Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions.     

Links between self-reported and laboratory behavioral impulsivity

Havik, M., Jakobson, A., Tamm, M., Paaver, M., Konstabel, K., Uusberg, A., Allik, J., Ööpik, V. & Kreegipuu, K. (2012). Links between self‐reported and laboratory behavioral impulsivity. Scandinavian Journal of Psychology 53, 216–223. A major problem in the research considering impulsivity is the lack of mutual understanding on how to measure and define impulsivity. Our study examined the relationship between self‐reported impulsivity, behavioral excitatory and inhibitory processes and time perception. Impulsivity – fast, premature, thoughtless or disinhibited behavior – was assessed in 58 normal, healthy participants (30 men, mean age 21.9 years). Self‐reported impulsivity as measured by Adaptive and Maladaptive Impulsivity Scale (AMIS) and behavioral excitatory and inhibitory processes as measured by Stop Signal Task were not directly related. Time perception, measured by the retrospective Time Estimation Task, was related to both. The length of the perceived time interval was positively correlated to AMIS Disinhibition subscale and negatively to several Stop Signal Task parameters. The longer subjects perceived the duration to last, the higher was their score on Disinhibition scale and the faster were their reactive responses in the Stop Signal Task. In summary our findings support the idea of cognitive tempo as a possible mechanism underlying impulsive behavior.     

More than one way to change: a study of course heterogeneity during and after short-term psychiatric in-patient treatment

This study describes differences in course and outcome, defined by GSI (SCL-90) at admission, discharge, and one‐year follow‐up, in 458 patients receiving in‐patient treatment for long‐standing symptom and/or personality disorders.
A K-mean cluster analysis identified seven subgroups of patients, representing four clinical distinct, meaningful patterns of change: early improvement, late improvement, relapsing after discharge, and a severe chronic course.
Main findings: the subgroups had unique correlates among socio-demographic, diagnostic, and treatment-related characteristics. One of the relapsing groups had a high rate of Cluster C personality disorders, whereas the other had low participation in the anxiety programme. The group with severe chronic course showed occupational maladjustment and high number of both Axis I and II disorders.
Implications: anxiety patients should participate in anxiety-treatment programmes, Cluster C patients should be followed and monitored for relapse, and severe chronic patients should be offered specialised treatment for their co‐existing substance abuse and/or eating disorders.     

Psychological characteristics of elderly insomniacs

Sixty insomniacs, aged 60 years or over, fulfilling the DSM-IV criteria for primary insomnia, completed a set of questionnaires measuring psychological distress. These included the Sleep Impairment Index (SIM), the Symptom Check List 90-Revised (SCL-90-R), the Penn State Worry Questionnaire (PSWQ), the Toronto Alexithymia Scale-20 (TAS-20) and the Elders Life Stress Inventory (ELSI). The insomniacs were compared on these measures with two contrast groups, one of elderly good sleepers and one an elderly community sample. As norms were developed for the SCL-90-R and PSWQ, insomniacs were also contrasted with the norm groups on these measures. In general, the results indicated a higher level of psychological distress among insomniacs than among the good sleepers, while there were negligible differences between insomniacs and the community sample on most measures. Overall, elderly insomniacs scored higher on measures of worry compared with the other groups, followed by measures of somatization, obsessive-compulsion and depression. It is concluded that excessive worrying was the most characteristic feature of elderly insomniacs.     

Risk Perception,Worry and Satisfaction Related to Genetic Counseling for Hereditary Cancer

In this multi center study, genetic counseling for hereditary cancer was evaluated by assessing patients’ worry, perceived risk of developing cancer and satisfaction with genetic counseling. An overall aim was to identify characteristics of vulnerable patients in order to customize genetic counseling. In addition, agreement between patients’ and counselors’ scores was measured. A total of 275 Norwegian patients were consecutively recruited, and 213 completed questionnaires before and after genetic counseling. Patients’ perceived risk decreased after the genetic counseling session. There was incongruence between risk perception expressed as a percentage and in words. Patients were significantly less worried after counseling. Higher levels of worry were predicted by low instrumental satisfaction with counseling, high degree of perceived risk of developing cancer and younger age. In conclusion, counselors met the patients’ psychological needs to a satisfactory degree during counseling. However, patients did not fully understand their risk of developing cancer.     

Changes in smoking behavior after a myocardial infarction

Among 383 participants in a longitudinal study of myocardial infarction (MI) patients, 230 smoked at the time of the MI. Posthospital smoking status was based on self-report for the day of follow-up, whereas information about length of continuous cessation was not available. Six months after the heart attack, 40.6% of the smokers had resumed smoking, whereas 49.4% smoked at a 3- to 5-year (M = 43-month) follow-up. Resumption of smoking within 6 months after the heart attack was associated with an increase in anxiety and depression during the first weeks after discharge, less cardiac health knowledge, and a less severe MI. In patients who relapsed at a later point, resumption of smoking was associated with a subsequent decline in general cardiac health knowledge, as well as in correct understanding of smoking at a risk factor. Long-term changes in smoking status were also related to previous heart disease, premorbid work instability, age, and severity of the MI. The results indicate that antismoking counseling of MI patients should not be limited to the health risks associated with smoking and that training in coping with negative affects without smoking may be valuable in promoting smoking cessation.     

Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes

Journal of Child and Family Studies - To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work....     

Outcome predictors in guided and unguided self-help for social anxiety disorder

Internet-based self-help with therapist guidance has shown promise as an effective treatment and may increase access to evidence-based psychological treatment for social anxiety disorder (SAD). Although unguided self-help has been suggested primarily as a population-based preventive intervention, some studies indicate that patients with SAD may profit from unguided self-help. Gaining knowledge about predictors of outcome in guided and unguided self-help for SAD is important to ensure that these interventions can be offered to those who are most likely to respond. Utilizing a sample of 245 patients who received either guided or unguided self-help for SAD, the present study examined pre-treatment symptoms and program factors as predictors of treatment adherence and outcome. The results were in line with previous findings from the face-to-face treatment literature: namely, the intensity of baseline SAD symptoms, but not depressive symptoms, predicted treatment outcomes in both unguided and guided self-help groups. Outcomes were unrelated to whether a participant has generalized versus specific SAD. Furthermore, for the unguided self-help group, higher credibility ratings of the treatment program were associated with increased treatment adherence. The findings suggest that guided and unguided self-help may increase access to SAD treatment in a population that is more heterogeneous than previously assumed.     

The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts

Panic disorder is a common mental disorder. Guided Internet-based cognitive behavioural therapy (Guided Internet-based cognitive behaviour therapy (ICBT)) is a promising approach to reach more people in need of help. In the present effectiveness study, we investigated the outcome of guided ICBT for panic disorder after implementation in routine care. A total of 124 patients were included in the study, of which 114 started the treatment. Large within-group effect sizes were observed on the primary panic disorder symptoms (post-treatment: d = 1.24; 6-month follow-up: d = 1.39) and moderate and large effects on secondary panic disorder symptoms and depressive symptoms at post-treatment and follow-up (d = .55–1.13). More than half (56.1%) of the patients who started treatment recovered or improved at post-treatment. Among treatment takers (completed at least five of the nine modules), 69.9% recovered or improved. The effectiveness reported in the present trial is in line with previous effectiveness and efficacy trials of guided ICBT for panic disorder. This provides additional support for guided ICBT as a treatment alternative in routine care.     

Social support and emotional adjustment during and after a severe life event: A study of wives of myocardial infarction patients

Abstract

This paper examines the relationship between quantitative and qualitative indicators of social support and anxiety. depression and use of health services in a sample of 37 wives of myocardial infarction (MI) patients. In a prospective design, the wives were interviewed during the acute phase of the illness, three months and 10 years post index-MI. Congruent with previous research, the quantitative aspect of social support, defined as number of persons giving help, was unrelated to adjustment, whereas qualitative aspect of social support, defined as the wives' dissatisfaction with social support, was associated with depression and use of health services. The observed association indicated, however, an effect in the opposite direction of the social support model. The findings were unexpected and may be due to a small sample. An alternative explanation is that long-term relationship between depression and social support is more complex, and more long-term studies are needed in this field.