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Interaction of neuropsychological and psychological factors in two cases of "space phobia".

Recent theories of psychological disorders are beginning to break down the traditional dichotomy between mental and physical processes. The present paper reports on two cases of space phobia in which this is especially apparent. Neuropsychological assessment indicated subtle disturbance in visuospatial functioning. The emotional response to this dysfunction appeared, however, to be somewhat excessive given the subtlety of the deficit. This is seen as a psychological reaction to a neuropsychological dysfunction.

Accidental Falls↗

Graded work exposure to promote work return after severe hand trauma: a replicated study.

Fifty-one patients with posttraumatic stress disorder after work-related hand injuries were placed on a graded work exposure program to facilitate return to work. These patients consisted of an initial group of 25 patients and a replication group of 26 patients. The program returned 92% of the initial group and 88% of the replicated group to work with their previous employers. At 6-month follow-up, 88% of the initial group and 80.1% of the replication group were still working full-time at the jobs to which they had returned. All of the patients not working with their previous employer at follow-up had appraisal/projected flash-backs, which have previously been associated with a 90% failure to return to work. This intervention was successful with 73% of the patients experiencing such flashbacks. In conclusion, graded work exposure was an effective treatment to promote return to work for patients experiencing significant psychological symptomatology after severe hand injury.

Accidents, Occupational↗

Strategies for living: teaching psychological self-help as adult education.

This paper briefly describes some of the traditional approaches to teaching psychological skills and self-help techniques to non-psychologists. It is stressed that there have been few attempts to teach individuals a broad range of self-help strategies for dealing with psychological problems. The paper goes on to give a detailed description of a 12-week course of adult education evening classes designed for this purpose. During the course participants were taught strategies to improve self-awareness and relationships, to control anxiety, confront fears, reduce worrying thoughts, fight depression and cope with major life changes. In the main it appeared that students were able to assimilate and benefit from the techniques offered. It was concluded that adult education classes are an appropriate way of teaching psychological self-help, and provide a relevant alternative to more traditional treatment approaches.

Adult↗

Progress in the treatment of female sexual dysfunction.

Over a decade of research since the publication of Human Sexual Inadequacy by Masters and Johnson has confirmed the effectiveness of psychological treatment for sexual problems, but has not advanced our understanding of aetiology very much. It is generally assumed that anxiety blocks normal function in sexual disorders such as impotence or frigidity, although hormonal changes have also been suggested. Evidence for either proposition is lacking. Our own attempts to understand mechanisms have included the use of a dismantling strategy to investigate the effective components of psychological treatment, and latterly the role of exogenous androgens. In our first study, brief treatment modelled on that of Masters and Johnson proved superior to another version of graded practice in sexual contact which lacked the counselling component. Similarly, the fuller version had more effect than did imaginal desensitization, suggesting that sexual dysfunctions cannot be treated like phobic anxiety. A second study focused on women complaining of little sexual interest or enjoyment. The use of a minor tranquillizer was compared with that of androgen (testoral) in the hope that different treatments would be shown to be best for different types of disorder. Unexpectedly, the androgen proved best overall while another variable, monthly vs weekly sessions, did not produce any differences in effect. In the most recent study, a further 48 women were given androgens or placebo, and were seen weekly or monthly for four months by either one or two therapists. There were few significant differences, the most consistent being greater subjective improvement by the women being seen at weekly intervals. The failure to find a positive hormone effect in comparison with placebo raises the possibility that the anxiolytic used earlier may have been counter-productive. If so, it seems unlikely that either excessive anxiety or simple androgen deficiency is an adequate aetiological explanation for female sexual dysfunction.

Anxiety↗

A follow-up study on short-term treatment of agoraphobia.

The differential effectiveness of three treatment packages for agoraphobia was tested. Patients received one of three short-term treatments: Breathing Retraining and Cognitive Restructuring, graded Self-Exposure in vivo, or a combination of both. No differential effects were found between the treatment conditions at posttest and at an 18 months follow-up. Improvement at follow-up assessment was associated with whether patients had further treatment during the follow-up period. No relationship was found between further improvement and demographic variables, pre- and posttest scores on psychological questionnaires or the use of medication at follow-up. Implications of these findings are examined.

Adult↗

The management of severe dental phobia in an adolescent boy: a case report.

Dental fear is a widespread problem that represents one of the major barriers to dental care. This report describes a case study of a 12-year-old boy who presented with dental phobia characterized as 'fear of catastrophe', 'generalized dental fear' and 'fear of specific stimuli'. The referral came from his general dental practitioner who had been unable to carry out even the simplest dental procedure on him. The patient required prevention, conservation and root canal therapy. The case illustrates the use of physical strategies, including muscle relaxation and relaxation breathing; practice strategies, including graded exposure and cognitive strategies, combined with individual control methods and inhalation sedation to successfully complete the dental treatment plan.

Adaptation, Psychological↗

Virtual reality based experiential cognitive treatment of anorexia nervosa.

The treatment of a 22-year old female university student diagnosed with Anorexia Nervosa is described. In the study the Experiential Cognitive Therapy (ECT) was used: a relatively short-term, integrated, patient oriented approach that focuses on individual discovery. Main characteristic of this approach is the use of Virtual Reality, a new technology that allows the user to be immersed in a computer-generated virtual world. At the end of the in-patient treatment, the subject increased her bodily awareness joined to a reduction in her level of body dissatisfaction. Moreover, the patient presented a high degree of motivation to change. The results are discussed with regard to Vitousek, Watson and Wilson (1998, Clinical Psychology Review, 18(4), 391-420) proposal of using the Socratic Method to face denial and resistance of anorectic patients.

Adult↗

Treatment of a man with a mild learning disability who was sexually assaulted whilst in prison.

The aim of this study is to describe the psychological effects on a man with a mild learning disability who was sexually assaulted whilst in prison, and the treatment which was carried out. J. suffered Post-Traumatic Stress Disorder (PTSD), as defined in DSM-III-R, combined with associated features of depression and anxiety. Treatment involved imaginal exposure to the assault, followed by systematic desensitization to the traumatic experience of imprisonment preceding the assault. Activities were also carried out to develop J.'s self-esteem, coping strategies and anxiety management. The successful outcome of treatment is discussed in relation to models of emotional processing. Some discrepancies between scores on self-evaluation questionnaires and behavioural observations raise issues concerning the best way of assessing treatment outcome for people with learning disabilities.

Adult↗

Assessment and treatment of social phobia.

Social phobia is an anxiety disorder characterized by heightened fear and avoidance of one or more social or performance situations, including public speaking, meeting new people, eating or writing in front of others, and attending social gatherings. People with social phobia are typically anxious about the possibility that others will evaluate them negatively and/or notice symptoms of their anxiety. Social phobia affects up to 13% of individuals at some time in their lives and is usually associated with at least moderate functional impairment. Research on the nature and treatment of social phobia has increased dramatically over the past decade. As with many of the anxiety disorders, sensitive assessment instruments and effective treatments now exist for people suffering from heightened social anxiety. Typical assessment strategies include clinical interviews, behavioural assessments, monitoring diaries, and self-report questionnaires. Treatments with demonstrated efficacy for social phobia include pharmacotherapy (for example, phenelzine, moclobemide, selective serotonin reuptake inhibitor [SSRI] medications) and cognitive behaviour therapy (CBT) (for example, cognitive restructuring, in vivo exposure, social skills training). Although preliminary comparative studies suggest that both approaches are about equally effective in the short term, each approach has advantages and disadvantages over the other. Trials examining combined psychological and pharmacological treatments are now under way, although no published data on the relative efficacy of combined treatments are currently available.

Anti-Anxiety Agents↗

Food exposure in patients with bulimia nervosa.

BACKGROUND: The aim of the study was to investigate psychological and physiological responses of bulimic patients to the repeated presentation of food cues. METHOD: On 2 subsequent days, 48 bulimic women (DSM-IV) were confronted with high- or low-caloric food for 20 min. A control group (n = 24) was exposed to high-caloric food once. Blood sugar levels were manipulated with a glucose load. RESULTS: High-caloric food only elicited increases in urge to binge, subjective and physiological stress in the first session. During the second session, reported urge to binge and subjective stress was significantly lower. Bulimic patients confronted with high-caloric food showed higher subjective and physiological stress in the first session compared to bulimic patients confronted with low-caloric food. In the second session, they reported more subjective stress and urge to binge, compared to the low-caloric group. Blood sugar levels did not affect psychological and physiological responses. DISCUSSION: The results are discussed in terms of the conditioning model of binge eating model, habituation models and implications for exposure therapy.

Adolescent↗

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↗

[Social phobia: clinical and therapeutic approach].

Although social phobia is a real pathological condition, it has often been neglected. In fact, social phobia is among the least studies of the major anxiety disorders. This is quite surprising, as approximately 2% of the population suffer from debilitating social phobia with devastating effects on career and quality of life, and as this disorder can now be considered as a treatable condition. After defining social phobia, the authors will describe the prevalence, clinical features and etiology of social phobia. Effective psychopharmacological and psychological treatments of social phobia will also be reviewed. The drugs that have been most studied are monoamine oxidase inhibitors and beta-blockers. Several controlled studies have also concluded that behavioral and cognitive therapies (exposure in vivo therapy, social skills training, cognitive restructuring) are beneficial for social phobics. The combination of psychopharmacotherapy and psychological interventions also seems promising. Finally, as it is necessary to distinguish among various subtypes of social phobia, further studies will have to investigate whether specific subtypes do better or worse with specific treatments.

Cognitive Behavioral Therapy↗

Psychological treatment of three urban fire fighters with post-traumatic stress disorder using eye movement desensitisation reprocessing (EMDR) therapy.

Fire fighters are at increased risk of developing mental health problems due to the nature of their work, which can sometimes be extremely traumatic. Arranging for immediate access to mental health specialists can often take a protracted time to arrange, leading to the individual remaining disabled and off work. The South Wales fire and rescue service have responded to this challenge and formed a partnership with their local NHS traumatic stress service. This has enabled fire fighters to receive early psychological assessment and treatment from a nurse therapist trained in cognitive behaviour therapy or referred to a consultant liaison psychiatrist. This paper will describe 3 cases which all suffered with PTSD and were treated via the partnership with a controversial therapy EMDR.

Adult↗

Brief treatment for elementary school children with disaster-related posttraumatic stress disorder: a field study.

Effective psychological intervention is needed to help children recover from disaster-related posttraumatic stress disorder (PTSD). This controlled study evaluated the effectiveness of a brief intervention for disaster-related PTSD. At one-year follow-up of a prior intervention for disaster-related symptoms, some previously treated children were still suffering significant trauma symptoms. Using a randomized lagged-groups design, we provided three sessions of Eye Movement Desensitization and Reprocessing (EMDR) treatment to 32 of these children who met clinical criteria for PTSD. The Children's Reaction Inventory (CRI) was the primary measure of the treatment's effect on PTSD symptoms. Associated symptoms were measured using the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). Treatment resulted in substantial reductions in both groups' CRI scores and in significant, though more modest, reductions in RCMAS and CDI scores. Gains were maintained at six-month follow-up. Health visits to the school nurse were significantly reduced following treatment. Psychosocial intervention appears useful for children suffering disaster-related PTSD. Conducting controlled studies of children's treatment in the postdisaster environment appears feasible.

Affect↗

The biology of trauma: implications for treatment.

During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis and can cause both short and long-term effects on many organs and systems of the body. Our expanding knowledge of the effects of trauma on the body has inspired new approaches to treating trauma survivors. Biologically informed therapy addresses the physiological effects of trauma, as well as cognitive distortions and maladaptive behaviors. The authors suggest that the most effective therapeutic innovation during the past 20 years for treating trauma survivors has been Eye Movement Desensitization and Reprocessing (EMDR), a therapeutic approach that focuses on resolving trauma using a combination of top-down (cognitive) and bottom-up (affect/body) processing.

Antisocial Personality Disorder↗

The difficult denture patient.

This article discusses the psychological parameters that dentists must take into account when constructing full denture prostheses. The etiologies of fear in the edentulous patient are discussed; and the intake, interview, and treatment protocols developed and used at the Mount Sinai Dental Phobia Clinic for this special patient population are presented.

Dental Anxiety↗

Self-healing interventions for clinical practice: brief psychotherapy with WHEE--the wholistic hybrid of EMDR and EFT.

Potent self-healing approaches are now available to help people to deal with their stresses, anxieties and pains of physical and emotional origins. The author, a wholistic psychiatrist, shares his clinical experiences in helping his clients deal expeditiously and successfully with a variety of physical and psychological symptoms. This article focuses on WHEE, a brief, potent method for releasing psychological and physical pains, negative beliefs and disbeliefs, and for installing positive feelings and beliefs. To use modern terminology, this method allows you to correct the serious but not fatal error you have made in letting a child program your lifetime computer. WHEE is a method for reprogramming your default programs.

Acupressure↗