Paradoxical intention in the treatment of urinary retention

Although most cases of psychogenic urinary retention can be ameliorated by a program composed of various behavioral techniques, there is a small percentage of cases which resists the behavioral treatment of choice. The present multiple case paper focused on the treatment of several resistant cases of functional urinary retention. Following a two week baseline period, each individual was exposed to eight weekly behavioral sessions. Whereas most cases of urinary retention have significantly improved by this time, the five individuals chosen for the present study were dissatisfied with their progress. Thus, following the eighth week, paradoxical intention was employed. Within six weeks treatment for the urinary problem was terminated as all clients were comfortable with this aspect of their daily behavior. It was hypothesized that cases of psychogenic urinary retention which resist behavioral techniques are possibly exacerbated by performance anxiety. Such anxiety can be efficiently handled by paradoxical intention.     

The treatment of obsessive-compulsive neurotics by modelling and flooding in vivo

Five obsessive-compulsive patients were treated by modelling plus flooding in an attempt to replicate earlier findings with this method. The attempt succeeded and the present results are discussed in the light of the outcomes observed in the total series of 20 patients. Modelling and/or flooding produced significantly greater improvements than a relaxation (control) treatment. Improvement continued to 6 months follow-up. Ten other patients have been followed up for 2 yr so far and maintained their improvement. The magnitude of clinically-assessed change is satisfactory in most cases but some failures are noted. The search for prognostic indices was unsuccessful. Subject to reservations, we feel that the treatment method can now be used with routine cases.     

Bethanechol chloride as a suggested adjunct to prolonged in vivo exposure therapy in the treatment of paruresis

A major difficulty in treating paruresis (psychogenic urinary retention) by prolonged in vivo exposure therapy involves the individual's inability to initiate urination in response to anxiety-provoking stimuli easily and frequently enough to generalize the desired behavior to everyday situations. Administration of bethanechol chloride, a parasympathomimetic compound that facilitates urination by prompting contraction of the detrusor muscle of the bladder, prior to therapeutic sessions is suggested to enhance the efficiency and effectiveness of in vivo desensitization procedures in the treatment of paruresis.     

The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD

This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dissociation, numbing, and depersonalization) were assessed at pretreatment using semi-structured interviews and questionnaires. In a pretreatment behavioral exposure test, patients were imaginally exposed to (part of) their trauma memory for 9 min, during which subjective fear was assessed. At posttreatment and 6 months follow-up PTSD, depressive and dissociative symptoms were again assessed in the completers (n = 60). Pretreatment levels of dissociative and depressive symptoms were similar in dropouts and completers and none of the dissociative phenomena nor depression predicted improvement. Against expectations, dissociative phenomena and depression were associated with enhanced rather than impeded fear activation during the behavioral exposure test. However, these effects disappeared after controlling for initial PTSD severity. Hence, rather than supporting contraindication, the current results imply that patients presenting with even severe dissociative or depressive symptoms may profit similarly from exposure treatment as do patients with minimal dissociative or depressive symptoms.     

Single prolonged stress disrupts retention of extinguished fear in rats

Clinical research has linked post-traumatic stress disorder (PTSD) with deficits in fear extinction. However, it is not clear whether these deficits result from stress-related changes in the acquisition or retention of extinction or in the regulation of extinction memories by context, for example. In this study, we used the single prolonged stress (SPS) animal model of PTSD and fear conditioning procedures to examine the effects of prior traumatic stress on the acquisition, retention, and context-specificity of extinction. SPS administered one week prior to fear conditioning had no effect on the acquisition of fear conditioning or extinction but disrupted the retention of extinction memories for both contextual and cued fear. This SPS effect required a post-stress incubation period to manifest. The results demonstrate that SPS disrupts extinction retention, leading to enhanced fear renewal; further research is needed to identify the neurobiological processes through which SPS induces these effects.     

Cognitive and affective predictors of treatment outcome in cognitive processing therapy and prolonged exposure for posttraumatic stress disorder

This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n = 145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to dropout of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols.     

Embedding social networks: How guanxi ties reinforce Chinese employees’ retention

Going beyond traditional inquiry into social support from local organizational constituents, this project examined how diverse resources from mutually affiliated contacts within and beyond local work environs boost propensity to stay in firms. We deployed Burt’s (1992) name generator and network closure index to more fully assess guanxi networks in China, which comprise strong, dense, and multiplex ties. Specifically, we tested how closed guanxi networks promote job loyalty among Chinese nationals, while investigating how high-commitment human resource management (HRM) systems moderate network effects. We collected egonet data from 417 employees in four high tech firms in China. Hierarchical linear modeling revealed that guanxi network closure increases propensity to stay, whose effects high-commitment HRM reinforce.     

The effects of prolonged exposure to phobic situations upon agoraphobic patients treated in groups

Nineteen female agoraphobic patients were treated by exposure to imaginal and real phobic stimulation in groups. There were three groups, including 7, 5 and 6 patients respectively, and each group received 9 hr of treatment spread over three sessions. The first two treatment hours of the first two sessions were arranged as a crossover design, patients being randomly allocated at the first session to imaginal or reality treatment for an hour followed by the other treatment for an hour, and receiving the treatments in reverse order at the second session. On both occasions there was a third hour of treatment after 1 hr unstructured group discussion over lunch. Psychological and behavioural measures were made before and after each part of treatment, and at follow-up 5 months after treatment.

Patients were significantly helped by this procedure. Practice sessions were associated with much more improvement than imaginal ones, and there was also an order effect, the first treatment received on each treatment day being more effective than the second. Group discussion over lunch did not improve the patient's phobias. The implications of these findings are discussed.