the biofeedback group were the most significantly improved compared to the no-treatment group. Finally, participants in the three treatment groups displayed significant improvement in mood states.

Adult↗

The effect of web based depression interventions on self reported help seeking: randomised controlled trial [ISRCTN77824516].

BACKGROUND: To date, there has been very little work investigating behaviour changes induced by interventions that are designed to increase help seeking. The present paper examines the effects of two Internet depression websites on help seeking. METHODS: 414 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website, a cognitive-behavioural skills training website (CBT) or an attention control condition. Reports of help seeking for specific treatments, from specific sources and for categories of treatments were assessed. RESULTS: Relative to the control, the depression information site was associated with decreases in seeking support from friends and family, the use of music and of everyday treatments and no increase in seeking evidence based interventions. The CBT site was associated with the report of help seeking for CBT, massage and exercise. CONCLUSION: Methods to encourage the use of evidence-based treatments need further research to determine whether the assistance sought is evidence based and whether there are unintended effects.

Adolescent↗

Regular exercise improves cognitive function and decreases oxidative damage in rat brain.

The biochemical mechanisms by which regular exercise significantly benefits health and well being, including improved cognitive function, are not well understood. Four-week-old (young) and 14-month-old (middle aged) Wistar rats were randomly assigned to young control and young exercised, middle-aged control and middle-aged exercised groups. Exercise groups were exposed to a swimming regime of 1 h a day, 5 days a week for 9 weeks. The passive avoidance test showed that middle-aged exercised rats had significantly (P<0.05) better short- (24 h) and long-term (72 h) memory than aged-matched control rats. Conditioned pole-jumping avoidance learning was improved markedly in both age groups by exercise. Brain thiobarbituric acid-reactive substances and 8-hydroxy-2'deoxyguanosine content in the DNA did not change significantly, while the protein carbonyl levels decreased significantly (P<0.05) in both exercised groups. This decrease was accompanied by an increase in the chymotrypsin-like activity of proteasome complex in the exercised groups, whereas trypsin-like activity did not differ significantly between all groups. The DT-diaphorase activity increased significantly (P<0.05) in the brain of young exercised animals. These data show that swimming training improves some cognitive functions in rats, with parallel attenuation of the accumulation of oxidatively damaged proteins.

Age Factors↗

An evaluation of self-instructional training in the treatment of obesity.

An experimental evaluation of a cognitive self-instructional procedure for increasing self-control of eating was carried out in a weight reduction programme for obese women. All subjects received a 'core', 16 week long treatment programme of nutritional advice and encouragement provided by five group meetings and one individual session. Subjects were randomly assigned to receive only the core programme, or the core programme plus seven individual sessions of one of three types of treatment. Thus there were four treatment conditions: (a) Cognitive Rehearsal (Self-instructional training attempting to teach subjects to resist temptation through the self-directing power of inner speech), (b) Insight Control (teaching subjects to become aware of, but not to change, unhelpful cognitions), (c) Individual Contact Control (encouragement and nondirective discussion of dieting) and (d) Group Contact Control (core programme only). Of the 94 subjects entering the programme 74 completed the 16 weeks of treatment and 69 were followed up a year later. There were no significant differences between treatments in obesity reduction either at the end of treatment or at followup. There were significant reductions in anxiety and depression and in initially unrealistically high outcome expectations. Initial weight loss, an apparently important variable, predicted subsequent losses.

Adult↗

Long-term efficacy of biobehavioral treatment of temporomandibular disorders.

This study evaluated the relative long-term efficacy of biofeedback, cognitive-behavioral skills training (CBST), combined biofeedback and CBST (Combined), and no-treatment comparison groups in 108 patients suffering from chronic temporomandibular disorder (TMD). After an initial evaluation, patients were assigned to one of the four treatment conditions. The three biobehavioral treatment interventions consisted of 12 standardized sessions. Patients were reevaluated 1 year after completing treatment. Results demonstrated that patients who received the biobehavioral treatments reported significant improvement in subjective pain, pain-related disability, and mandibular functioning 1 year after receiving treatment. The no-treatment comparison group did not demonstrate such improvements. The combined biofeedback and CBST treatment produced the most comprehensive improvements across all outcome measures. These results again demonstrate the heuristic value of adopting a biopsychosocial perspective to the assessment and treatment of chronic medical/dental disorders such as TMD.

Adult↗

Strike while the iron is hot: can stepped-care treatments resurrect relapsing smokers?

The efficacies of 2 group counseling step-up treatments for smoking cessation, cognitive-behavioral/skill training therapy (CBT) and motivational interviewing/supportive (MIS) therapy, were compared with brief intervention (BI) treatment in a sample of 677 smokers. Differential efficacy of the 2 step-up treatments was also tested in smokers at low and high risk for relapse (no smoking vs. any smoking during the first postquit week. respectively). All participants received 8 weeks of nicotine patch therapy. BI consisted of 3 brief individual cessation counseling sessions; CBT and MIS participants received BI treatment and 6 group counseling sessions. Neither CBT nor MIS treatment improved long-term abstinence rates relative to BI. Limited support was found for the hypothesis that high-risk smokers would benefit more from MIS than CBT. Other hypotheses were not supported.

Administration, Cutaneous↗

Intellectual Function Training in adults with acquired brain damage. An occupational therapy method.

An occupational therapy method termed Intellectual Function Training (IFT) is presented for cognitive retraining of patients with brain damage. Comprehensive training material, comprising about 900 pages, is described. The method is used to remediate intellectual dysfunction and to give intellectual stimulation, particularly concerning the following abilities: visual perception ability, spatial ability, verbal ability, numerical ability, memory ability and logical ability. The material is used for systematic individualized, daily treatment over a period of 2-4 months. The way in which the material is used is based on neuropsychological and pedagogical principles. Examples of training tasks and the training procedure are given.

Adult↗

Efficacy of an early intervention for patients with acute temporomandibular disorder-related pain: a one-year outcome study.

BACKGROUND: The authors conducted a randomized clinical trial to evaluate the efficacy of a biopsychosocial intervention for patients who were at high risk (HR) of progressing from acute to chronic temporomandibular disorder (TMD)-related pain. METHODS: The authors classified subjects' risk using a predictive algorithm and randomized them into an early-intervention (EI) or a nonintervention (NI) group. The EI included cognitive behavioral skills training and biofeedback. The authors assessed pain and psychosocial measures at intake and at a one-year follow-up. Subjects' self-reported pain levels were measured on an analog scale and as a response to palpation. RESULTS: At one year, EI-group subjects had significantly lower levels of self-reported pain and depression. At one year, more NI-group subjects than EI-group subjects had utilized health care for jaw-related pain. NI-group subjects were 12.5 times as likely to have a somatoform disorder, more than seven times as likely to have an anxiety disorder, and 2.7 times more likely to have an affective disorder at one year, compared with EI-group subjects. CONCLUSIONS: EI-group subjects had reduced pain levels, improved coping abilities and reduced emotional distress at one year. CLINICAL IMPLICATIONS: The TMD-related pain experience is complex and requires early identification with a biopsychosocial EI to achieve maximal, sustainable results.

Adolescent↗

Effects of a cognitive-behavioral pain-management program.

A cognitive behavioral multidisciplinary pain management program was evaluated in two separate outcome studies; one controlled study (study I) and one study conducted on a consecutive sample with a long-term follow-up (study II). The 4-week inpatient treatment program included education sessions, goal setting, graded activity training, pacing, applied relaxation, cognitive techniques, social skills training, drug reduction methods, contingency management of pain behaviors, and planning of work return. The outcome of study I showed significant between-group differences in favor of the treatment group on measures of occupational training at 1-month follow-up, activity level in the sparetime at post-treatment and at follow-up, and decreased catastrophizing and pain behaviors at post-treatment. In study II significant improvements over time were found on measures of sick leave, pain intensity, pain interference, life control, affective distress, activity level in the sparetime, physical fitness and use of analgetics at 2-month follow-up and at 1-year follow-up. The results of the two outcome studies reported show that cognitive behavioral multidisciplinary pain management programs can successfully be applied to Swedish musculoskeletal pain patients.

Adaptation, Psychological↗