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Results for “Desensitization, Psychologic”
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Long-term prognosis of behavior therapy in practice.
A prognosis study was carried out on 30 cases of patients treated with behavior therapy. The treatments, which took more than three years before the study, averaged four years and eight months. The results are as follows: (1) The improvement achieved by therapy was maintained or further improved in 29 cases during the post-therapeutic period of more than three years. (2) The prognosis largely depended on the grade of improvement at the end of therapy. A complete disappearance of symptoms at the end of therapy did not necessarily mean that it was a fair prognosis. (3) There was no relation between the prognosis and the length of history of illness or the situation of therapy terminated. (4) The impression is that long-term prognoses are different depending on the main symptoms.
Two cases of panic disorder treated with autogenic training and in vivo exposure without medication.
The aim of this study was to use autogenic training in combination with in vivo exposure in the behavioral treatment of panic disorder without medication. Two cases of panic disorder with agoraphobic avoidance were presented. Case 1 was a 33 year old married female who exhibited mild panic symptoms, and case 2 was a 23 year old single male who had severe panic symptoms. Both subjects were successfully treated with the combination of these two techniques. Treatment effects were maintained for 9 years as a follow up in case 1, and for 4 years in case 2.
A desensitization programme for the treatment of mutism in a seven year old girl: a case report.
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Anorexia nervosa in a pre-adolescent girl: a multimodal behaviour therapy approach.
A multimodal method of behavioural therapy was used in the case of a pre-adolescent girl with anorexia nervosa. This followed two previous admissions to a paediatric department. Three main conclusions emerged from pre and post therapy objective evaluations. Weight gain in anorexia is a necessary but insufficient basis for sustained improvement. Important interactive psychosocial factors have to be adequately addressed to improve the chances of effective therapy. A focused approach relevant to each of a number of important different, but overlapping, areas is likely to facilitate better potential for treatment effectiveness than a general ('non-specific') management approach.
Practitioner review: assessment and treatment of refugee children and adolescents who have experienced war-related trauma.
BACKGROUND: Increasingly clinicians are being asked to assess and treat young refugees, who have experienced traumatic events due to war and organised violence. However, evidence-based guidance remains scarce. METHOD: Published studies on the mental health difficulties of refugee children and adolescents, associated risk and protective factors, as well as effective interventions, particularly those designed to reduce war-related post-traumatic stress disorder (PTSD) symptoms, were identified and reviewed. The findings are summarised. RESULTS: Young refugees are frequently subjected to multiple traumatic events and severe losses, as well as ongoing stressors within the host country. Although young refugees are often resilient, many experience mental health difficulties, including PTSD, depression, anxiety and grief. An awareness of relevant risk and protective factors is important. A phased model of intervention is often useful and the need for a holistic approach crucial. Promising treatments for alleviating symptoms of war-related PTSD include cognitive behavioural treatment (CBT), testimonial psychotherapy, narrative exposure therapy (NET) and eye movement desensitisation and reprocessing (EMDR). Knowledge of the particular needs of unaccompanied asylum-seeking children (UASC), working with interpreters, cross-cultural differences, medico-legal report writing and the importance of clinician self-care is also necessary. CONCLUSION: More research is required in order to expand our limited knowledge base.
Phobic anxiety and clumsiness in a 10-year-old girl.
During assessment of a girl with a long-standing phobic state, it was found that she also had previously unrecognised perceptuo-motor problems, which were associated with continuing problems in balance and spatial awareness. Her phobia improved after a desensitisation programme, but the physical disorder persisted, despite physiotherapy. The authors conclude that the girl's phobic anxiety may have had its origin in her experience of the perceptual disorder during development.
Effects of brief relaxation training on autonomic response to anxiety-evoking stimuli.
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An application language for psychophysiological experimentation. ABS: an application language for psychophysiological experimentation. IBM 1130 (8K).
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Imagery vividness affects habituation rate.
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Behavior therapy in a family context: treating elective mutism.
This paper discusses the necessity of using both behavioral and family approaches in combination, while working with electively mute children. The symptom and its significance within the family system is presented along with a rationale for avoiding the pitfalls of individual approaches with such children. A case history outlining specific behavioral techniques is described in detail with an exploration of the use of reinforcement theory, counter-conditioning, and successive approximations in bringing about change in electively mute children. The need for bringing about changes within the family system so as to maintain the changes that have occurred through use of the behavior techniques is discussed and presented as crucial to the treatment process. The paper takes the position that either approach, by itself, will not be effective in helping electively mute children but that the treatment of choice is a combination of therapeutic techniques.
Gynecological care for women with mental retardation.
Gynecologic care of women with mental retardation often is overlooked because of the physical and ethical difficulties involved in providing such care. Nurse practitioners can use their assessment skills to understand these women better and provide safe care for them. Fertility and hygiene problems can be helped with medroxyprogesterone or low-dose contraceptives. Examinations can be accomplished by using a combination of desensitization classes and sedatives. Clinicians using such a protocol have been able to examine mentally retarded residents at Tacachale (a community for developmentally disabled people in Florida) without the use of general anesthesia.
Ephedra alkaloids and brief relapse in EMDR-treated obsessive compulsive disorder.
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Expectations of improvement and attitudes to treatment processes in relation to outcome with four treatment methods for phobic disorders.
One hundred and three agora- or sociophobic women who were not suitable for insight-oriented psychotherapy filled in an inventory with questions pertaining to expectations as to improvement, and attitudes towards goal of treatment and function of the therapist. The patients received one of four randomly assigned types of outpatient treatment for 3 months. All patients received basal therapy in the form of medication, standardized information and self-exposure instructions. One group received this treatment only once a month (B). The others received in addition either therapist-directed prolonged exposure in vivo (PE), dynamically oriented supportive therapy (ST), or relaxation therapy (R). The patients were rated by an independent rater with regard to symptoms and functions at the start and termination of the treatment, and at the end of the follow-up period 9 months after termination. 1) The patient's expectation as to improvement was positively associated with outcome with R and B, but there was no association with PE and ST. Thus, expectancy was associated with outcome when the treatment given was fairly unspecific. 2) A good match between the patient's pretreatment attitude to the goal of treatment and how the therapist should function was associated with a better outcome.
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.
Early interpersonal relations: experience of four treatment methods in phobic women.
One hundred and three phobic women not suitable for insight-oriented psychotherapy were randomized to either therapist-directed prolonged exposure in vivo (PE), supportive therapy of dynamic type (ST), relaxation therapy (R), or basal therapy (B). History taking was lengthy and included ratings of early interpersonal relations. These were combined into a scale with a range from 0, least favourable, to 13 most favourable. The patients filled in an inventory with regard to their experience of the therapist and the therapy at the beginning of the treatment, at midtreatment, and at the end of treatment, 3 months later. This inventory, the ETI, comprises different scales with ranges from least to most favourable experiences. The associations between the scales on the experience of early interpersonal relations and the ETI scales were studied. Most correlations were positive, indicating a similarity between the experience of early personal relations and the experience of the therapist and the therapy. The associations were significant at the start of therapy with B, and at the termination of therapy with R. These results are taken to indicate that when the desire for a personal relation with the therapist is frustrated the nature of the relation is interpreted according to the nature of the early relations. The fact that there was no association in ST indicates that when the patient is helped to express her reactions to current relations there is no need to fall back on early relations for the interpretation of the current ones. The opinion that it is possible to predict the character of the therapeutic relation from the character of early relations was supported.
Relation between outcome and the patient's initial experience of the therapist and therapeutic conditions in four treatment methods for phobic disorders.
One hundred and three phobic women not suitable for insight-oriented psychotherapy were randomized to either therapist-directed prolonged exposure therapy (PE), supportive therapy of dynamic type (ST), relaxation therapy (R), or basal therapy (B). Immediately after seeing their therapist for history taking and beginning of treatment, the patients were asked to report their experience of the therapist, of themselves in relation to the therapist, and of the therapy (Experience of Therapy Inventory, ETI). The patients were informed that the therapists would not see the ETI. The patients were rated by an independent rater with regard to symptoms and functions at the beginning of treatment, at termination of treatment 3 months later, and at a follow-up 1 year after the commencement of the study. 1) Patients treated with PE and R were more satisfied with their therapists than patients treated with ST or B. The PE patients considered their therapists provided better contact, were more assured and knowledgeable, and gave what seemed to be the correct therapy, the R patients considered their therapist showed more warmth. Both PE and R patients felt their therapists were more interested than the ST and B therapists. These differences were probably due to differences in the amount of time offered, in the attitudes of the therapists, and in the characteristics of the therapies. 2) In the PE group there were positive associations between outcome and the initial experience of the therapist. There is, thus, empirical evidence that a good therapist-patient relation is of importance to a good outcome in this type of behaviour therapy. In the ST group there was an association between a good outcome and a positive experience of the rather conflict-centred beginning of the procedure. A positive experience of a conflict-centred approach may thus be regarded as an indication for dynamic therapy.
Prognostic factors with four treatment methods for phobic disorders.
The associations between prognostic factors and outcome with four treatment methods for phobic disorders were studied in 103 women. The prognostic factors were sociodemographic, intelligence, personality, early interpersonal relations, aspects of previous and current mental disorder, and intensity of symptoms at start of treatment. All patients received basal therapy, which implied information, advice on exposure in vivo, and anxiolytics. One group received this treatment only (B), while others received supplementary treatment, with therapist-directed prolonged exposure in vivo (PE), supportive therapy (ST) of dynamic type, or relaxation (R). The patients were treated for 3 months, with a 9-month follow-up period. Factors associated with a better outcome were: PE: greater needs for succourance and lower avoidance; ST: higher social class, better relations between parents and with father during childhood, inner conflicts as cause, and lower levels of free anxiety; R: satisfaction with contact when aged 15, bereavement as a cause, and lower levels of several symptoms; B: greater needs for order, stress at the onset, shorter duration and satisfaction with work. There were thus interactions between prognostic factors and type of treatment. The prognostic factors should be taken into account in the choice and design of treatment.