Strategies for Improving Long-Term Outcomes in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: Insights From Learning Theory

Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is often highly effective, yet some patients experience relapses following a seemingly successful course of treatment. In this article we describe the components of CBT for OCD and then present a patient who relapses after making significant gains during a course of CBT. Likely explanations for the patient’s relapse, and methods for optimizing long-term treatment outcomes, are explored from the standpoint of research on learning and memory. These strategies mainly apply to the implementation of situational (in vivo) and imaginal exposure therapy, but also include suggestions for optimizing the psychoeducational and cognitive therapy components.     

Electro-aversion therapy of chronic alcoholism

Twenty-six male patients with severe chronic alcoholism were treated with electro-aversion therapy according to two different designs. At follow-up after 12 months, 24 per cent had not had any relapse requiring admissions to hospital, 12 per cent were lost during the follow-up period, and 64 per cent had relapses. Before treatment all the patients had been admitted to hospital several times a year.

Aversion therapy without supplementary treatment is indicated mainly for patients who have intact social relationships and regular work. Treatment of advanced states of alcoholism requires supplementary treatment in the form of anxiety-relieving methods, psychosocial support and teaching the patient new and alternative habits.     

Relationships Between Social Support, Social Coping and Life Events in the Relapse of Schizophrenic Patients

The vulnerability-stress model for schizophrenia posits that relapses are at least partly determined by interacting triggering and protecting psychosocial factors. This study examined social support and general coping style in 42 consecutively admitted DSM:III schizophrenic patients, who were followed prospectively for up to four years. In a second part of the study, a subgroup of the patients were interviewed using the Life Event and Difficulty Schedule 9 months after discharge or at relapse. Patients contented with low social integration had a higher relapse rate over four years than patients lacking of social provisions, but wanting more. We found an excess of life events three weeks before relapse compared to events reported in the non-relapsing group. Suggesting a buffering effect of social factors, time between life event and relapse was significantly extended among patients with a high availability of attachment and a coping strategy characterised of active support seeking.     

Psychosocial predictors of relapse in cocaine-dependent patients in treatment

Relapses in cocaine abusers in treatment are an important problem. The majority of patients are incapable of sustaining abstinence over any length of time. To identify the factors associated to relapses risk in the cocaine use can be an optimal choice to improve the treatment strategies. The aim of this study was to analyze relapse-risk factors in cocaine-dependent patients on treatment. Participants were 102 patients who had begun outpatient treatment at a public health center in Spain. Some functional areas and cocaine use are evaluated for a period of six months. A structural equations model was used to identify possible predictive variables. The results show that social-family environment and economic-employment situation were associated with greater risk of relapse. Likewise, the social-family environment was related to severity of addiction. It is concluded that the incorporation of family intervention strategies and vocational/employment counseling may help to reduce relapse rates in cocaine addicts receiving treatment.     

Radiological pictures of the skull following brain-tumor surgery]

In 90 patients, the majority of whom was operated upon for a brain tumour, we have systematically controlled the post-operative x-ray pictures of the skull. Clips set in during surgery, calcified epiphysis and changes of the sella due to pressure were the most important signs. To complete the follow-up of tumours we should like to propose to use clips not only as a hemostyptic measure, but also to have marks in cases of possible relapses.     

The treatment of stammering in children by the shadowing method

There are very few reports about the application of behaviour therapy to child stammering and these are not encouraging. Remedial education treatment is followed by frequent relapses. The present work gives data about the methods, effects and long-term results in nineteen child stammerers treated by the shadowing technique. A discussion of some of the theoretical problems involved is given and shows how the theoretical analysis influences treatment procedures. Seventy per cent of the cases were successfully treated by the shadowing technique and subsidiary procedures; relapses occurred in only 12 per cent of the cases.     

Cognitive Antecedents and Sequelae of Smoking Relapse Crises1

This study examines Marlatt's account of the cognitions surrounding relapse episodes. Interviews with 143 ex-smokers who called a relapse prevention hotline provided mixed support for this account. Most subjects, especially those who smoked, stated that they had expected smoking to result in reduced tension. Subjects who were motivated by reduction of craving were unlikely to smoke. Contrary to expectations, all subjects experienced significant drops in self-efficacy as a result of the relapse crisis, regardless of whether or not they smoked. Subjects who did not smoke worried about future crises, while those who did felt guilty about their transgression. Both groups reported feelings of failure, which were related to the absence of coping. These unexpected results, though based on a limited sample, suggest that many subjects' experience of relapses and near-relapses are not well described by current theory.     

Training the disturbed enuretic

Twenty-two disturbed enuretic children were treated for their bedwetting with training procedures. Eighteen of 22 (81.8%) reached the initial success criterion in an average of 57.5 days. Ten of the 18 (55.6%) met the retraining criteria of relapse, and 9 of the relapses were successfully retrained, while I stopped wetting spontaneously. As compared to non-relapsed children, relapsed children had a significantly higher number of initial symptoms checked. The results indicate that a training approach is effective for the treatment of enuresis in disturbed children, but the more disturbed have a greater likelihood of relapse.     

Effects of a waking schedule on primary enuretic children treated with full-spectrum home training

Examined the effects of adding a waking schedule to full-spectrum home training (FSHT) for primary enuresis. Twenty children received FSHT, and 17 children received FSHT plus a waking schedule. The groups did not reliably differ in average bedwettings per week in treatment and length of treatment. Also, the groups did not reliably differ with respect to proportion of treatment successes and proportion of relapses at 1-year follow-up. Further, across both treatment groups, 76% achieved a dry bed, and only 16% experienced a relapse by 1-year follow-up. Although results support the efficacy of FSHT, the beneficial effects of a waking schedule reported previously were not replicated. The findings suggest the need for closer examination of individual differences among children with primary nocturnal enuresis.     

The Role of the Family in the Course and Treatment of Bipolar Disorder

ABSTRACT— Bipolar disorder is a highly recurrent and debilitating illness. Research has implicated the role of psychosocial stressors, including high expressed-emotion (EE) attitudes among family members, in the relapse–remission course of the disorder. This article explores the developmental pathways by which EE attitudes originate and predict relapses of bipolar disorder. Levels of EE are correlated with the illness attributions of caregivers and bidirectional patterns of interaction between caregivers and patients during the postepisode period. Although the primary treatments for bipolar disorder are pharmacological, adjunctive psychosocial interventions have additive effects in relapse prevention. Randomized controlled trials demonstrate that the combination of family-focused therapy (FFT) and pharmacotherapy delays relapses and reduces symptom severity among patients followed over the course of 1 to 2 years. The effectiveness of FFT in delaying recurrences among adolescents with bipolar disorder and in delaying the initial onset of the illness among at-risk children is currently being investigated.     

The effect of callosotomy on novel versus familiar bimanual actions: a neural dissociation between controlled and automatic processes?

The corpus collosum is the large band of fibers that connects the two cerebral hemispheres of the brain. Individuals who have had the fibers of these tracts surgically severed by callosotomy are able to draw two different spatial figures simultaneously using the left and right hands, without evidence of interactions in the spatial planning processes. Paradoxically, tasks (e.g., tying shoes) that appear to depend on spatial interactions between the left and right hands, each of which is controlled by a separate cerebral hemisphere, pose little difficulty. How can this be? In the study reported here, we observed that well-learned cooperative actions of the hands remain intact in 2 callosotomy patients, whereas actions novel to these patients are virtually impossible for them to produce without visual guidance. We infer that duplicate memory engrams of well-learned actions can be accessed by both cerebral hemispheres without callosal mediation, whereas callosal interactions are necessary for precise cross-matching of sensory information during spatial planning or perceptual-motor learning.     

An alternative approach to relapse analysis: Using Monte Carlo methods and proportional rates of response

Relapse is the recovery of a previously suppressed response. Animal models have been useful in examining the mechanisms underlying relapse (e.g., reinstatement, renewal, reacquisition, resurgence). However, there are several challenges to analyzing relapse data using traditional approaches. For example, null hypothesis significance testing is commonly used to determine whether relapse has occurred. However, this method requires several a priori assumptions about the data, as well as a large sample size for between‐subjects comparisons or repeated testing for within‐subjects comparisons. Monte Carlo methods may represent an improved analytic technique, because these methods require no prior assumptions, permit smaller sample sizes, and can be tailored to account for all of the data from an experiment instead of some limited set. In the present study, we conducted reanalyses of three studies of relapse (Berry, Sweeney, & Odum, 2014 ; Galizio et al., 2018 ; Odum & Shahan, 2004 ) using Monte Carlo techniques to determine if relapse occurred and if there were differences in rate of response based on relevant independent variables (such as group membership or schedule of reinforcement). These reanalyses supported the previous findings. Finally, we provide general recommendations for using Monte Carlo methods in studies of relapse.     

基于非侵入性脑刺激的认知增强：方法、伦理和应用

作为人类追求卓越的方式之一,基于非侵入性脑刺激的认知增强成为众多学科和公众关注的问题。首先阐述了非侵入性脑刺激的两种主要技术手段(经颅磁刺激和经颅直流刺激)的技术原理及其在提升健康个体认知功能上的应用,并分析了这两种技术可能带来的安全、自主选择、公平等伦理问题,最后总结了该认知增强技术在体育和军事等两个具体领域的应用。未来可进一步提高技术手段的深部脑区刺激能力及该增强技术的持续和真实效果。     

Clinicians' fidelity to a manual-based family treatment as a predictor of the one-year course of bipolar disorder

This study assessed whether therapist adherence to the family focused treatment model for patients with bipolar disorder and their relatives was associated with patient outcomes at one year after treatment entry. A total of 78 videotaped sessions of FFT consisting of 26 families with a member with bipolar disorder (3 sessions/family) were rated on fidelity using the Therapist Competence/Adherence Scale (TCAS; see Endnote 1, p. 130). Patients' outcomes (relapse status) were assessed using the Brief Psychiatric Rating Scale (BPRS) and selected items from the Schedule of Affective Disorders and the Schizophrenia-Change (SADS-C) scale (measured at 3-month intervals for 12 months). Contrary to expectations, therapist fidelity was not related to overall outcome as assessed by the BPRS and the SADS-C. Among patients who did relapse, higher levels of cooperation among therapists predicted a later date for relapse than did lower levels of cooperation. Surprisingly, and in opposition to the study's hypotheses, patients who were hospitalized because of relapses had therapists who were rated as more competent in their ability to conduct the problem-solving module of FFT. Study implications are discussed.     

Dynamic influences on smoking relapse process

This article describes a program of research applying Ecological Momentary Assessment (EMA) methods to study relapse to cigarette smoking, with a particular focus on the role of negative affect (NA) and self-efficacy (SE). Day-to-day changes in mood and stress did not predict lapse risk, but more proximal changes in affect were associated with lapses: Many lapses were marked by intense NA and by NA increases in the preceding hours. Individual differences in baseline SE predicted lapse risk, but daily SE was relatively stable during abstinence and did not influence lapse risk. However, lapses resulted in immediate drops in SE, and day-to-day changes in postlapse SE predicted progression to relapse, even after accounting for concurrent smoking. SE showed momentary drops associated with NA, but only among smokers with low baseline SE. Individual differences in baseline SE were only expressed situationally under conditions of NA. The findings highlight the importance of dynamic changes in background conditions and in immediate states as important influences on lapses and relapse and also suggest the importance of considering person by situation interactions.     

Dual brain,creativity, and health

Abstract

The importance of the specialized functions of the right and left hemispheres is reviewed, with applications to education, treatment, creativity, and research duly noted. Experimental studies serve as indications of how alexithymia and creativity of the so‐called dual brain has been examined. Patients with com‐missurotomies, patients in psychotherapy, priests, creative subjects, and normal controls have been compared through a variety of experimental methods in terms of hemispheric specialization. The results indicate that creative and healthy subjects tend to have freer access to mutual interaction of both hemispheres without marked inhibitory or disinhibitory effects from either cerebral hemisphere.     

Psychological stress reactivates dextran sulfate sodium-induced chronic colitis in mice

Inflammatory bowel disease (IBD) is a chronic condition with alternating active and quiescent phases of inflammation. Stress has been suggested as a factor triggering a relapse of IBD. We investigated the role of repetitive psychological stress [water avoidance stress (WAS)] in reactivating colonic inflammation in a murine model of dextran sulfate sodium (DSS)-induced chronic colitis. Colitis was induced in C57BL/6 female mice by exposure to 3% DSS (5 days). During chronic inflammation(day 34), mice underwent repetitive WAS (1 h/day/7 days) and were given a sub-threshold concentration of DSS (1%, 5 days)or normal water to drink. At euthanasia (day 40), inflammatory parameters were assessed (colon inflammatory score, levels of inflammatory markers and histology). Mice with chronic colitis exposed to WAS had higher macroscopic and microscopic colonic inflammatory scores and levels of inflammatory markers (mainly IL-1beta, IL12p40 and CCL5) than non-stressed mice. Inflammatory responses were further enhanced by the presence of a sub-threshold concentration of DSS (1%). In mice without chronic inflammation, neither WAS nor 1% DSS, individually or in combination, elicited any inflammation. Hence stress, per se, reactivates a quiescent chronic inflammation, but does not initiate inflammation in healthy mice. Stress should be regarded as an environmental factor triggering IBD relapses in humans.     

The Houdini Transformation: True,but Illusory

Molenaar (2003, 2011) showed that a common factor model could be transformed into an equivalent model without factors, involving only observed variables and residual errors. He called this invertible transformation the Houdini transformation. His derivation involved concepts from time series and state space theory. This article verifies the Houdini transformation on a general latent variable model using algebraic methods. The results show that the Houdini transformation is illusory in the sense that the Houdini-transformed model remains a latent variable model. Contrary to common knowledge, a model that is a path model with only observed variables and residual errors may, in fact, be a latent variable model.     

Assessing the combined effects of resurgence and reinstatement in children diagnosed with autism spectrum disorder

Resurgence and reinstatement are laboratory models of relapse following treatments for problem behavior that arrange alternative sources of reinforcement, such as differential reinforcement of alternative behavior and noncontingent reinforcement. Resurgence models the elimination or reduction of reinforcers during treatment and reinstatement models the re‐presentation of reinforcers previously maintaining problem behavior. The present study examined individual and combined effects of resurgence and reinstatement in a translational model of treatment relapse with three children diagnosed with Autism Spectrum Disorder. We first reinforced and then extinguished an arbitrary response while providing access to a preferred toy to model a version of noncontingent reinforcement with extinction. In the following phases, we examined resurgence by removing the toy, reinstatement by presenting the training reinforcer response‐independently, and a combination of resurgence and reinstatement. Overall, relapse of target responding reliably exceeded functionally similar responses never reinforced in the experimental situation. Most importantly, relapse tended to be greater when combining resurgence and reinstatement than when assessing either alone. These findings support previous studies showing that combinations of operations can increase treatment relapse. This translational model arranging simulated problem behavior with arbitrary tasks provides a platform from which to thoroughly and systematically assess methods for understanding and improving behavioral treatments.     

Filling of the Circle of Willis in carotid angiography using halothane anesthesia

A comparative study of 150 carotid angiographies carried out under local anaesthesia and the same number under halothane anaesthesia did not show any great deviation from the well-known filling rates of the counter-lateral carotid region and the ipsilateral A. cerebri posterior nor any striking differences in the two methods of anaesthesia which could convince of a favourable influence of halothane on the demonstration of the vessels. The causative factors of the filling of adjacent vascularisation regions can certainly only be explained from the complex co-action of physiological and any external factors in cerebral angiography.