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Behavior therapy in South Africa: a review.

Behavior therapy in South Africa has, after strong beginnings, undergone a slump which seems largely due to the drain of leading behavior therapists from this country. During the last decade there has been evidence of a revival of this approach, due largely to the increasing place of behavior therapy in clinical training curricula. Questionnaire and interview data from universities and hospitals indicated that therapy training was "eclectic" in the sense that interns and registrars were expected to master the basics of several approaches; and this was reflected in clinical practice in that most therapists used behavior therapy in conjunction with other approaches. It was noted that relatively little research in behavior therapy was published by South Africans, but that this appeared to be increasing in the last few years. Cross-cultural issues were assuming increasing importance as psychotherapeutic services were increasingly extended to the indigenous African population of this country, and it was suggested that behavior therapy was an effective approach in this context when due consideration was given to the cultural beliefs and patterns of the particular patient.

Behavior Therapy↗

Has behavior therapy drifted from its experimental roots? A survey of publication trends in mainstream behavioral journals.

In recent years it has been suggested that behavior therapy, characterized in part by single-subject designs and an idiographic approach to addressing practical problems, is drifting from its experimental roots. To examine trends in behavior therapy, and to provide an objective index of drift, two archival studies were conducted to identify publication trends in the use of single-subject designs vs. group designs, as well as citations to select basic behavioral science journals. In Study 1, articles appearing in Behavior Therapy from 1970 through 1996 were reviewed and categorized in terms of type of article, design, and citations to experimental journals. Findings from Study 1 suggest declining publication trends in single-subject designs and citations to experimental journals in Behavior Therapy, with a modest increase in the use of group designs over the period. Study 2 was designed to replicate and extend our initial findings by surveying three behavioral journals in addition to Behavior Therapy using the PsychLit database and years covering 1974 through 1996: Behaviour Research and Therapy, Journal of Behavior Therapy and Experimental Psychiatry, and Behavior Modification. Consistent with Study 1, results of Study 2 showed declining trends in single-subject designs for all mainstream behavioral journals. The significance of these findings in light of the argument that behavior therapy has drifted from its experimental roots is discussed, with emphasis on contingencies that may be responsible for the trends observed.

Behavior Therapy↗

Does behavior therapy normalize the classroom behavior of hyperactive children?

This study evaluated the effectiveness of eight weeks of intensive behavioral treatment in normalizing the classroom behavior of 28 children with attention deficit disorder with hyperactivity (ADDH). Using blind classroom observers, treatment efficacy was examined for full normalization, partial normalization, and the rate of hyperactive children classified as being like normals. Evidence for normalization was scarce. With treatment, there was no significant change in the percentage of hyperactive children classified as normal. Some normalization gains were found at midtreatment but were not sustained. Attention, activity, and impulsivity, the primary features of ADDH, were not normalized. Aggression, however, was consistently and fully normalized. The modification of aggression does not appear to remedy hyperactive behaviors. The clinical meaningfulness of treatment was minimal; the hyperactive children remained deviant in many aspects of classroom conduct.

Aggression↗

Behavioral therapy for overactive bladder.

What is behavioral therapy? On the one hand there is no consensus in the literature as to the definition of the treatment or the optimal mode of delivery. On the other hand, it is possibly the "best" single treatment for urinary incontinence when viewed from a risk:benefit analysis. There is general agreement that within this framework wide variations exist in intensity of treatment, expertise required to deliver the treatment, and the subsequent cost of therapy. A definition of behavioral therapy should include at least the following techniques: first, education and explanation of normal lower urinary tract function; second, micturition charts and diaries; and finally, timed voiding/bladder training regimens. All of the behavioral methods are demonstrably effective, with improvement rates in incontinence episodes uniformly in excess of 50%. Our challenge is to define the critical parts of behavioral therapy and develop algorithms that can be delivered to the incontinent population in the most cost-effective manner.

Behavior Therapy↗

Behavior therapy for obsessive compulsive disorder.

Behavior therapy for OCD with exposure and response prevention is effective in reducing obsessions and rituals in at least half of those suffering this disabling disorder. Office-based sessions in which patients participate actively in designing exposure and response prevention homework are usually sufficient. Therapist assistance is sometimes needed for those who fail to perform these assignments on their own. Poor compliance, severe comorbid conditions, and CNS-depressing drugs can interfere with behavior therapy. Techniques to manage these difficulties, including modifications of behavior treatment and the use of serotonin reuptake inhibiting drugs, can increase substantially the number of patients responsive to behavior therapy.

Adaptation, Psychological↗

[Behavior therapy with aggressive children].

Modern behavior therapy strategies which reduce aggressive behavior are based on developmental psychopathological assessments. These help to confirm intervention steps adapted to each specific age group. The extensive spectrum of methods in child behavior therapy offers different cognitive and social elements which are used to help the child effectively. The training for aggressive children by PeTERMANN and PeTERMANN (1994) which generally includes behavior-oriented family counselling shall be considered.

Aggression↗

Behavioral therapy: its application to reduce disruptive behaviors of the elderly in nursing homes.

Nurses who care for the elderly in nursing homes and auxiliary hospitals have many goals. They provide for the health, recreational, social and emotional needs of their patients. They also strive to increase their patients' levels of self-care and self-respect. Unfortunately, because many patients exhibit disruptive behaviors--striking staff or other patients, throwing temper tantrums, lying on the floor in corridors, refusing to take medication and so on, these desirable goals cannot always be met. What nurses need, in addition to their specialized, medically oriented training, is training in a consistent strategy for handling these problems. Behavioral therapy provides this strategy.

Aged↗

[Possibilities of cognitive behavior therapy in general practice].

Cognitive behavior therapy has achieved an important standing among the various approaches in psychotherapy. The article gives a short overview over the history of cognitive behavior therapy and delineates its applications in psychotherapy, especially in the treatment of mild to moderate depressions. Further indications include the treatment of anxiety disorders, as well as in the skills training and self-management of schizophrenic patients. Therapeutic experience underscores the importance of a multimodal concept, embedded in a trusting therapeutic relationship. Cognitive behavior therapy must not be viewed as mere therapeutic technique but rather as a therapeutic attitude with the goal of helping the patient achieve better self-efficacy.

Cognitive Behavioral Therapy↗

Behavior therapy: endogenous serotonin therapy?

In numerous controlled trials, behavior therapy involving exposure and ritual prevention, either alone or in combination with pharmacotherapy, has been found to be highly effective in treating obsessive-compulsive disorder (OCD) and panic disorder. Although some animal research suggests that serotonin level affects classical conditioning, there is little knowledge of the effect of conditioning or reconditioning on serotonin. Indirect support for such an effect comes from the neuroimaging research finding that behavior therapy, as well as pharmacotherapy with a serotonin reuptake inhibitor, normalizes glucose metabolism in successfully treated OCD patients. A novel, automated approach to making behavior therapy more widely available via telephone is discussed.

Behavior Therapy↗

What is behavior therapy? A very short description of behavioral weight control.

Behavior therapy of obesity is very widely used and is the subject of numerous reports in the medical literature. The background of this therapy is described and a table lists the 49 most commonly used elements of behavioral weight control as abstracted from five of the most widely read publications on the topic.

Behavior Therapy↗

[Behavior therapy in disorders of dietary behavior].

Behaviour therapies using conditioning principles have been successful in the treatment of some psychopatological eating behaviours. Such have been the cases for anorexia nervosae in adolescents and adults, refusal to eat in the young child and difficulties of swallowing. Some of these cases are described. Research has been done in different countries on the applications of these methods to the treatment of obesity caused by overeating which appears very frequently in our societies. Systematic and covert desensitization and operant conditioning using positive reinforcements are more frequently used in these behaviour modification procedures than aversive methods. More recently, researches on self-control (self-reward and self-punishment) have shown it as a very efficient tool for inducing weight loss. These methods using self-control have been applied to large populations: after a first, careful examination of the patient's eating behaviour, the program of reinforcement is established. It can be partially controlled by written instructions and letters. Results are already encouraging although they need to be followed up. But more research should be done on overeating behaviours, the way they appear and are maintained and on different programs of reinforcement for weight loss.

Adolescent↗

Clinical behavior therapy and the experimental analysis of behavior.

Advances in areas of behavior analysis are discussed to show the relevance of experimental science to behavior therapy. It is concluded that there are many areas of mutual interest between experimental operant psychologists and behavior therapists that may serve to enhance the clinical efficacy and range of behavior problems addressed by behavior therapists. Specific examination is given to areas of experimental behavior analysis such as reinforcement, including schedules of reinforcement; the matching law; advanced issues in stimulus control; the interaction between operant and classical conditioning; behavioral momentum; rule-governed behavior; and stimulus equivalence. The argument that behavior therapists are not knowledgeable about behavior analysis is disputed, and it is concluded that behavior therapists are in a unique position to be the practice professionals best able to utilize the principles of learning and behavior analysis in the service of adaptive behavior change.

Behavior↗

Long-term efficacy of simple behavioral therapy for daytime wetting in children.

PURPOSE: Behavioral therapy has proved benefit for children with daytime wetting but most studies have used biofeedback techniques and provide no long-term assessment of results. We previously reported similar results using simple behavioral therapy without biofeedback. We report the long-term efficacy of behavioral therapy for daytime wetting. MATERIALS AND METHODS: Our program of behavioral therapy included timed voiding, modification of fluid intake, positive reinforcement techniques and pelvic floor (Kegel) exercises to promote pelvic floor strengthening and relaxation. Questionnaires to assess therapeutic efficacy were mailed to patients who had completed therapy more than 1 year previously. RESULTS: A total of 48 patients responded. Mean ages at the time of the initial clinic visit and questionnaire were 8.2 and 12.9 years, respectively. Improvement in symptoms was noted in approximately 74% of the cases during the first year following therapy. At a mean of 4. 7 years after treatment 59.4% of the patients had improved daytime urinary control, 51.1% improved daytime urinary frequency and 45.6% improved daytime urinary urgency. The frequency of urinary tract infections decreased in 56.4% of the cases. Measures of psychological well-being were also noted to be improved in a majority of patients. A total of 77.3% of the patients stated that they would recommend the program to others. CONCLUSIONS: Simple behavioral therapy without biofeedback techniques is an effective and durable first line therapy for children with daytime wetting.

Adolescent↗

[Behavior therapy of anxiety disorders].

Behavior therapy is rapidly gaining on importance in the treatment of anxiety disorders. A brief overview of assessment and models of the origins and maintenance of anxiety is presented and demonstrated with a case example of strong avoidance behavior based on feared anxiety attacks in specific situations. The cognitive behavioral intervention comprised 4 sessions of treatment in the office with extensive self-exposure to the feared and previously avoided situation, namely driving the car on the highway and visiting shopping centers, between sessions. The exposure treatment in conjunction with cognitive restructuring and provided problem solving strategies lead to rapid elimination of avoidance behavior as well as the fear of anxiety attacks within one month. Two years later, the patient is free of the previously presented symptoms.

Adult↗

An open trial of outpatient group therapy for bulimic disorders: combination program of cognitive behavioral therapy with assertive training and self-esteem enhancement.

The purposes of this study were to examine the therapeutic efficacy of combined group cognitive behavioral therapy (CGCBT) and to explore the characteristics of the patients who failed to complete it. Our group cognitive behavioral therapy combined with assertiveness training for alexithymia and self-esteem enhancement therapy were attended over a 10-week period. Twenty-five participants were enrolled in the study. The clinical symptoms were assessed before and after treatment, using rating scales including the Eating Disorder Inventory-2, the Bulimic Investigatory Test, Edinburgh, the Toronto Alexithymia Scale, the Rosenberg Self-Esteem Scale, and Global Assessment of Functioning. Sixteen participants (64%) completed the CGCBT program. Completion of the CGCBT resulted in significant improvements in reducing binge-eating behavior and improving social functioning. Eight patients (32%) significantly improved using the Clinical Global Impression Change (CGI-C). Stepwise logistic regression analysis of the results indicated that a lower age (P=0.04) and psychiatric comorbidity (P=0.06) were predictors of dropout from the CGCBT program. Our CGCBT program is a promising first-line treatment for bulimic outpatients. Lower age and the presence of comorbidity had effects on dropout rates.

Adult↗