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PubMed2005

Day treatment programme for patients with eating disorders: randomized controlled trial.

AIM: This paper reports a randomized controlled trial to compare the effects of day treatment programmes for patients with eating disorders with those of traditional outpatient treatment. BACKGROUND: Eating disorders are common, especially in adolescents, and their worldwide prevalence is increasing. Treatment interventions for patients with eating disorders have traditionally been offered on an outpatient or inpatient basis, but the recent introduction of day hospital programmes offers the possibility of greater cost-effectiveness and relapse-prevention for this population. METHODS: Volunteers from an outpatient clinic for eating disorders were randomly assigned either to a treatment group (n = 21), participating in a modified day treatment programme based on the Toronto Day Hospital Program, or to a control group (n = 22) receiving a traditional outpatient programme of interpersonal psychotherapy, cognitive behaviour therapy and pharmacotherapy. Data were collected from January to December 2002 using the Eating Disorder Examination, Eating Disorder Inventory-2, Beck Depression Inventory, and Rosenberg Self-Esteem Scale. RESULTS: Participants in the day treatment programme showed significantly greater improvements on most psychological symptoms of the Eating Disorder Inventory-2, frequency of binging and purging, body mass index, depression and self-esteem scores than the control group. They also showed significant improvement in perfectionism, but the group difference was not significant. CONCLUSION: Nurses in day treatment programmes can play various and important roles establishing a therapeutic alliance between patient and carer in the initial period of treatment. In addition, the cognitive and behavioural work that is vital to a patient's recovery, that is, dealing with food issues, weight issues and self-esteem, is most effectively provided by a nurse therapist who maintains an empathic involvement with the patient.

Adult↗
PubMed1989

Stress and coping in families with ill or disabled children: application of a model to pediatric therapy.

Chronic illness or disability of a child is a specific stressor affecting the entire family. To analyze the factors influencing the family's stress response, the ABCX and Double ABCX Models of Family Stress are reviewed. Four factors of the model which are particularly relevant when applied to the experience of the family with a chronically ill or disabled child are discussed: the specific characteristics of the child's disorder, the family's perception of the stressor, the chronicity of the problem, and the social network of the family. Therapists having frequent and intimate contacts with families may benefit from knowledge of the factors of the model to enhance their ability to reduce family stress. Specific therapist roles in reducing stress are respecting the parents' emotional and social needs, interpreting and anticipating medical and developmental events, and facilitating functional adaptation of the child. Health care professionals in pediatrics frequently encounter families under tremendous stress related to serious health problems in a child. The professionals' words and actions, their management of the family and the child, their responses to the parents' behaviors all are potential sources for ameliorating or increasing stress on the family. Professionals who deal with children with chronic disabilities or illnesses, and with their families, must empathize with the experience of parents in the foreign world of medicine and disability, respect the immediacy and gravity of their concern, and tolerate their occasional confusion and irrational behavior. Physical therapists and occupational therapists in pediatrics have both the opportunity and responsibility to enhance the effective coping of parents who struggle to deal with their child's difficulties and the stress their child's problems place on the entire family. To be effective, therapists must understand the factors and processes of family coping. Models which structure family response to stressors and coping efforts have been developed to facilitate analysis of the complex processes. Hill developed the original ABCX model of family stress, which McCubbin and Patterson expanded into the Double ABCX Model of Adaptation, identifying factors affecting a family's adjustment to a severe ongoing stressor (Figure 1). The expanded model includes the family's adjustment to cumulative effects of the stressor after the impact of the original crisis. Both the original ABCX and the expanded Double ABCX models identify variables which account for observed differences among families' adaptations to stressful situations.

Journal Article↗
PubMed2003

Empathy, communication, deception.

Empathy is understood as a mode of understanding operating on a subconscious level of mental processing. The cognitive element can only abstractly be distinguished from its affective expression. When recognizing a fellow creature we involuntarily sympathize with it. Recognition of covert motivations of overt behavior is the first step in formation of a communication channel between two (or more) empathizing agents. Yet, since communication evolved in variably complex social environments it was subject to pressure of conflicting individual interests. Deception thus evolved as an adaptive evolutionary strategy. Empathic understanding does not necessarily entail recognition of agent's real intentions. Deception may be achieved on both conscious and unconscious processing levels. A sufficient degree of biopsychosocial maturity must be reached for a child to be able to independently recognize verbal and non-verbal communication finesses. Once this level has been attained, the prevailing emotional orientation determines his/her degree of empathizing competence.

Communication↗
PubMed1994

The teaching of empathy for high school and college students: testing Rogerian methods with the Interpersonal Reactivity Index.

The teachability of empathy is discussed with particular regard to developmental issues. One hundred and four high school and college students were administered Davis's (1980) Interpersonal Reactivity Index (IRI) both before and after a standard course of Rogerian-based peer facilitation skills training. The IRI offers four independent subscales which measure the cognitive and affective components of empathy. Statistically significant findings indicate greater developmental readiness for learning empathic communication in the college sample, particularly for subscales measuring Empathic Concern and Perspective Taking. A group of untrained college students taking a course in behavioral psychology showed no progress on any IRI subscales. Although college females began with higher empathy scores, both genders were equally teachable. Implications for prevention and counseling readiness are discussed, along with suggestions for future research.

Adolescent↗
PubMed2004

Behavioral and emotional response of Japanese macaque (Macaca fuscata) mothers after their offspring receive an aggression.

The authors of this study investigated the behavioral and emotional response of female Japanese macaques (Macaca fuscata) to an aggression received by their offspring to evaluate the existence of cognitive empathic responses in a naturalistic setting. After their offspring received an aggression, mothers did not direct increased affiliative contacts to them. The factors likely to affect the degree of distress in the offspring or the perceived risk for the mother failed to appropriately modulate maternal behavior. Finally, mothers did not increase their frequency of scratching (a behavioral indicator of anxiety) after their offspring had received an aggression. The results suggest Japanese macaque mothers may be unable to understand their offspring's need for distress alleviation after the receipt of aggression.

Aggression↗
PubMed2001

Impact of the therapist-child dyad on children's pain and coping during medical procedures.

This study examined the effects of physical therapists' behaviors on the levels of distress and coping of 32 children (19 males, 11 females; age range 2.6 to 9.1 years) during a painful medical procedure. This is the second study to assess children throughout rehabilitation following selective posterior rhizotomy and the first to assess the impact of physical therapists' behaviors. Results of the Child-Adult Medical Procedure Interaction Scale-Revised confirmed the hypotheses that: (1) children exhibit more coping behaviors and fewer distress behaviors over time, and (2) positive relationships exist between coping-promoting behaviors in physical therapists and coping in children, and distress-promoting behaviors in physical therapists and distress in children. Prompts for children to use a coping strategy, reassuring comments, and non-procedural talk by therapists explained 67% of the variance in children's coping. Criticism, reassurance, checking child's status, praise, and empathic statements by therapists explained 65% of the variance in children's distress. Older children and children with higher IQ scores exhibited more coping behaviors.

Adaptation, Psychological↗
PubMed2004

Behavioral interventions for dual-diagnosis patients.

Dual diagnosis patients come to treatment with a variety of deficits,talents, and motivations. A biopsychosocial treatment plan involves multiple interventions, including medications, medical treatment, psychotherapy, family therapy, housing, and vocational rehabilitation. Treatment must be individualized and integrated, and this requires collaboration among a variety of health caregivers. There is empirical evidence that dual-diagnosis patients can be helped to stabilize, to remain in the community,and even to enter the workforce. Behavioral interventions are key ingredients to integrated and comprehensive treatment planning. There is no single model for dual disorders that explains why substance use and psychiatric illness co-occur so frequently. Mueser et al described four theoretical models accounting for the increased rates of comorbidity between psychiatric disorders and substance use disorders. They suggested that there could be a common factor that accounts for both, primary psychiatric disorder causing secondary substance abuse, primary substance abuse causing secondary psychiatric disorder, or a bidirectional problem, where each contributes to the other. There is evidence for each, although some are more compelling than others, and none is so compelling that it stands alone. Although family studies and genetic research could explain the common factor, no common gene has appeared. Antisocial personality disorder has been associated with very high rates of substance use disorders and mental illness; however, its prevalence is too low to explain most of the co-occurring phenomena. Common neurobiology, specifically the dopamine-releasing neurons in the mesolimbic system, also may be involved in mental illness, but this is not compelling at the moment. The Self-medication model is very appealing to mental health professionals, as an explanation for the secondary substance abuse model. Mueser et al suggest that three lines of evidence would be present to support this explanation: (1) patients would report beneficial effects of substance use on their symptoms; (2) epidemiology would report that a specific substance would be used by specific psychiatric disorders, and (3) psychiatric patients with severe symptoms would be more likely to abuse substances than those with mild symptoms. Unfortunately the research data do not support these. The primary substance abuse causing secondary psychiatric disorder model could be explained by neuronal kindling from substance-induced disorders. Patients who develop the psychiatric disorder after the substance use disorder do have a course of illness similar to those with a psychiatric disorder, but without substance use disorder. The bidirectional model is consistent with the tendency of disturbed teenagers to socialize with youth using alcohol and drugs; however, this model has not been tested rigorously in research studies. With such a disparate set of models, behavior interventions are conceptualized best as a multi-component program, a treatment plan that generates a problem list and devises an intervention to respond to each member of the list. This requires a talented, multi-disciplinary team or network that can assess carefully and package the interventions creatively, and dose the treatment components empathically to fit the patient's tolerance, motivation, and abilities.

Behavior Therapy↗
PubMed1992

Perinatal loss. A critique of current hospital practices.

Dramatic improvements in the hospital management of perinatal loss have taken place in the past 20 years. However, there has been no critical examination of current approaches. Four possible hazards of current hospital practice are described: 1) Institutionalization of bereavement: Instead of offering parents an empathic awareness of the unique dimensions of their perinatal loss, caregivers often interact according to detailed behavioral protocols. 2) Idealization of contact with the dead baby: This approach may equate actual physical contact with the dead child with the more complicated and variable process of mourning. 3) Homogenization of grief: Counselors tend to denigrate different grief responses by focusing on a preconceived grief reaction. Thus, they may mistakenly label many such reactions pathologic if they deviate from the rigidly prescribed "norm." 4) Lecturing the bereaved: Telling parents the "right" thing to do may deprive them of a crucial aspect of the process that empowers parents after they experience the helplessness associated with perinatal loss--that of making their own decisions. These problems are illustrated by a clinical vignette, and alternative approaches are explored.

Bereavement↗
PubMed1981

Empathic versus directive preparation of children for needles.

A review of the literature on preparation of children for medical procedures revealed that: (1) preparation is widely recommended but there is little empirical evidence documenting its effectiveness, (2) the relative efficiency of different preparations generally has not been determined, and (3) preparation for procedures that are routine for medical personnel but painful and stressful for children (e.g., fingers sticks) has not received much attention. The present study compared the reactions of a group of children that received empathic, supportive preparation for needles (including statements such as, "It is going to hurt a little," and "I don't mind if you cry.") with a group that was told to be big, brave, and not cry. The group that was instructed not to cry actually cried more, and had more other negative reactions, than did the empathically prepared group. Thus, style of preparation even for routine medical procedures can affect children's behavior and medical personnel might benefit from instruction in effective preparation techniques.

Analysis of Variance↗
PubMed1999

Assessing the critical behavioral competencies of outstanding managed care primary care physicians.

This study used job competence assessment to identify the behavioral characteristics that distinguish outstanding job performances of primary care physicians (PCPs) within a network-model HMO. Primary care physicians were chosen for the study based on six standard performance measures: (1) member satisfaction, (2) utilization, (3) patient complaints, (4) emergency room referrals, (5) out-of-network referrals, and (6) medical record completeness. Outstanding PCPs (N = 16) were identified as those performing within one standard deviation above the mean on all six of the performance measures. A control group of typical PCPs (N = 10) was selected from those performing outside the peer group mean on at least two performance measures. Subjects were administered the Behavioral Event Interview and the Picture Story Exercise. Higher overall competency levels of achievement orientation, concern for personal influence, empathic caregiving, and empowerment drive distinguished outstanding from typical PCPs. Outstanding PCPs also had higher overall frequency of competency in building team effectiveness and interpersonal understanding when compared with typical PCPs. This study suggests that PCP performance is the product of measurable competencies that are potentially amenable to improvement. Competency assessment and development of PCPs may benefit both organizational efficiency and physician and patient satisfaction.

Behavior↗
PubMed1995

Patient-therapist interaction in the behavioral treatment of panic disorder with agoraphobia.

Although effective behavioral techniques have been developed, what aspects of the patient-therapist interaction affect treatment outcome remain largely unknown. This study hypothesized that the interaction between patient and therapist develops over several phases. Further, the association between behavior modes and treatment outcome was expected to alter as that interaction developed. Thirty patients diagnosed with panic disorder with agoraphobia were treated with a standardized behavioral treatment program of 12 sessions. The interpersonal verbal therapist and patient behavior modes were studied at Sessions 1, 3, and 10, using an observational instrument. It was found that behavior modes change over the course of treatment, in line with predictions derived from social-psychological models. The hypothesis that establishing a therapeutic relationship requires an empathic and nondirective stance by the therapist in Session 1 was partly confirmed.

Adolescent↗
PubMed1979

Child rearing and children's prosocial initiations toward victims of distress.

Maternal rearing behavior was examined in relation to children's reparation for transgressions and altruism as bystanders to distress in others. The children were 1 1/2-2 1/2 years old. Mothers were trained in techniques of observing. They recorded their child's reactions and their own behaviors in everyday encounters with expressions of distress in others (sorrow, discomfort, pain). Distress was also simulated by mothers and investigators. Mothers' empathic caregiving was rated during home visits. Mothers' affectively delivered explanations regarding the distresses their children had caused to others were associated with children's reparations for transgressions. Such explanations were also associated with children's altruism when they were bystanders to another's distress. Empathic caregiving by mothers was positively associated with children's reparation and altruism. Findings are discussed in relation to theories of altruism, conscience, and child rearing.

Altruism↗
PubMed1987

Developmental origins of moral masochism: a failure-to-thrive toddler's interactions with mother.

The case of a toddler diagnosed as failure to thrive with an unusual history of "accidents" illustrates the circumstances which may account for the infant's intense attachment to a sadistic love object and lead to moral masochism in adulthood. The observed behaviors of the toddler in interaction with mother show the pathological consequences of the infant's openness to influences of the social environment. He becomes attuned to his mother's wishes and performs behaviors which successfully evoke her attention and reciprocity even if these behaviors are contradictory to his survival. The mother's own experiences with unempathic and hostile parents are reflected in her attitudes and behaviors to the child. Suffering and victimization evoke her interest although she lacks the capacity for an empathic response to pain. Berliner's work on the origin of moral masochism, as well as the work of Steele on generational repetition, suggest the processes through which the infant's attachment to a sadistic mother gives rise to masochistic tendencies which may be reenacted throughout life in an effort to reproduce the affective feelings associated with mother's love and affection.

Attention↗
PubMed1997

Deconstructing the myth of the neutral analyst: an alternative from intersubjective systems theory.

A critique is offered of four conceptions of neutrality that have been prominent in the psychoanalytic literature: neutrality as (1) abstinence, (2) anonymity, (3) equidistance, and (4) empathy. It is argued that once the psychoanalytic situation is recognized as an intersubjective system of reciprocal mutual influence, the concept of neutrality is revealed to be an illusion. Hence, interpretations are always suggestions, transference is always contaminated, and analysis are never objective. An alternative to neutrality is found in the investigatory stance of empathic-introspective inquiry. This mode of inquiry is sharply distinguished from the prescribing of self-expressive behavior on the part of analysis, and the distinction is illustrated with a clinical vignette.

Adult↗
PubMedDate not supplied

"I got some swords and you're dead!": violent fantasy, antisocial behavior, friendship, and moral sensibility in young children.

Relations between an early interest in violent fantasy and children's social understanding, antisocial and emotional behavior, and interactions with friends were investigated in 40 "hard-to-manage" preschoolers and 40 control children matched for gender, age, and school and ethnic background. Children were filmed alone in a room with a friend, and tested on a battery of cognitive tests, including false-belief, executive function, and emotion understanding tasks. Teachers reported on their friendship quality. At age 6 years, the children's understanding of the emotional consequences of antisocial and prosocial actions was studied. The hard-to-manage group showed higher rates of violent fantasy; across both groups combined, violent fantasy was related to poor executive control and language ability, frequent antisocial behavior, displays of anger and refusal to help a friend, poor communication and coordination of play, more conflict with a friend, and less empathic moral sensibility 2 years later. The usefulness of a focus on the content of children's pretend play-in particular, violent fantasy-as a window on children's preoccupations is considered.

Age Factors↗
PubMed2004

Essential characteristics of effective Balint group leadership.

OBJECTIVE: Balint work in the United States has suffered from a lack of written material on how Balint group leaders structure and guide group process. This study identified characteristics of effective Balint group leadership by gathering information from experienced Balint leaders. METHODS: We used evaluations of the leadership methods used by 21 Balint group leaders assembled at an American Balint Society workshop to pilot test the Society's credentialing process. Free text and rating data from leader evaluation forms were analyzed using qualitative text analysis and factor analysis. We also conducted focus groups. RESULTS: Convergence was seen on several characteristics across all sources of data. Effective Balint leaders operate to create a safe environment and move the group toward a new understanding of a specific doctor-patient relationship. Specific leader behaviors include protecting the presenter from interrogation, encouraging open speculation by group members, avoiding premature solutions, and tolerating silence and uncertainty. DISCUSSION: Although Balint group leaders rely on behaviors common to other small-group methods, they create a space and purpose markedly different from that seen in other small groups in medical education. Balint group leaders model and create a safe environment for shared, creative speculation and a more empathic experience of the doctor-patient relationship.

Behavior↗
PubMed1982

Patient characteristics that influence physician behavior.

We examined whether four patient characteristics (age, ethnicity, sex and appearance) influenced five physician behaviors with the patient (interviewing, nonverbal attention, courtesy, information giving and empathy). Ten physician-patient interactions were observed through a one-way mirror for each of 15 physicians. Physicians were rated higher on information giving (p = 0.002) and empathic skills (p = 0.02) when they were with female patients; on interviewing (p = 0.02) and empathy (p = 0.0007) with Anglo-American compared with Spanish-American patients; on interviewing (p = 0.01), nonverbal attention (p = 0.001) and courtesy (p = 0.02) when with the best groomed patients; and on courtesy (p = 0.03) with elderly patients. In addition, there were fewer physician-initiated interruptions with female patients (p = 0.03) and with well-groomed patients (p = 0.02). Each of the four patient characteristics studied acted independently in influencing physician behavior. The recognition that patient characteristics influence physician behavior should stimulate physicians to examine their reactions in order to insure that all types of patients receive thorough, courteous and empathic care.

Adult↗