A behavior-analytic account of depression and a case report using acceptance-based procedures

Although roughly 6% of the general population is affected by depression at some time during their lifetime, the disorder has been relatively neglected by behavior analysts. The preponderance of research on the etiology and treatment of depression has been conducted by cognitive behavior theorists and biological psychiatrists and psychopharmacologists interested in the biological substrates of depression. These approaches have certainly been useful, but their reliance on cognitive and biological processes and their lack of attention to environment-behavior relations render them unsatisfactory from a behavior-analytic perspective. The purpose of this paper is to provide a behavior-analytic account of depression and to derive from this account several possible treatment interventions. In addition, case material is presented to illustrate an acceptance-based approach with a depressed client.     

对肺癌TNM分期的思考

TNM分期系统是进行肿瘤诊断和治疗的“国际语言”。1997年新版的肺癌TNM分期标准作为指导肺癌诊断和治疗的重要参考指标,能在一定程度上反映肺癌的预后,但并没有完全反映肺癌的本质生物学行为。本文认为真正反映肺癌本质生物学行为的是肺癌的组织学类型及分化程度等指标,传统的TNM分期系统应当进一步完善。     

Contemporary Psychotherapy: Promoting Personal Responsibility for Therapeutic Change

An assortment of factors in modern society can be involved in the etiology and treatment of mental illness. Theories about etiology usually underlie, and therefore guide, most strategies for treatment. Although a comprehensive bio-psycho-social approach to mental illness can help to foster the collaboration of an interdisciplinary treatment team, a heavy emphasis on biological factors or cultural deprivation may reduce the client's feelings of personal responsibility for change. Contemporary psychotherapy can help clients reduce their tendency to attribute blame to biological predispositions or external societal factors. Instead, it is more helpful to cultivate attributions for personal responsibility for change, growth, and maturation.     

Malpractice arising from negligent psychotherapy: ethical, legal, and clinical implications of Osheroff v. Chestnut Lodge

Traditionally, there have been few legal actions brought against psychotherapists that allege negligent psychotherapy and negligent treatment of psychiatric disorders. However, in the case of Osheroff v. Chestnut Lodge, a patient-physician (Dr. Osheroff) sued Chestnut Lodge, a private psychiatric facility, for negligence based on the staff's decision to apply a psychodynamic model of treatment (through psychotherapy) and not a biological model. The case sparked a heated debate between adherents of the psychodynamic model and those of the biological model. This article explores the implications of the Osheroff litigation for mental health professionals. It is proposed that an interactive informed consent process be used to protect psychotherapists against Osheroff-type litigation.     

Could Treatment Matching Patients’ Beliefs About Depression Improve Outcomes?

Patients’ beliefs about depression and expectations for treatment can influence outcomes of major depressive disorder (MDD) treatments. We hypothesized that patients with weaker biological beliefs (less endorsement of [a] biochemical causes and [b] need for medication) and more optimistic treatment expectations (greater improvement and shorter time to improvement), have better outcomes in cognitive therapy (CT). Outpatients with recurrent MDD who received acute-phase CT (N = 152), and a subset of partial or unstable responders (N = 51) randomized to 8 months of continuation CT or fluoxetine with clinical management, completed repeated measures of beliefs, expectations, and depression. As hypothesized, patients with weaker biological beliefs about depression, and patients who expected a shorter time to improvement, experienced greater change in depressive symptoms and more frequent response to acute-phase CT. Moreover, responders who received continuation treatment better matched to their biological beliefs (i.e., responders with weaker biological beliefs about depression who received continuation CT, or responders with stronger biological beliefs about depression who received continuation fluoxetine) had fewer depressive symptoms and less relapse/recurrence by 32 months after acute-phase CT than did responders who received mismatched continuation treatment. Specific screening and/or intervention targeting patients’ biological beliefs about depression could increase CT efficacy.     

炎症性肠病的药物治疗现状及进展

炎症性肠病（IBD）病程迁延反复,影响患者生活质量,耗费卫生资源。虽然传统药物如5-氨基水杨酸、糖皮质激素、免疫抑制剂等仍是目前治疗主流,但是大量有关发病机制的研究以及循证医学的发展对IBD的治疗产生了积极的推进作用。IBD的治疗正步入免疫调节的生物学时代,多种新型生物制剂的出现为IBD的治疗提供了新的策略和选择。现就目前IBD药物治疗现状以及最新进展进行综述,以期对临床IBD治疗提供参考。     

Dispositional optimism, trait anxiety, and coping: unique or shared effects on biological response to fertility treatment?

The aim of this study was to examine the unique and shared predictive power of psychological variables on reproductive physical health. Three months before fertility treatment, 97 women completed measures of dispositional optimism, trait anxiety, and coping. Information about biological response to treatment (e.g., estradiol level) was collected from medical charts after treatment. Structural equation modeling showed that measured psychological variables were all significant indicators of a single latent construct and that this construct was a better predictor of biological response to treatment than was any individual predictor. This research contributes to evidence suggesting that the health benefits of dispositional optimism are due to its shared variance with neuroticism.     

Different types—Different rights

Drawing on a social construction theory of ownership in biological material this paper discusses which differences in biological material might motivate differences in treatment and ownership rights. The analysis covers both the perspective of the person from whom the material originates and that of the potential recipient. Seven components of bundles of rights, drawing on the analytical tradition of Tony Honoré, and their relationship to various types of biological material are investigated. To exemplify these categories the cases of a heart, a kidney, stem cells and hair are used.     

生物运动及其在社会认知障碍研究中的应用

人类对生物运动具有较强的视觉敏感性,即使在视觉线索有限的情况下,仍能提取其中的社会性信息。本研究系统梳理了当前生物运动视知觉实验研究涉及的各类社会性信息,并归纳分析社会认知缺陷与生物运动视知觉加工之间的内在联系,以期促进对生物运动视知觉加工心理机制问题的深入探讨     

Female Juvenile Offenders: Defining an Early-Onset Pathway for Delinquency

We examined whether childhood factors predict age of first arrest in adolescent girls referred for placement and treatment for serious delinquency problems (N = 62). Measures included child characteristics (i.e., age of menstrual onset, childhood ADHD, and IQ), family environmental factors (i.e., severe punishment, parental transitions, and sexual abuse), biological parent criminality, and juvenile court records. Parental transitions and biological parent criminality significantly predicted the age of first arrest (M = 12.5 years), and IQ showed a trend to be a significant predictor. The final model accounted for 52% of the variance. A younger age of first arrest was related to increased health-risking sexual behaviors and to increased self-reported delinquency. Logistic regression analyses indicted that membership in an early-onset group could be reliably formed using family and child predictors, with accurate classifications for 46-90% of the girls. Family environmental and child characteristics played a strong role in predicting which girls would be arrested at an earlier age. The strong predictive utility of parental transitions and biological parent criminality, in particular, suggest two avenues for identifying girls at risk for delinquency problems.     

Negative Affectivity,Political Contention,and Turnout: A Genopolitics Field Experiment

Recent genopolitics and political psychology research suggests individuals' biological differences influence political participation. The interaction between individual differences and environments has received less attention, not least because of the confound of self‐selection into environments. To test the interaction between innate predispositions and an exogenous environmental influence, we conducted a field experiment during the 2010 California midterm elections. We randomly assigned subjects to receive a postcard mobilization treatment designed to induce an emotional response to the degree of political contention in the election. We tested the possibility that subjects who are genetically predisposed toward negative affectivity will be less likely to vote after treatment exposure. To our knowledge, this is the first field experiment in political science to measure genetic moderation of a treatment, and it suggests experimental approaches can benefit from the inclusion of genetically and other biologically informative covariates.     

风湿性心脏病瓣膜置换术后抗凝治疗中“度”的把握

风湿性心脏瓣膜病在世界范围内发病率极高,瓣膜置换术是目前治疗该病的主要方法,根据不同的病情及需要可置换机械瓣或生物瓣,我国患者更常选择机械瓣置换,术后生物瓣置换需抗凝3个月～6个月,而机械辩置换者需终身抗凝,故抗凝治疗非常关键。本文从辨证思维的角度分析如何在瓣膜置换术后把握好抗凝治疗。     

Infant-parent psychotherapy with an autistic toddler

This paper describes the 3½ -year treatment of an autistic toddler, who by age 5 showed normal social relationships and only minor residual cognitive features of the disorder. The treatment approach integrated infant-parent psychotherapy with techniques of special education and involved a two-person team that worked simultaneously in the family's home. The early work focused on discovering ways to mediate environmental stimulation so as to enhance the child's availability for social interaction. The treatment helped the parents understand this and explored and interpreted misconceptions about their son that interfered with parental feelings and functions. Multiple issues in the parent-child relationship and in the child's social and cognitive development eventually were addressed. This case illustrates one scenario in the development of relationships when an infant lacks the biological fittedness for social interaction. It demonstrates the possibility of ameliorating the autistic condition through a modification of infant-parent psychotherapy. The successful outcome of the case seems to be the result of several factors: The child's age at the beginning of treatment, his areas of cognitive strength, and his parents' exceptional ability to use and extend the therapy.     

Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment

This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues, selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring.     

LOVING THE PATIENT AS THE BASIS FOR TREATMENT

The author’s conviction is that a successful treatment is based on feelings of love by the therapist/analyst toward his or her patients. One should differentiate between love that is based on biological erotic-sexual drives and emotional love without erotic biological drive. The treatment process, especially for severely disturbed personalities, should be regarded as a process of new birth and new kind of development. Thus what the patient needs most is a kind of parental “primary love” (according to Balint). This paper presents a full report of a session through which the basic love to the patient is illustrated as enabling the treatment.Yecheskiel Cohen, Ph.D., is a member of the Israeli Psychoanalytic Society and the International Psychoanalytic Association.A version of this paper was presented at a conference of the Israel Psychoanalytic Society, May 2004.     

A FADED BEDTIME WITH RESPONSE COST PROTOCOL FOR TREATMENT OF MULTIPLE SLEEP PROBLEMS IN CHILDREN

The sleep-wake cycles of 4 developmentally delayed individuals with longstanding severe sleep disturbances were regulated using a faded bedtime procedure with response cost. Bedtimes were systematically delayed for each individual, thus increasing the probability of short latency to sleep onset. The response cost component, consisting of removing the individual from bed for 1 hour, was implemented when an individual did not experience short latency to sleep onset. A fading procedure was then applied successfully to advance the bedtimes and to gradually increase durations of sleep. Specifically, all 4 individuals had decreased amounts of nighttime sleep that increased following treatment. Two of the 4 individuals showed excessive daytime sleep that decreased following treatment. Three of the 4 individuals experienced decreases in night wakings following treatment. Both environmental and biological manipulations of the sleep-wake cycle are hypothesized as mechanisms of treatment. The relative advantages of this procedure over other procedures for the treatment of pediatric sleep disorders are discussed, as are directions for future research.     

Biological motion preference in humans at birth: role of dynamic and configural properties

The present study addresses the hypothesis that detection of biological motion is an intrinsic capacity of the visual system guided by a non-species-specific predisposition for the pattern of vertebrate movement and investigates the role of global vs. local information in biological motion detection. Two-day-old babies exposed to a biological motion point-light display (depicting a walking hen) and a non-biological motion display (a rotating rigid object) preferentially looked at the biological display (Experiment 1). A new group of newborns showed themselves to be capable of discriminating, following habituation, a biological motion display from a spatially scrambled version of it (Experiment 2). However, a third group of newborns, at their first exposure to such displays, did not show any preference between them (Experiment 3). Results confirm and extend previous comparative and developmental data, supporting an inborn predisposition to attend to biological motion in humans. This ability is presumably part of an evolutionarily ancient and non-species-specific system predisposing animals to preferentially attend to other animals.     

Delayed Bedtimes Are Associated With More Severe Obsessive-Compulsive Symptoms in Intensive Residential Treatment

Delays in behavioral and biological circadian rhythms (e.g., sleep timing, melatonin secretion) are found more frequently in individuals with severe and treatment-resistant obsessive-compulsive disorder (OCD). In recent years, it has been documented that these delays in behavioral and biological circadian rhythms are associated with more severe OCD symptoms and poorer response to some OCD treatments. This study examined self-reported sleep behaviors in individuals taking part in an intensive treatment for OCD and the relations between these and OCD symptoms (both at admission to and discharge from the treatment program). Replicating previous findings in less severe populations, delayed sleep phases were relatively common in this group and later bedtimes were associated with more severe OCD symptoms at admission. Sleep onset latency and sleep duration were not associated with OCD symptom severity at admission. Later bedtimes were not associated with self-reported depression or worry symptom severity. There was no evidence of sleep behaviors affecting change in OCD symptoms from admission to discharge from treatment—however, later bedtimes at admission were associated with more severe OCD symptoms at admission and discharge from treatment. There was no evidence of sleep onset latency or sleep duration having a similar predictive effect. More severe OCD symptoms at admission were also associated with later bedtimes at admission and discharge from treatment. These bidirectional predictive relations between late bedtimes and OCD symptoms were of small effect size but support the potential value of evaluating sleep timing in individuals with severe and/or treatment-resistant OCD.     

Mental Health Clinicians' Beliefs About the Biological, Psychological, and Environmental Bases of Mental Disorders

The current experiments examine mental health clinicians' beliefs about biological, psychological, and environmental bases of the DSM-IV-TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians' beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena.