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PubMed1996

Review: treatment of schizophrenia. State of the art.

As a result of the multifactorial etiopathology of schizophrenia, a treatment strategy combining drug therapy with psychosocial measures is indicated. Depending on the stage of the disease and on the individual condition of the patient, the accent is set alternatively more on one approach or on the other. However, under aspects of symptom reduction and relapse prophylaxis, the therapy with neuroleptics plays the most important role. In order to keep their side effects to a minimum during acute and long term treatment, there is nowadays a trend towards administration of the lowest possible dose. Under this aspect, the use of so called atypical neuroleptics should be taken into consideration. The treatment of negative symptoms, especially in the context of chronic residual syndrome, is still a problem which hasn't been solved to satisfaction. Beside the use of atypical neuroleptics, treatment with antidepressives should be tried. During the long term relapse prophylactic treatment, it is important that not only the criterion "reduction of the relapse rate" but also that of individual risk/benefit relation be considered. Concerning psychosocial therapies, especially focused behavioural therapy approaches, for example educational programs and specific family therapeutical intervention following the high-EE-concept, as well as training of social and cognitive competences have proved useful beside supportive psychotherapy and the whole range of sociotherapeutical measures. However they need further evaluation before they get integrated in routine treatment.

Antipsychotic Agents↗

PubMed1991

Evaluation of a psychological treatment for inflammatory bowel disease.

Inflammatory bowel disease (IBD) encompasses two related gastrointestinal-tract diseases, ulcerative colitis (UC) and Crohn's Disease (CD). This study, a randomized controlled trial, compared the effectiveness of a multi-component behavioral treatment package (n = 11), which included IBD education, progressive muscle relaxation, thermal biofeedback, and training in use of cognitive coping strategies, to the effectiveness of symptom-monitoring (n = 10) as a control condition; 8 controls subsequently completed treatment. At posttreatment, the treatment group showed mean reductions on 5 symptoms, while the symptom monitoring controls showed mean reductions on all 8 symptoms. On a measure of Total Symptomatic change, the controls showed more improvement than the treated group; the treated controls at posttreatment, showed increases on all 8 symptoms. However, treated subjects perceived themselves as coping better with IBD, as feeling less IBD-related stress, and as experiencing less depression and anxiety. It is hypothesized that inherent differences may have existed between CD and UC subjects which could have led to the differences seen in treatment responses.

Adaptation, Psychological↗

PubMed1991

AIDS risk and prevention among adolescents.

Although relatively few teenagers have been diagnosed with AIDS and the extent of asymptomatic human immunodeficiency virus (HIV) infection among adolescents remains largely unknown, there is cause for concern about teens' risk of contracting HIV disease The incubation period (the time from initial infection to the development of full-blown AIDS) is estimated to average eight years, and therefore it is probable that most of the individuals in their twenties who have AIDS (20% of all the people with AIDS) contracted HIV during their teenage years. The sexual and drug use activities of many teenagers place them at increased risk for HIV transmission. Sexually transmitted diseases (STDs) are pervasive and a major cause of morbidity among sexually active adolescents. The rates of STDs have continued to rise even during the 'age of AIDS'. These rates are of concern since the behaviors associated with the acquisition and transmission of STDs are also the behaviors associated with HIV transmission. In addition, the presence of STDs may increase the likelihood of HIV transmission. Although condoms reduce the risk of HIV transmission, their use remains low among sexually active teenagers. Reducing or eliminating high risk behaviors is the only way to limit further spread of HIV. Effective prevention programs should be based on models and theories of risk behavior so that the programs can be designed to change those factors which lead to the undesirable risky behaviors. The AIDS Risk Reduction Model (ARRM) is presented as an example of such a social-physiological model. The ARRM model characterizes why people persist in engaging in high risk activities or make efforts to alter those activities. The three stages theorized to be necessary to reduce risky sexual activities are: (1) recognizing that one's activities make oneself vulnerable to contracting HIV; (2) making the decision to alter risky sexual behaviors and committing to that decision; (3) overcoming barriers to enacting the decision, including problems in sexual communication and seeking help when necessary to learn strategies to reduce risky behaviors. Each stage includes a number of constructs identified in prior research as important for engaging in 'healthy' or low risk behaviors. Innovative strategies must be developed and implemented to reach all adolescents, ranging from teenagers who attend school and live with their families to those teens who are runaways, live in detention facilities or are otherwise 'disenfranchised'. To be most effective, HIV prevention programs must utilize strategies which combine cognitive and behavioral skills training.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗

PubMed2004

Cardiovascular fitness and neurocognitive function in older adults: a brief review.

We provide a brief review of the extant research on the influence of cardiovascular fitness training on brain and cognition. The review includes an examination of the non-human animal literature that has reported molecular, cellular, and behavioral consequences of fitness interventions. We relate this literature to human studies of the relationship between fitness and cognition, as well as the nascent literature on fitness influences on human brain structure and function with state-of-the art neuroimaging techniques. We also consider the important topic of participant adherence in clinical exercise trials. Finally, we suggest future directions for studies of cardiovascular fitness, aging, and neurocognitive function.

Aged↗

PubMed2006

Sustained neuroprotection and facilitation of behavioral recovery by the Ginkgo biloba extract, EGb 761, after transient forebrain ischemia in rats.

The effects of the Ginkgo biloba extract, EGb 761, on ischemia-induced learning/memory impairments and hippocampal damage were evaluated in a non-food motivated, aversive radial maze task (AvRM). Rats were subjected to 15 min transient, global cerebral ischemia (TGCI). In the first experiment, rats were rendered ischemic, and 23 days later were tested for acquisition performance (post-operative training). In a second experiment, rats were trained for 10 days and then subjected to ischemia (pre-operative training); the retention of cognition performance was assessed on days 31, 35 and 39 after ischemia. Acquisition and retention performances were expressed by (a) latency to find a goal box, (b) number of reference memory errors, and (c) number of working memory errors. EGb 761 (50 or 150 mg/kg) was given orally, starting before ischemia and continuing for up to 3 days after ischemia. TGCI markedly disrupted both acquisition and retention performance (p < 0.001-0.05). EGb 761 (150 mg/kg) completely reversed acquisition impairment as measured by the parameters 'latency' and 'number of reference errors' when performance was examined across sessions (p < 0.01-0.05). The total number of reference errors was also completely abolished by EGb 761 (150 mg/kg). However, EGb 761 did not statistically reduce the effects of TGCI on the parameter 'working memory errors' (across session and total). At 50 mg/kg, EGb 761 did not affect ischemia-induced acquisition impairment at all. The retention deficit caused by ischemia was not statistically reduced by EGb 761 (150 mg/kg), whatever examined across session or as total. EGb 761 reduced the extent of hippocampal CA1 cell loss (p < 0.01-0.001), an effect sustained at least up to 40 days after ischemia. These findings show that EGb 761 is effective in reducing, at least partially, both the cognitive impairments and hippocampal damage after TGCI in rats, and suggest that its effect on behavioral recovery may be dissociated from the neuroprotective effect on the hippocampus. The present results also validate the AvRM as an alternative, reliable behavioral test to assess the effects of drugs on behavioral recovery after ischemic brain damage.

Analysis of Variance↗

PubMed1988

Cultural and cognitive considerations in the prevention of American Indian adolescent suicide.

A description of cultural considerations associated with American Indian adolescent coping is presented within a transactional, cognitive-phenomenological framework. Select cultural values and cultural beliefs of American Indians associated with death are discussed in terms of person variables and situational demand characteristics that interplay in the transactional coping process. Three situational demand characteristics (ambiguity of identity, frequency of loss, and pervasiveness of hardships) are then presented to illustrate the reciprocal relationship between environmental contingencies and American Indian individual and community efforts at coping. The dynamic interdependence between person and environmental variables is emphasized and considered essential for inclusion in the design of interventions to prevent suicide. Existing intervention efforts with American Indian adolescent suicide attempters are reviewed and a school-wide cognitive behavioural approach based on the transactional model of coping with suicide is described. It is suggested that on-going cognitive restructuring, social skills training, and peer counselling training activities be culturally adapted and integrated into relevant areas of the school curricula in order that coping be enhanced and suicide ameliorated.

Adaptation, Psychological↗

PubMed1988

Group psychotherapy as an aid in the medical treatment of eczema.

The ongoing management of severe adult eczema is often difficult and problematic for both patient and doctor. A group of ten adult eczema patients were given group psychotherapy as a supplement to their regular medical regimen. Five target symptoms were rated on a biweekly basis first to establish individual baselines of disease course and later to measure treatment effect. The psychologic treatment combined behavioral and cognitive interventions with relaxation training. Patients used multiple self-rating sheets to provide feedback with the goal of increasing their skills in the management of scratching behaviors. At the end of treatment all ten patients showed significant reduction in targeted symptoms.

Behavior Therapy↗

PubMed1997

Pain coping and the pain experience during mammography: a preliminary study.

This study examined how pain coping efficacy and pain coping strategies were related to reports of pain during mammography. Subjects were 125 women over the age of 50 undergoing screening mammograms. Prior to their mammogram, all subjects completed the Coping Strategies Questionnaire (CSQ) to assess how they cope with day-to-day pain experiences. Ratings of pain during the mammogram were collected using a 6-point pain/discomfort scale, a 100-mm Visual Analog Scale, the adjective checklist of the McGill Pain Questionnaire, and the Brief Pain Inventory. Up to 93% of the women reported the mammogram examination was painful. On average, women rated the mammography pain in the low to moderate range. Considerable variability in pain ratings was found, however, with some women reporting severe pain and others reporting little or no pain. Correlational analyses were conducted to examine how coping efficacy (CSQ ratings of ability to decrease pain and ability to control pain) and coping strategies (CSQ pain coping strategy subscales) related to variations in pain report. There was a pattern for ratings of ability to decrease pain to be related to lower ratings of current mammography pain. Women who rated their ability to decrease pain as high reported lower average levels of mammography pain, lower ratings on the mammography pain/discomfort scale, and were much more likely to report having had lower levels of pain during their last mammogram. These findings suggest that women who rate their coping efficacy in decreasing day-to-day pain as low may be at higher risk for having a painful mammogram. Individual pain coping strategies were not generally correlated with pain ratings. Behavioral interventions (e.g., patient controlled breast compression) and cognitive therapy interventions (e.g., training in the use of calming self-statements or distraction techniques) designed to increase coping efficacy potentially could be useful in reducing pain in women who are at risk for pain during mammography.

Adaptation, Psychological↗

PubMedDate not supplied

Preventing illicit drug use in adolescents: long-term follow-up data from a randomized control trial of a school population.

National survey data indicate that illicit drug use has steadily increased among American adolescents since 1992. This upward trend underscores the need for identifying effective prevention approaches capable of reducing the use of both licit and illicit drugs. The present study examined long-term follow-up data from a large-scale randomized prevention trial to determine the extent to which participation in a cognitive-behavioral skills-training prevention program led to less illicit drug use than for untreated controls. Data were collected by mail from 447 individuals who were contacted after the end of the 12th grade, 6.5 years after the initial pretest. Results indicated that students who received the prevention program (Life Skills Training) during junior high school reported less use of illicit drugs than controls. These results also support the hypothesis that illicit drug use can be prevented by targeting the use of gateway drugs such as tobacco and alcohol.

Adolescent↗

PubMed2000

Group rehabilitation for cancer patients: satisfaction and perceived benefits.

Satisfaction with a group rehabilitation programme (GR) was evaluated in a heterogeneous group of cancer patients. Of the patients that were invited, 67% (N = 132) participated in the GR. The GR included eight sessions plus one booster-session, each including information and/or cognitive-behavioural techniques combined with physical training and relaxation and started approximately 4 months after diagnosis. Men and women participated to the same extent. A mailed questionnaire was used to assess patients' satisfaction, perceived benefits and level of difficulty of the GR components. The majority of patients stated that the number of sessions and timing of the GR was adequate. The usefulness of the GR components were rated in the following descending order: relaxation, physical training, encountering others in the same situation, breathing exercises, information and cognitive-behavioural skills. Patients were more satisfied with diagnosis-specific group meetings than with those including several diagnoses. Assessment of patient satisfaction seems appropriate to elucidate patient priorities.

Aged↗

PubMedDate not supplied

Getting off the fence: procedures to engage treatment-resistant drinkers.

Historically there have been few options for individuals seeking help for treatment-resistant loved ones with substance abuse problems. This article describes a program with empirical backing called Community Reinforcement and Family Training (CRAFT). This cognitive-behavioral treatment teaches the concerned significant other how to use behavioral principles to reduce the loved one's drinking and to encourage the drinker to seek treatment. Additionally it assists the concerned significant other in alleviating other types of stress and in introducing meaningful reinforcers into his or her own life.

Alcohol Drinking↗

PubMedDate not supplied

Pilot test of a behavioral skill building intervention to improve overall diet quality.

OBJECTIVE: To determine the effect of a cognitive and behavioral skills building intervention delivered via a small group or correspondence on improvement in total diet quality. DESIGN: Randomized, controlled trial comparing 2 intervention groups with a usual care (UC) group. PARTICIPANTS: Generally healthy men (n = 35) and women (n = 63); mean age = 49.6 years (range = 29 to 71 years). INTERVENTION: 20-session behavioral and cognitive skills curriculum to train participants to improve personal dietary habits that were inconsistent with public health guidelines. One group (weekly meeting [WM]) met in small groups with 2 cofacilitators. A correspondent (CR) group received the curriculum via mail and an interactive study Web site. The UC group received a copy of a consumer nutrition book. MAIN OUTCOME MEASURE: Modified Healthy Eating Index (MHEI) score derived from 9 components of the US Department of Agriculture's Healthy Eating Index. RESULTS: The WM group significantly improved their MHEI score compared with the CR (P =.04) and UC (P =.002) groups. The CR group's improvement in MHEI score was not significantly different from that of the UC group (P =.19). CONCLUSIONS AND IMPLICATIONS: A behaviorally focused intervention can improve overall diet quality, especially if delivered through small-group meetings.

Adult↗

PubMed2003

Do patients drop out prematurely from exposure therapy for PTSD?

Many studies have demonstrated the efficacy of exposure therapy in the treatment of chronic post-traumatic stress disorder (PTSD). Despite the convincing outcome literature, a concern that this treatment may exacerbate symptoms and lead to premature dropout has been voiced on the basis of a few reports. In this paper, we examined the hypothesis that treatments that include exposure will be associated with a higher dropout rate than treatments that do not include exposure. A literature search identified 25 controlled studies of cognitive-behavioral treatment for PTSD that included data on dropout. The results indicated no difference in dropout rates among exposure therapy, cognitive therapy, stress inoculation training, and EMDR. These findings are consistent with previous research about the tolerability of exposure therapy.

Humans↗

PubMed1995

Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents.

Substance-dependent adolescents (N = 34) in a residential drug treatment facility received either a 6-session behavior skills training HIV-risk reduction intervention or standard HIV education. After the intervention, adolescents who received behavior skills training exhibited increased knowledge about HIV-AIDS, more favorable attitudes toward prevention and condom use, more internal locus of control, increased self-efficacy, increased recognition of HIV risk and decreases in high-risk sexual activity. Self-report data were corroborated by records for the treatment of sexually transmitted diseases. The results from this pilot demonstration effort suggest that skills training based on cognitive-behavioral principles may be effective in lowering high-risk adolescents' vulnerability to HIV infection and warrant evaluation in a controlled comparison with a larger sample.

Acquired Immunodeficiency Syndrome↗

PubMed1995

The effects of smoking schedules on cessation outcome: can we improve on common methods of gradual and abrupt nicotine withdrawal?

This study compared the efficacy of 2 traditional methods of smoking cessation, gradual reduction and "cold turkey," with a new approach involving variation in the intercigarette interval. One hundred twenty-eight participants quit smoking on a target date, after a 3-week period of (a) scheduled reduced smoking (progressive increase in the intercigarette interval), (b) nonscheduled reduced smoking (gradual reduction, no specific change in the intercigarette interval), (c) scheduled nonreduced smoking (fixed intercigarette interval, no reductions in frequency), or (c) nonscheduled nonreduced smoking (no change in intercigarette interval or smoking frequency). Participants also received cognitive-behavioral relapse prevention training. Abstinence at 1 year averaged 44%, 18%, 32%, and 22% for the 4 groups, respectively. Overall, the scheduled reduced group performed the best and the nonscheduled reduced group performed the worst. Both scheduled groups performed better than nonscheduled ones. Scheduled reduced smoking was associated with reduced tension, fatigue, urges to smoke, withdrawal symptoms, increased coping effort (ratio of coping behavior to urges), and self-efficacy, suggesting an improved adaptation to nonsmoking and reduced vulnerability to relapse.

Adult↗

PubMed2006

The meeting of meditative disciplines and Western psychology: a mutually enriching dialogue.

Meditation is now one of the most enduring, widespread, and researched of all psychotherapeutic methods. However, to date the meeting of the meditative disciplines and Western psychology has been marred by significant misunderstandings and by an assimilative integration in which much of the richness and uniqueness of meditation and its psychologies and philosophies have been overlooked. Also overlooked have been their major implications for an understanding of such central psychological issues as cognition and attention, mental training and development, health and pathology, and psychological capacities and potentials. Investigating meditative traditions with greater cultural and conceptual sensitivity opens the possibility of a mutual enrichment of both the meditative traditions and Western psychology, with far-reaching benefits for both.

Humans↗

PubMed2005

Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: report of a multisite randomized trial.

Mothers of children with cancer experience significant distress associated with their children's diagnosis and treatment. The efficacy of problem-solving skills training (PSST), a cognitive-behavioral intervention based on problem-solving therapy, was assessed among 430 English- and Spanish-speaking mothers of recently diagnosed patients. Participants were randomized to usual psychosocial care (UPC; n=213) or UPC plus 8 sessions of PSST (PSST; n=217). Compared with UPC mothers, PSST mothers reported significantly enhanced problem-solving skills and significantly decreased negative affectivity. Although effects were largest immediately after PSST, several differences in problem-solving skills and distress levels persisted to the 3-month follow-up. In general, efficacy for Spanish-speaking mothers exceeded that for English-speaking mothers. Findings also suggest young, single mothers profit most from PSST.

Adaptation, Psychological↗

PubMed1996

Judgement research and neuropsychological assessment: a narrative review and meta-analyses.

The authors review judgment research in the area of neuropsychological assessment. Topics include the reliability and validity of judgments, the appropriateness of confidence ratings, the value of training and experience, the cognitive processes of neuropsychologists, and the use of decision aids, including automated assessment programs and statistical prediction rules. Most of the research is on reliability and validity. The results indicate that neuropsychologists frequently make reliable and moderately valid judgments. However, for several tasks, experimenters have not studied the reliability and validity of judgments.

Bias↗