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PubMed2002

Evaluation of child therapy and caregiver training in the treatment of school refusal.

OBJECTIVE: To evaluate the relative efficacy of (1) child therapy, (2) parent/teacher training, and (3) the combination of child therapy and parent/teacher training in the treatment of anxiety-based school refusal. METHOD: Sixty-one school-refusing children (aged 7-14 years) from throughout Melbourne, Australia, were randomized to a child therapy program, a parent and teacher training program, or a combination of the two. Children were assessed before and after treatment, and at 4.5-month follow-up, by means of attendance records, self-report of emotional distress and self-efficacy, parent and teacher reports of emotional distress, and clinician ratings of overall functioning. RESULTS: Statistically and clinically significant pretreatment-posttreatment change occurred for each group. Immediately posttreatment, child therapy appeared to be the least effective in increasing attendance. By follow-up, the attendance and adjustment of those in the child therapy group equalled that of children whose parents and teachers were involved in treatment, whether on their own (parent/teacher training) or together with their children (combined child therapy and parent/teacher training). CONCLUSION: Contrary to expectations, combined child therapy and parent/teacher training did not produce better outcomes at posttreatment or follow-up.

Adolescent↗
PubMed1992

Fluvoxamine in the treatment of obsessive compulsive disorder.

Obsessive compulsive disorder is a chronic, often severe condition that is associated with considerable long term morbidity and suffering. Potent serotonin reuptake inhibitors are now regarded as first line treatments and their efficacy has been established in a series of placebo-controlled studies. The first of these compounds to become available, clomipramine, has undesirable effects on a number of other receptor systems and is associated with marked anticholinergic side effects. Of the selective serotonin reuptake inhibitors fluvoxamine is the most widely studied, with three small positive placebo-controlled and two recent large multicentre studies. These two studies show that fluvoxamine is associated with significant improvement on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive Compulsive Scale (NIMH-OC) and the Global Improvement item of the Clinical Global Impression (CGImp) Scale, compared with placebo.

Combined Modality Therapy↗
PubMed1975

Systematic desensitization to reduce dream-induced anxiety.

A modified version of systematic desensitization was used to reduce the anxiety and negative interpersonal consequences produced by a recurrent aversive dream resulting from events in the real world. The subject, a 16-year-old incarcerated male, was first taught a standard relaxation technique. The subject's dream was divided into 12 hierarchical imaginal scenes. Following initial relaxation, each scene was sequentially introduced and followed by the therapist's suggestion that the subject was still very relaxed. After three sessions with the therapists and several practice sessions by himself, the subject reported no further anxiety to the dream (which continued to occur) and improved relations with the institutional staff. Six months of follow-up showed no recurrence of the anxiety or the subsequent irritability which the subject had initially reported as leading to negative interpersonal relations with the staff.

Adolescent↗
PubMed1983

Treatment of phobophobia by exposure to CO2-induced anxiety symptoms.

It is argued that fear of fear, or phobophobia, can be an important maintaining factor in cases of seemingly free-floating anxiety with periodic panic attacks and that effective treatment consists of exposure to the feared neurovegetative sensations. The case history presented suggests that inhalation of CO2-O2 mixtures induces the phobic interoceptive sensations and that it can be used in the exposure treatment of phobophobia.

Adult↗
PubMed1983

The treatment of social dysfunction in nonpsychotic outpatients. A review.

A sizable proportion (7 to 16 per cent) of psychiatric outpatients suffer from social dysfunction, either as the main complaint or in conjunction with other psychiatric problems. Social skills training is a newly evolved treatment regimen that involves teaching patients new forms of social behavior by their rehearsal within sessions and their practice in real life between sessions. In an overview of controlled studies, social skills training was found to have been useful for up to 16 months follow-up in mainly nonpsychotic socially dysfunctional outpatients. Its effects supersede "no-treatment" periods and it appears a more potent treatment of social dysfunction than contrasting methods such as short term psychotherapy, systematic desensitization, sensitivity training, etc. The adjunct use of an anxiolytic or cognitive modification has not enhanced outcome. Social skills training is recommended as the treatment of choice for patients with social dysfunction, especially when no other major psychiatric disorders are present.

Ambulatory Care↗
PubMed1985

Behavior therapy for panic disorder.

Eleven patients who met DSM-III criteria for panic disorder were treated with behavior therapy techniques. Seven patients had mixed phobic avoidance and none were agoraphobic; three had no phobic symptoms. Mean duration of symptoms was 3.4 years. Treatment lasted a mean of 14 weeks and consisted of 1) education about physiology and management of panic symptoms; 2) relaxation, abdominal breathing, and cognitive anxiety management skills; and 3) imaginal and in vivo exposure. Upon termination of treatment, 10 of 11 patients were panic-free and six of seven mixed phobics showed complete remission or significant improvement of phobias. Follow-up data revealed excellent stability of remission. Clinical implications for the use of behavior therapy for panic disorder and directions for future research are discussed.

Adult↗
PubMed1987

The aftermath of rape. Profiles of immediate and delayed treatment seekers.

Seventy-eight sexual assault victims who sought treatment within 1 month of their assaults were compared with 40 victims who delayed seeking treatment. Demographic, rape situation, and psychiatric history characteristics were examined as were postrape symptom profiles and responses to treatment. More of the delayed treatment seekers were raped by a "friend," and fewer used physical means to defend themselves against the assailant. With respect to symptomatology, delayed treatment seekers reported considerable rape-related distress and were more anxious and significantly more fearful than were recent rape victims. Implications for clinical practice and for the tailoring of services for victims of sexual assault are suggested.

Anxiety Disorders↗
PubMed1987

The placebo effect in agoraphobia.

This paper presents two sets of data that suggests a weak but specific placebo response in agoraphobia. First, analyses in 20 agoraphobic patients given single-blind placebo over a 2-week period, without the customary confound of instructions for exposure to phobic situations, revealed a statistically significant reduction in panic and phobic symptoms. However, symptoms remained in the moderate to severe range and functioning was virtually unchanged. Second, comparisons between six agoraphobic patients receiving double-blind placebo and six others receiving "no pills," matched for age, sex and exposure treatment, revealed a significant placebo effect over an 8-week period. Implications for clinical research are briefly discussed.

Adult↗
PubMed1995

Effects of a Vietnam War Memorial pilgrimage on veterans with posttraumatic stress disorder.

We compared the scores of Vietnam veterans in treatment for posttraumatic stress disorder on the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder just before, just after, and 6 months after they participated in a pilgrimage to the Vietnam War Memorial in Washington, DC. Significant short-term improvement was reported on Mississippi total scores and on 10 of its 35 items. The number of items showing significant improvement between the initial assessment and the 6-month follow-up did not exceed chance, but significant variance increases appeared on 8 of 35 items. This suggests that the pilgrimage led to a) short-term improvements on several posttraumatic stress disorder symptoms and b) long-term improvements for some participants, but equally large exacerbations for others on a subset of symptoms.

Adult↗
PubMed1998

Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder.

The purpose of this treatment package design study was to investigate the differential efficacy of cognitive therapy or exposure in vivo with response prevention for obsessive compulsive disorder (OCD) versus the sequential combination with fluvoxamine. Patients with OCD (N = 117) were randomized to one of the following five conditions: a) cognitive therapy for weeks 1 to 16, b) exposure in vivo with response prevention for weeks 1 to 16, c) fluvoxamine for weeks 1 to 16 plus cognitive therapy in weeks 9 to 16, d) fluvoxamine for weeks 1 to 16 plus exposure in vivo with response prevention in weeks 9 to 16, or e) waiting list control condition for weeks 1 to 8 only. Assessments took place before treatment (pretest) and after 8 (midtest), and 16 weeks (posttest). In the first 8 weeks, six treatment sessions were delivered. During weeks 9 to 16, another 10 sessions were given. Thirty-one patients dropped out. Outcome was assessed by patient-, therapist- and assessor-ratings of the Anxiety Discomfort Scale, the Yale-Brown Obsessive Compulsive Scale, and the Padua Inventory-Revised. In contrast with the four treatments, after 8 weeks the waiting list control condition did not result in a significant decrease of symptoms. After 16 weeks of treatment, all four treatment packages were effective on these OCD ratings, but they did not differ among each other in effectiveness. In OCD, the sequential combination of fluvoxamine with cognitive therapy or exposure in vivo with response prevention is not superior to either cognitive therapy or exposure in vivo alone.

Adult↗
PubMedDate not supplied

Marked lability in urinary cortisol levels in subgroups of combat veterans with posttraumatic stress disorder during an intensive exposure treatment program.

OBJECTIVE: The objective of this study was to obtain longitudinal data on lability of cortisol levels in posttraumatic stress disorder (PTSD) because previous studies have largely been based on sampling at a single time point and have yielded varying results. METHODS: This study measured urinary cortisol levels at admission, midcourse, and discharge during a 90-day hospitalization period in male Vietnam combat veterans with PTSD (N = 51). RESULTS: Although there were no significant differences in the mean +/- SEM urinary cortisol levels between the admission (59.4 +/- 3.0 microg/d), midcourse (55.6 +/- 3.9 microg/d), and discharge (53.4 +/- 3.4 microg/d) values, marked lability of cortisol levels in individual patients was observed over time, with changes ranging from +93 to -58 microg/d from admission to midcourse. In addition, this hormonal lability defined discrete subgroups of patients on the basis of the longitudinal pattern of cortisol change during exposure treatment, and there were significant psychometric differences in the level of social functioning between these subgroups. CONCLUSIONS: The findings do not support the concept of either a static "hypocortisolism" or "hypercortisolism" in PTSD, but rather suggest a psychogenic basis for cortisol alterations in PTSD in relation to psychosocial stress and indicate a central regulatory dysfunction of the hypothalamic-pituitary-adrenal axis characterized by a dynamic tendency to overreact in both upward and downward directions. The longitudinal findings fit with recent observations that cortisol elevations occur when acutely superimposed stressful conditions emotionally engage patients and overwhelm the usually dominating disengaging coping mechanisms associated with suppression of cortisol levels in PTSD. The findings emphasize the importance of longitudinal data in studies of the hypothalamic-pituitary-adrenal axis in PTSD.

Adult↗
PubMed1986

Postpanic anxiety disorder: diagnosis and treatment.

Patients with a postpanic anxiety disorder (PPAD) have panic attacks less frequently than patients with a panic disorder. A PPAD must be suspected when a physician notes the following: persistent somatic complaints despite repeatedly normal results of physical examinations and laboratory tests, reluctance to engage in certain activities or avoidance of activities because the patient fears the precipitation of panic or aggravation of symptoms, and history of one or more panic attacks. Three different groups of medication are effective in the treatment of PPAD: alprazolam (a triazolobenzodiazepine), imipramine (a tricyclic antidepressant), and phenelzine (a monoamine oxidase inhibitor). Relaxation training, desensitization, and family conferences assist in lowering anxiety and in improving the prognosis. An early diagnosis of PPAD reduces the patient's discomfort and morbidity and lowers the cost of medical care.

Adult↗
PubMed2002

The development of virtual reality therapy (VRT) system for the treatment of acrophobia and therapeutic case.

Virtual reality therapy (VRT), based on this sophisticated technology, has been recently used in the treatment of subjects diagnosed with acrophobia, a disorder that is characterized by marked anxiety upon exposure to heights and avoidance of heights. Conventional VR systems for the treatment of acrophobia have limitations, over-costly devices or somewhat unrealistic graphic scenes. The goal of this study was to develop an inexpensive and more realistic virtual environment (VE) in which to perform exposure therapy for acrophobia. It is based on a personal computer, and a virtual scene of a bunge-jump tower in the middle of a large city. The virtual scenario includes an open lift surrounded by props beside a tower, which allows the patient to feel a sense of heights. The effectiveness of the VE was evaluated through the clinical treatment of a subject who was suffering from the fear of heights. As a result, it was proved that this VR environment was effective and realistic at overcoming acrophobia according not only to the comparison results of a variety of questionnaires before and after treatment but also to the subject's comments that the VE seemed to evoke more fearful feelings than the real situation.

Chronic Disease↗
PubMed2002

The treatment of fear of flying: a controlled study of imaginal and virtual reality graded exposure therapy.

The goal of this study was to determine if virtual reality graded exposure therapy (VRGET) was equally efficacious, more efficacious, or less efficacious, than imaginal exposure therapy in the treatment of fear of flying. Thirty participants (Age = 39.8 +/- 9.7) with confirmed DSM-IV diagnosis of specific phobia fear of flying were randomly assigned to one of three groups: VRGET with no physiological feedback (VRGETno), VRGET with physiological feedback (VRGETpm), or systematic desensitization with imaginal exposure therapy (IET). Eight sessions were conducted once a week. During each session, physiology was measured to give an objective measurement of improvement over the course of exposure therapy. In addition, self-report questionnaires, subjective ratings of anxiety (SUDs), and behavioral observations (included here as flying behavior before beginning treatment and at a three-month posttreatment followup) were included. In the analysis of results, the Chi-square test of behavioral observations based on a three-month posttreatment followup revealed a statistically significant difference in flying behavior between the groups [chi(2) (4) = 19.41, p < 0.001]. Only one participant (10%) who received IET, eight of the ten participants (80%) who received VRGETno, and ten out of the ten participants (100%) who received VRGETpm reported an ability to fly without medication or alcohol at three-month followup. Although this study included small sample sizes for the three groups, the results showed VRGET was more effective than IET in the treatment of flying. It also suggests that physiological feedback may add to the efficacy of VR treatment.

Adult↗
PubMedDate not supplied

Children who do not talk at school.

This paper contains two case reports illustrating the use of behaviour modification in the treatment of elective mutism. The programme was carried out by two social workers in the natural environment of the home and school.

Behavior Therapy↗
PubMed1984

Responses to acute pain and the nursing implications.

Management of acute pain offers many techniques--peripherally, to reduce the sensory input from the nociceptors and ascending fibres, and centrally by altering cognition, evaluation and emotional arousal to the sensory input. Scientifically-based nursing intervention is imperative. Therefore, nurses needed a better understanding of recent research regarding pain. As well, recognition that all individuals express and cope with pain in different ways, and therefore exhibit different pain behaviours, is necessary if effective nursing care is to be given. Finally, with all the interacting variables and methods of intervention available, pain medication should never be the only intervention used for the patient with pain.

Affect↗
PubMed2006

A study of nurses' inferences of patients' physical pain.

AIM: The aim of this study was to establish if postregistration education and clinical experience influence nurses' inferences of patients' physical pain. BACKGROUND: Pain is a complex, subjective phenomenon making it an experience that is elusive and difficult to define. Evaluation of an individual's pain is the product of a dynamic, interactive process that frequently results in ineffective pain management. Educating nurses should address the deficit, however the clinical environment is thought to be most influential in the acquisition of knowledge. DESIGN: A series of vignettes was used to consider nurses' inferences of physical pain for six hypothetical patients; these were employed within a self-administered questionnaire that also addressed lifestyle factors of patients in pain, general attitudes and beliefs about pain management and general knowledge of pain control. METHOD: One hundred questionnaires were distributed; 86 nurses returned the questionnaire giving a response rate of 86%. Following selection of the sample 72 nurses participated in the study: 35 hospice/oncology nurses (specialist) and 37 district nurses (general). Data analysis was carried out using SPSS and qualitative analysis of the written responses. RESULTS: The specialist nurses tended to infer lower levels of physical pain than the general nurses when considering the patients in the vignettes. CONCLUSION: Education and clinical experience influence nurses' knowledge, attitudes and beliefs about pain. However, it would appear that the specialist nurses' working environment and knowledge base engenders a practice theory divide, resulting in desensitization to patients' physical pain. RELEVANCE TO CLINICAL PRACTICE: It is suggested that the specialist nurses use defence mechanisms to protect them from the conflict that arises from working within the clinical environment. These cognitive strategies have the potential to ease cognitive dissonance for the nurse, but may increase patient suffering.

Defense Mechanisms↗