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Results for “Desensitization, Psychologic”

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A sexual-enhancement workshop: beyond group systematic desensitization for women's sexual anxiety.

This study investigated whether six women who previously had received 15 sessions of group systematic desensitization (SD) for their sexual anxiety would report additional treatment gains from participation in a sexual-enhancement workshop with their partners. After group SD six couples participated in six, 1 1/2 hour weekly group sessions. The women reported a significant increase in marital adjustment and a significant decrease in sexual anxiety. A significant decrease was found in the women's sexual nonresponsiveness as perceived by their partners. Future studies should (1) contrast the effects of group SD with women alone versus couple group treatment, (2) determine which treatment components are most influential for defined subject types, and (3) obtain data on men's sexual functioning.

Anxiety↗

Retarded ejaculation reconceptualization and implications for treatment.

Retarded ejaculation, RE, has received little attention in the past; however with greater sexual awareness, therapists may find a significant increase in requests for help with this dysfunction. A major concern of this paper is that RE has been too narrowly defined. Additional problems in previous literature include conceptual confusion, poorly defined criteria, vague descriptors, and methodological problems. Incidence, definitions and categorizations are followed by a look at etiology, assessment, and treatment results. The present article broadens the definition of RE, presents psychophysiological stimulation deprivation as a generally overlooked cause, and offers a thorough bibliography for reference purposes.

Desensitization, Psychologic↗

Anaesthetic ejaculation.

Literature on the uncommon symptom of anaesthetic ejaculation and the relevant physiology is reviewed. Seven case vignettes describing the clinical pictures, background histories and common features of this problem are presented, along with some psychometric data. No physical causative factors could be elucidated. The main features shared in common by these men were problems in the recognition and expression of emotions, and a performance orientation. Treatment by sex-therapy procedures was ineffective.

Adult↗

Perspectives of sex therapy outcome: a survey of AASECT providers.

Randomly selected AASECT members who reported that they conduct sex therapy (N = 289) responded to a questionnaire about their sex therapy caseloads. Desire discrepancies between partners was the most common problem (31%). Least commonly reported problems were vaginismus (5%), ejaculatory inhibition (5%), and primary erectile dysfunction (2%). Highest success rates (client satisfaction with sexual functioning) were for premature ejaculation (62%), secondary orgasmic dysfunction (56%), and desire discrepancies (53%). Primary erectile dysfunctions had the lowest success rate (25%). The most commonly used treatment methods were a focus on communication skills, general sex education, homework assignments, and a focus on the sexual interaction; sensate focus, and the discussion of nonsexual individual and/or relationship issues also were quite commonly used. From a discriminant function analysis, the combined Therapists and Multiple-certified provider groups reported focusing on sexual interactions more than the combined Counselors and Educators; the Educators were the least likely providers to use a focus either on sexual interactions or on homework assignments. The Counselors were the most likely, and the Educators the least likely, to use communication skills. Therapists and the Multiple-certified providers estimated higher treatment success rates than Counselors and Educators for premature ejaculation, secondary erectile dysfunction, vaginismus, primary orgasmic dysfunction, sexual avoidance, ejaculatory inhibition, and sexual arousal problems. The Educators were the least successful with dyspareunia. Educators and Counselors were similar in reporting the fewest clients with sexual arousal problems. Therapists and Multiple-certified providers reported spending more treatment hours with desire discrepancies and desire problems. The implications of the findings for clinical practitioners and researchers are discussed.

Communication↗

The effect of therapist presence on a desensitization program for test anxiety.

This study investigated the effect of varying degrees of therapist presence on outcome measures of a test anxiety program on systematic desensitization. Three treatments, which included face-to-face administration by a therapist, some therapist involvement, and fully automated administration were compared to a waiting list control group. It was found that all three treatments were effective when compared to the control group in terms of reduction of reported anxiety as measured by the STABS. It was noted that clients who used the automated program were more likely to terminate prematurely. It was concluded that, while all of the treatments may be effective in a laboratory setting, the presence of a counselor would seem to be important for the use of this type of program in a service agency.

Adolescent↗

Effectiveness of a stress management program in reducing anxiety and depression in nursing students.

This study sought to develop a stress management program based on the arousal-attribution stress model and to evaluate the effectiveness of the program in reducing anxiety and depression experienced by nursing students. Forty-two sophomore and 34 senior nursing students in a private, sectarian, liberal arts college were randomly assigned to experimental and control groups. All subjects were given pre- and posttests consisting of the State form of the State-Trait Anxiety Inventory and the Institute for Personality and Ability Testing Depression Scale. Posttest analysis indicated that the experimental group had significantly lower anxiety and depression than the control group (p less than .05). These results support the use of the arousal-attribution stress model as a theoretical framework for stress management training.

Adult↗

Focus on "cognition" in cognitive behavior therapy for ocd: is it really necessary?

The past decade has witnessed a significant shift toward a more cognitive emphasis in our understanding and treatment of obsessive-compulsive disorders (OCD). This article discusses the shortcomings in more standard behavioral treatment of OCD, which despite its demonstrated efficacy, led to the recent cognitive-behavioral approaches to the disorder. Current cognitive behavior therapy for OCD is described and a short critical review of the comparative treatment outcome literature on cognitive behavior therapy vs exposure and response prevention is provided. The article concludes that although the clinical utility of a more cognitive approach to OCD has not been consistently demonstrated, it would be premature to abandon cognitive formulations until some key research questions have been addressed.

Cognition↗

Potentials and limitations of cognitive treatments for obsessive-compulsive disorder.

Exposure and response prevention (ERP) is a well-established treatment for obsessive-compulsive disorder (OCD). However, it is not completely effective for many patients, and some do not benefit from or tolerate this treatment. Over the past 3 decades there has been growing interest in using cognitive interventions, either as adjuncts or alternatives to exposure-based treatments such as ERP, to address these shortcomings. Cognitive therapy and cognitive behavior therapy for OCD have both demonstrated greater efficacy than no treatment at all, and appear to have a lower incidence of dropout than ERP. Unfortunately, however, for the average OCD patient, cognitive interventions have not improved treatment efficacy; that is, cognitive interventions, either alone or combined with ERP, are no more effective than ERP alone. Reasons for this disappointing result are considered, and indications for the use of cognitive interventions are discussed. Future research directions are suggested in order to evaluate more fully the merits of, and indications for, cognitive methods for treating OCD.

Cognitive Behavioral Therapy↗

Evaluation of an inference-based approach to treating obsessive-compulsive disorder.

This study evaluated an inference-based approach (IBA) to the treatment of obsessive-compulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. "Maybe the door is open", "My hands could be dirty") as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty-four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y-BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome.

Adult↗

Involving family members in the treatment of OCD.

This review focuses on previous research with families of adults and children with obsessive-compulsive disorder (OCD). Three primary areas of research are covered: (i) characteristics of family members and the family environment; (ii) the prediction of treatment response based on family variables; and (iii) the inclusion of family members in treatment. Much of the research supports a hypothesized model of family response to symptoms of OCD that ranges on a continuum from overly accommodating to overly antagonistic. Further research indicates that responses at either extreme of this continuum are associated with poorer response to both exposure and response prevention (ERP) and pharmacotherapy. Finally, results of preliminary treatment outcome studies suggest that family-based interventions aimed at reducing such responses and/or including family members in ERP as coaches or co-therapists may enhance patients' response to treatment. Based on current theory and research, suggestions for future research and general recommendations for involving family members in treatment are made.

Adolescent↗

A brief motivational intervention for treatment-refusing OCD patients.

Cognitive behavioral therapy involving exposure and response prevention (ERP) is the psychosocial treatment of choice for obsessive-compulsive disorder (OCD). Despite this, ERP is not widely used by mental health practitioners, and so dissemination of ERP and other empirically supported treatment (ESTs) has become a priority. Even so, utilization of ESTs such as ERP remains below 50% even among therapists who self-identify as having a cognitive behavioral orientation. Barriers to the acceptance of ERP include practical obstacles such as lack of training and the cost of treatment, but also patient variables such as treatment refusal. It has been estimated that approximately 25% of OCD patients refuse ERP. This paper describes a brief, 4-session readiness intervention (RI) designed to decrease ERP refusal among patients with OCD. In this study, 12 patients with OCD who had refused ERP were randomized to RI or wait-list (WL). 86% of participants in the RI condition and 20% of participants in WL condition agreed to begin ERP following the 4-week period. ERP following RI, but not WL, was associated with a decrease in OCD symptoms comparable to that observed in OCD patients who did not refuse ERP. However, ERP following RI was associated with a high drop-out rate (50%), a figure that exceeds that typically seen in OCD treatment studies. Techniques to reduce drop-out as well as directions for future research are discussed.

Adult↗

A brief cognitive-behavioral approach to reducing anxiety sensitivity decreases pain-related anxiety.

Anxiety sensitivity (AS; fear of anxiety-related sensations) is a known risk factor for anxiety disorders and recently has been linked to pain disorders. The present study was guided by the hypothesis that a program designed to reduce AS levels might also result in a decrease in anxiety related to pain sensations. Female undergraduates, selected as either high or low in AS according to screening scores on the Anxiety Sensitivity Index (ASI), were randomly assigned to participate in 3 1-hour, small group sessions of either cognitive behavioral therapy (CBT; psycho-education, cognitive restructuring, and interoceptive exposure) or a non-specific treatment (NST). Immediately prior to and following the intervention, participants completed the 20-item Pain Anxiety Symptoms Scale (PASS-20). Consistent with hypothesis, results revealed a 3-way interaction between AS group, intervention condition, and time on PASS-20 total scores. Only participants with high pre-morbid levels of AS assigned to the CBT condition showed a significant reduction in scores on the PASS-20 from pre- to post-treatment. Implications for improving CBT approaches for pain disorders are discussed.

Adolescent↗

Exposure therapy for phobias and obsessive-compulsive disorders.

When abnormal fears or excessively compulsive behavior begin to rule a person's life, the consequences can be devastating to both patient and family. But three quarters of cooperative patients can be restored to normal functioning through a form of therapy based on exposing the patient continually to the stimuli that evoke symptoms until they can be tolerated and the phobic or compulsive behavior dissipates.

Adult↗

Inhibition of hypervigilance in the treatment of traumatic simple phobias: three case examples.

OBJECTIVE: In traumatic simple phobia (TSP) fear of retraumatisation tends to be enduring and may show little reduction with time despite frequent and prolonged exposure. This paper describes how hypervigilant behaviour may account for this enduring response by interfering with exposure. METHOD: Three case histories illustrating the clinical features of TSP and its treatment using in vivo exposure coupled with direct inhibition of hypervigilance are presented. RESULT: In all three cases, reduction of anxiety occurred with spontaneous generalisation of improvement. CONCLUSIONS: The efficacy of in vivo therapeutic exposure for fear of retraumatisation may be enhanced by the use of strategies to inhibit hypervigilant behaviour.

Accidents, Traffic↗

Does reducing safety behaviours improve treatment response in patients with social phobia?

OBJECTIVE: This study assessed the efficacy of instructions to drop 'safety behaviours' during exposure tasks in a cognitive-behaviour therapy (CBT) group treatment program for social phobia. METHOD: Fourteen subjects with social phobia received a standardised CBT treatment program and were compared to 16 subjects with social phobia who were given additional instructions to drop safety behaviours. RESULTS: Repeated measures of ANOVA between groups on a specific social phobia measure (SPAI) demonstrated significant benefit when instructions to drop safety behaviours were added to the treatment program. CONCLUSIONS: The addition of instruction to drop safety behaviours in exposure tasks in the course of CBT treatment for social phobia may be useful. This result supports the cognitive model of social phobia developed by Clark and Wells (1995), which postulates that anxiety and negative beliefs about social situations are in part maintained by engaging in safety behaviours. Further replication with larger samples is required and warranted on the basis of the present study.

Adult↗

Real-time monitoring of brain activity in patients with specific phobia during exposure therapy, employing a stereoscopic virtual environment.

Exposure therapy is a behavioral technique that is reported to be the most effective, long-lasting treatment for patients suffering from specific phobia. During the performance in enclosed spaces, the patients show a strong psychophysiological response to the phobic stimulus that is normally avoided. This psychophysiological response changes characteristically during the course of exposure. We implemented an electroencephalographic monitoring focusing on event-related potentials to resolve the modulation of preattentive information processing by the anxiety state of the subject. Therefore, mismatch-negativity (MMN) was chosen as parameter using a passive auditory oddball paradigm that does not interfere with performance in the virtual environment. The results of this neurophysiological monitoring are demonstrated in one patient suffering from claustrophobia.

Adult↗