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PubMedDate not supplied

Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: results from a controlled trial.

BACKGROUND: Recent factor-analytic studies in obsessive-compulsive disorder (OCD) identified consistent symptom dimensions. Support for the validity of these dimensions comes from studies of psychiatric comorbidity, functional brain imaging, genetic transmission, and treatment response to medications. This study examined whether previously identified OCD symptom dimensions are associated with treatment compliance and response to behaviour therapy (BT) for OCD. METHODS: One hundred and fifty-three OCD outpatients who participated in a multi-centre randomised controlled trial of computer- versus clinician-guided BT for OCD were included in the study. Logistic and multiple regression models tested for significant predictors of compliance with and response to BT and relaxation. RESULTS: The patients studied were phenomenologically comparable (including the presence of 'pure' obsessions and mental rituals) to those in previous serotonin reuptake inhibitor (SRI) trials and those in clinical epidemiology studies. High scorers on the 'hoarding' dimension were more likely to drop out prematurely from the study and tended to improve less. For those completing treatment, the strongest predictor of outcome was pre-treatment severity. Initial depression scores were unrelated to outcome. After controlling for symptom severity, higher scores on the 'sexual/religious obsessions' factor predicted poorer outcome with BT, especially when computer-guided. CONCLUSIONS: BT is especially indicated for OCD patients with aggressive/checking, contamination/cleaning and symmetry/ordering symptoms. Previous accounts of unsuccessful BT in patients with hoarding symptoms may be due in part to their propensity to drop out earlier from treatment. Patients with sexual/religious obsessions, but not those with mental rituals, might respond less well to traditional BT techniques. Existing treatments need to be refined and/or new treatments developed to improve these patients' adherence and response to treatment.

Adult↗
PubMed2006

Shared obsessive-compulsive disorder.

BACKGROUND: Shared psychotic disorder (folie à deux) is an uncommon entity reported mainly in the context of delusions. Obsessions and compulsions occur very rarely as shared psychopathology. MATERIAL AND METHODS: We present two sisters who manifested shared obsessive-compulsive disorder. RESULTS: Both sisters were managed in keeping with their shared obsessive-compulsive disorder leading onto a similar pattern of response. CONCLUSIONS: Shared obsessions could represent the continuum concept of obsessions and delusions, and their relationship needs to be evaluated in greater detail.

Adult↗
PubMed2006

Eye movement desensitization and reprocessing for posttraumatic stress disorder: a pilot blinded, randomized study of stimulation type.

BACKGROUND: Eye movement desensitization and reprocessing (EMDR) is becoming a recognized and accepted form of psychotherapy for posttraumatic stress disorder (PTSD). Yet, its mechanism of action remains unclear and much controversy exists about whether eye movements or other forms of bilateral kinesthetic stimulation contribute to its clinical effects beyond the exposure elements of the procedure. METHODS: Twenty-one patients with single-event PTSD (average Impact of Event Scale score: 49.5) received three consecutive sessions of EMDR with three different types of auditory and kinesthetic stimulation (tones and vibrations): intermittent alternating right-left (as commonly used with the standard EMDR protocol), intermittent simultaneous bilateral, and continuous bilateral. Therapists were blinded to the type of stimulation they delivered, and stimulation type assignment was randomized and counterbalanced. RESULTS: All three stimulation types resulted in clinically significant reductions of subjective units of distress (SUD). Yet, alternating stimulation resulted in faster reductions of SUD when only sessions starting with a new target memory were considered. CONCLUSIONS: There are clinically significant effects of the EMDR procedure that appear to be independent of the nature of the kinesthetic stimulation used. However, alternating stimulation may confer an additional benefit to the EMDR procedure that deserves attention in future studies.

Acoustic Stimulation↗
PubMed2007

Cue exposure therapy for the treatment of opiate addiction: results of a randomized controlled clinical trial.

BACKGROUND: Persistent cue reactivity to drug-related stimuli is a well-known phenomenon among abstinent drug users and has been found to be a predictor of relapse. Cue exposure therapy (CET) aims to reduce this cue reactivity by exposing abstinent drug users to conditioned drug-related stimuli while preventing their habitual response, i.e. drug use. METHODS: 127 abstinent heroin-dependent Dutch inpatients were randomized to CET (n = 65; 55 completers) and placebo psychotherapy treatment (PPT) (n = 62; 59 completers). It was examined whether CET would lead to a decrease in drug-related cue reactivity (using mixed-design ANOVA) and subsequently to lower dropout and relapse rates (using logistic regression) compared to PPT. RESULTS: Both groups responded with a similar decrease in self-reported cue reactivity (craving, mood). The CET group did show a significant decrease in physiological reactivity (skin conductance) compared to PPT. However, dropout and relapse rates were, contrary to our expectations, significantly higher in the CET group. CONCLUSIONS: This is the first randomized controlled trial showing that CET, compared to a non-specific psychotherapy, might increase dropout and relapse rates among abstinent heroin-dependent clients in a drug-free setting. Caution is warranted when applying CET in this specific context.

Adult↗
PubMed1996

Models, mechanisms and management of anticipatory nausea and emesis.

Anticipatory nausea and vomiting (ANV) are learned responses to chemotherapy that develop in up to 25% of patients by the fourth treatment cycle. Post-treatment nausea and emesis must occur before development of ANV can take place. Certain patient characteristics and other responses to chemotherapy can also be used to predict their occurrence. Once they develop, ANV cannot be controlled by pharmacologic means including use of new 5-HT3 receptor antagonists. By contrast, behavioral therapies involving relaxation, most notably systematic desensitization, can be used to effectively treat ANV. Clinic personnel including oncologists and oncology nurses as well as behavioral psychologists can effectively administer systematic desensitization to chemotherapy patients.

Animals↗
PubMed1975

In vivo desensitization of a phobic shop steward.

Techniques used in behaviour therapy effectively counteract the symptoms presented by the patient. The question arises as to the precise nature of such intervention, and whether this form of treatment is in fact a superficial one which deals only with symptom removal, or whether this is really a much more fundamental form of therapy, in which the patient alters as a whole. The case reported here is of interest in that, during a course of in vivo desensitization, in which the therapist accompanied the patient on journeys through London, it was shown that, as the symptoms were alleviated, there were concomitant changes in his whole personality structure. He no longer needed to be a militant shop steward and developed an amicable relationship with his employers, and yet he was still able to negotiate a pay rise for the men. This suggests that the treatment had an effect on his hostility level, so that he could deal effectively with his superiors without the need to fight them. This has important theoretical and ethnical implications.

Adult↗
PubMed1986

Behavioural and drug treatments of phobic and obsessive-compulsive disorders.

The two most-used treatments for phobic and obsessive-compulsive disorders are exposure and drugs. In exposure therapy, the patient is persuaded to re-enter the phobia- or ritual-evoking situation and to stay there despite the ensuing panic until it starts to subside, which may take 1 h or more. The patient does this repeatedly and systematically, noting outcome in an exposure-homework diary which the clinician reviews. Controlled studies show that such self-exposure treatment (requiring little time from the clinician) has lasting value. Only a minority of cases need additional therapist-aided exposure. Antidepressants are useful adjuvants to exposure in dysphoric phobics and ritualisers. No antidepressant is clearly superior to any other. Relapse on stopping medication is a problem. Neither beta-blockers nor benzodiazepines are yet of proven lasting value for these syndromes. It is too easy to forget that drugs have unpleasant side-effects which are not seen with exposure therapy.

Agoraphobia↗
PubMed1989

Treatment of social phobia by homework exposure.

Ten consecutive patients suffering from DSM-III-R social phobia were treated by homework exposure assignments, without therapist-aided exposure or other cognitive-behavioral methods. The 7 patients who completed therapy displayed highly significant decreases in social phobic symptoms and anxiety. Such improvements were maintained on a 1-year follow-up.

Adult↗
PubMed1994

Should treatment distinguish anxiogenic from anxiolytic obsessive-compulsive ruminations? Results of a pilot controlled study and of a clinical audit.

In a small pilot controlled study over 8 weeks, 12 obsessive-compulsive ruminators listened for 2 h daily to their own audiotaped voice either (1) describing their anxiogenic thoughts (exposure) but omitting anxiolytic thoughts (mental/cognitive rituals), or (2) reading neutral prose or poetry. Taking all patients, both groups improved similarly. However, exposure patients who became anxious early in exposure slightly more improved. Consistent with this, in a clinical audit of 57 ruminators treated by trainee clinicians over 12 years, outcome improved significantly once practice changed so that exposure only involved anxiogenic thoughts, not anxiolytic thoughts, the latter being stopped.

Adult↗
PubMed1994

Cognitive-behavioral treatment of choking phobia: 3 case studies.

The present study describes 3 case examples of patients with choking phobia who were given a brief, cognitive-behavioral treatment that combined the interventions of psychoeducation, cognitive restructuring, interoceptive and in vivo exposure. This program was designed to address fears of anxiety and choking sensations as well as fears of swallowing. The patients were treated for 11-13 sessions. All 3 patients responded to the program as measured by their progression on their food hierarchy and by weight gain. Issues in the treatment of these patients are discussed.

Adult↗
PubMed1996

Does exposure to internal cues enhance exposure to external cues in agoraphobia with panic? A pilot controlled study of self-exposure.

BACKGROUND: The value of internal (interoceptive) cues for exposure is under debate and so was tested in a pilot controlled study. METHODS: Outpatients with panic disorder and severe agoraphobia were randomised to 10 weeks of self-exposure to either (1) both internal (interoceptive) and external cues (n = 12) or (2) external cues only (n = 14). Both groups were trained in slow deep breathing and asked to carry out daily self-exposure homework. Neither group had cognitive restructuring. RESULTS: By post-treatment and follow-up all outcome measures improved significantly in both treatment groups. The two groups did not differ significantly in outcome, though slightly more patients who had exposure to both internal and external cues improved 50% or more on phobic avoidance and fear. CONCLUSIONS: A larger controlled study is now worthwhile to tell if such small differences can be significant.

Adolescent↗
PubMed1996

Exposure and participant modelling in a case of injection phobia.

BACKGROUND: From the literature it appears that there may be two types of injection phobia, (1) the 'vasovagal' type, and (2) the 'resistant' type. The first type is characterized by a diphasic cardiovascular response during or after injection and by a tendency to react in a passive, nonresisting way when injected. The second type is characterized by strong, sometimes violent resistance and no vasovagal reaction to an injection. Characteristics of blood injury phobia apply to the first type, but not to the second. The possibility is considered that exposure may be an effective treatment in the first type, and participant modelling in the second type. METHOD: A single case study was carried out with a case of injection phobia of the second type in which exposure with modelling, followed by participant modelling of the injection, was applied. Measures of state anxiety (STAI) and heart rate were obtained. RESULTS: According to expectation, participant modelling of injections was effective in eliminating the fear of injections in a patient of the second type of injection phobia. CONCLUSIONS: The results of this study warrant further investigation of the model in a group design in which the differential treatment effects of exposure and participant modelling are tested.

Adult↗
PubMed1976

The current status of behavioral psychotherapy: theory and practice.

Behavioral psychotherapy has become one of the definitive treatments available for the relief of psychiatric suffering. Although hardly a panacea for all ills, the behavioral approach is the treatment of choice for certain selected problems. Behavioral methods make their contribution in the context of general psychiatric management and often must be used in conjunction with other treatment. The theoretical and practical aspects of behavioral psychotherapy have changed a great deal over the past few years and continue to evolve rapidly. Although useful molecular theories are emerging to guide the discipline, no global theory is likely to be satisfactory in the foreseeable future.

Anxiety↗
PubMed1976

Management of interpersonal issues in systematic desensitization.

The authors use the management of typical clinical problems that arise during systematic desensitization as a model for the analysis and solution of problems associated with behavior therapy techniques. Three main problem areas are considered: initiation of the technique, therapist and patient difficulties, and therapeutic decision making. The discussion is designed primarily to help therapists with varied backgrounds to deal with clinical issues that arise in the application of behavior therapy techniques such as systematic desensitization.

Behavior Therapy↗