Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome

We conducted a follow-up of a previously reported study of internet-delivered cognitive behavior therapy (CBT) for IBS, based on exposure and mindfulness exercises (Ljótsson et al. (2010). Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome – a randomized controlled trial. Behaviour Research and Therapy, 48, 531–539). Seventy-five participants from the original sample of 85 (88%) reported follow-up data at 15–18 months (mean 16.4 months) after completing treatment. The follow-up sample included participants from both the original study’s treatment group and waiting list after it had been crossed over to treatment. Intention-to-treat analysis showed that treatment gains were maintained on all outcome measures, including IBS symptoms, quality of life, and anxiety related to gastrointestinal symptoms, with mainly large effect sizes (within-group Cohen’s d = 0.78–1.11). A total of fifty participants (59% of the total original sample; 52% of the original treatment group participants and 65% of the original waiting list participants) reported adequate relief of symptoms. Improvements at follow-up were more pronounced for the participants that had completed the full treatment and maintenance of improvement did not seem to be dependent on further treatment seeking. This study suggests that internet-delivered CBT based on exposure and mindfulness has long-term beneficial effects for IBS-patients.     

Long-term follow-up of women institutionalized in childhood: Factors promoting good functioning in adult life*

The early adult functioning of 89 women from inner London who had been reared in residential Children's Homes was compared with that of 41 women sampled from the general population of the same area. The behaviour of both groups had previously been studied in middle childhood by means of standardized questionnaires. The adult assessment comprised detailed standardized interviews with the women and with their spouses, together with systematic observations of mother-child interaction in the home for those with 2–3 1/2-year-old children. The adult outcome of the institution-reared women as a whole was substantially worse than that for the comparison group, but the course of their personality development had been greatly modified by positive school experiences in childhood and by the characteristics of their spouse and marriage in adult life. The institution-reared women in good psychosocial circumstances in adulthood functioned as well as the comparison group women. The findings are interpreted in terms of direct and indirect effects of experiences leading to both continuities and discontinuities in social development.     

Teaching an amnesic a complex cognitive skill

G.P., a Korsakoff's amnesic, was able to learn an algorithm for squaring two-digit numbers mentally over a 7-day period at a rate comparable to that of age-matched controls. He failed to show normal positive transfer to specific problems or to specific numbers used in components of the task. He also exhibited slight improvement in simple naming speed, forward digit span, simple multiplication speed, but no apparent improvement for the recall of repeated supraspan digit strings. He was unable to state the algorithm he had learned to square two-digit numbers, though he could implement it successfully. The results suggest that the compilation of a skill may involve two dissociable components: composition and proceduralization, with the former, but not the latter, occurring at normal rates for Korsakoff's amnesics.     

Long-term consequences of childhood physical and psychological maltreatment

This study assessed whether some of the correlates of learned helplessness—depression, low self-esteem, and a maladaptive attributional style—are long-term consequences of child abused. In this study, 260 subjects were identified as physically abused, psychologically abused, both physically and psychologically abused, or nonabused, based on responses to the Child Abuse Questionnaire (CAQ). Subjects were tested for levels of nonclinical depression via the Beck Depression Inventory (BDI), for levels of self-esteem via the Rosenberg Self-Esteem Scale (RSE), and for the adaptiveness of attributional style via the Attributional Style Questionnaire (ASQ). It was hypothesized that each of the three abuse groups would differ from the control group on the three dependent measures; differences among the three abuse groups were also explored. Three one-way analyses of variance indicated that (1) BDI scores reflected a greater tendency toward depression in subjects reporting both types of abuse than in nonabused subjects or in subjects reporting either psychological or physical abuse, (2) subjects reporting psychological abuse only or both psychological and physical abuse showed lower self-esteem than did nonabused subjects, and (3) abused subjects did not seem to exhibit a more maladaptive attributional style than that of nonabused subjects. In addition, multiple linear regression analyses pointed to psychological abuse as a critical variable in predicting levels of depression, self-esteem, and attributional style, when physical abuse effects were controlled. Controlling for the effects of psychological abuse, however, indicated that physical abuse did not significantly contribute to the variance in these variables. Implications for the learned helplessness model and for future research are discussed. © 1992 Wiley-Liss, Inc.     

Family-focused cognitive behaviour therapy versus psycho-education for adolescents with chronic fatigue syndrome: Long-term follow-up of an RCT

The aim of this study was to investigate the long term efficacy of family-focused cognitive behaviour therapy (CBT) compared with psycho-education in improving school attendance and other secondary outcomes in adolescents with chronic fatigue syndrome (CFS). A 24 month follow-up of a randomised controlled trial was carried out. Participants received either 13 one-hour sessions of family-focused CBT or four one-hour sessions of psycho-education. Forty-four participants took part in the follow-up study. The proportion of participants reporting at least 70% school attendance (the primary outcome) at 24 months was 90% in CBT group and 84% in psycho-education group; the difference between the groups was not statistically significant (OR = 1.29, p = 0.80). The proportion of adolescents who had recovered in the family-focused CBT group was 79% compared with 64% in the psycho-education, according to a definition including fatigue and school attendance. This difference was not statistically significant (Fisher's exact test, p = 0.34). Family-focused CBT was associated with significantly better emotional and behavioural adjustment at 24 month follow-up compared to psycho-education, as reported by both adolescents (F = 6.49, p = 0.02) and parents (F = 4.52, P = 0.04). Impairment significantly decreased in both groups between six and 24 month follow-ups, with no significant group difference in improvement over this period. Gains previously observed for other secondary outcomes at six month follow-up were maintained at 24 month follow-up with no further significant improvement or group differences in improvement. In conclusion, gains achieved by adolescents with CFS who had undertaken family-focused CBT and psycho-education generally continued or were maintained at two-year follow-up. The exception was that family-focused CBT was associated with maintained improvements in emotional and behavioural difficulties whereas psycho-education was associated with deterioration in these outcomes between six and 24-month follow-up.     

Memory deficits in early infantile autism: some similarities to the amnesic syndrome.

Autistic children were compared with control children on tasks in which retention was tested by different methods. In three tests of recall, using named pictures, written words and spoken words as test stimuli, autistic children were impaired in comparison with age-matched normal children and with controls matched for verbal ability. In one test of forced-choice recognition of pictures, autistic children were impaired in comparison with ability-matched controls. In three tests of cued recall, using named pictures, written words and spoken words as test stimuli, and acoustic, graphemic and semantic cues, autistic children were not impaired in comparison with normal age-matched controls. In one test of paired-associate learning using non-related word pairs as test stimuli autistic children were not impaired in comparison with normal age-matched controls. These experimental paradigms were similar to some that have been used to investigate the amnesic syndrome in man. Thus findings on paired-associate learning differ in autistic and amnesic subjects, but findings on recall, recognition and cued recall are comparable. A possible parallel between autism and amnesia is discussed.     

Behaviorally treated irritable bowel syndrome patients: a four-year follow-up

Nineteen of 27 patients suffering from Irritable Bowel Syndrome (IBS) who had completed a multicomponent treatment involving progressive muscle relaxation, thermal biofeedback, cognitive therapy and IBS education were located and evaluated 4 yr posttreatment. Seventeen of 19 (89.5, or 63% of the total original sample) rated themselves as more than 50% improved. Six of the 12 patients (50%) who submitted symptom monitoring diaries met our criteria for clinical improvement, i.e. achieving at least a 50% reduction in primary IBS symptom scores. The means on all measures at long-term follow-up were lower than those obtained prior to treatment. When follow-up symptom means were compared with pretreatment means, significant (P less than 0.05) reductions were obtained on abdominal pain/tenderness, diarrhea, nausea, and flatulence.     

A five-year follow-up of patients with borderline pathology of childhood

Borderline pathology of childhood (BPC) may be a precursor of personality disorders. There is a lack of data concerning outcome in adolescence. A group of 59 adolescents, who had been treated as children in a Child Psychiatry Day Hospital five to seven years earlier, was evaluated. Using the child version of the Retrospective Diagnostic Interview for Borderlines, 28 participants had been diagnosed with BPC while the remaining 31 participants who did not have a history of BPC served as the comparison group. The youth and their parents were given a battery of measures assessing current psychopathology and functional status. The group with a history of BPC was more likely than the comparison group to exhibit a combination of internalizing and externalizing behavior problems. Adolescents with a history of BPC were more impaired than the comparison group on a global measure of functional status. Compared to children with no history of BPC, children diagnosed with BPC are more likely to display poorer functioning as adolescents and continue to be at risk for psychopathology during adolescence. Future directions for research are discussed.     

IQ in childhood and the metabolic syndrome in middle age: Extended follow-up of the 1946 British Birth Cohort Study

IQ in early adulthood has been inversely associated with risk of the metabolic syndrome in midlife. We tested this association in the British 1946 birth cohort, which assessed IQ at age eight years and ascertained the metabolic syndrome at age 53 years based on modified (non-fasting blood) ATPIII criteria. Childhood IQ was inversely associated with risk of the metabolic syndrome, but this association was almost entirely mediated by educational attainment and achieved occupational social class. This may be consistent with a pattern where childhood IQ is strongly associated with outcomes that reflect neurological disorder, such as the degenerative dementias, but less so with common chronic physical diseases of ageing.     

Long-term follow-up of physical activity behavior in older adults.

OBJECTIVE: To examine the contribution of social-cognitive factors (self-efficacy and affect) in predicting long-term physical activity in a sample of older adults (N=174). DESIGN: A prospective design assessed physical activity and psychosocial variables at 2 and 5 years following a 6-month randomized, controlled exercise trial. MAIN OUTCOME MEASURES: The primary outcome variable was self-reported physical activity, with previous behavior, self-efficacy, and affect assessed as determinants of physical activity. RESULTS: Covariance modeling analyses indicated that physical activity at Year 2 was the strongest predictor of physical activity at 5-year follow-up. Both self-efficacy and affect at Year 2 were also associated with physical activity at Year 5, as was original treatment condition. Variables accounted for 35% of the variance in Year 5 activity. CONCLUSION: Older adults with higher levels of physical activity, more positive affect, and higher self-efficacy at Year 2 were more likely to continue to be active at Year 5. This study is one of the longest follow-ups of exercise behavior in older adults and has implications for structuring environments to maximize the maintenance of physical activity.     

Long-term adverse health outcomes of physical workplace violence: a 7-year population-based follow-up study

The aim of the present study was to analyse whether physical workplace violence increases the risk of long-term adverse health outcomes (i.e., high number of visits to the general practitioner, outpatient treatment, hospital admittance, antidepressant use, and/or having a mental disorder). The study was based on representative survey data from 2006 and 2010 (entitled “How are you?”) merged with register data for a 7-year follow-up period (N = 30,812). To examine if physical workplace violence was a predictor of adverse health outcomes, logistic regression models were conducted for the total follow-up period and for each follow-up year with the different outcome measures as the dependent variables. In the follow-up period, individuals who were exposed to physical workplace violence had a higher number of visits to the general practitioner, had more often received outpatient treatment, and had more often been admitted to hospital than their non-exposed counterparts. Moreover, exposed individuals had higher odds of using antidepressants in the last three follow-up years than did non-exposed individuals. The findings call for heightened attention to securing preventive as well as rehabilitative strategies to help victims of physical workplace violence with the aim of avoiding adverse long-term health consequences.     

Adult outcomes as a function of an early childhood educational program: an Abecedarian Project follow-up

Adult (age 30) educational, economic, and social-emotional adjustment outcomes were investigated for participants in the Abecedarian Project, a randomized controlled trial of early childhood education for children from low-income families. Of the original 111 infants enrolled (98% African American), 101 took part in the age 30 follow-up. Primary indicators of educational level, economic status, and social adjustment were examined as a function of early childhood treatment. Treated individuals attained significantly more years of education, but income-to-needs ratios and criminal involvement did not vary significantly as a function of early treatment. A number of other indicators were described for each domain. Overall, the findings provide strong evidence for educational benefits, mixed evidence for economic benefits, and little evidence for treatment-related social adjustment outcomes. Implications for public policy are discussed.     

The maintenance of fluency after intensive in-patient therapy: Long-term follow-up

Maintenance of fluency after intensive in-patient treatment was studied in eight male stammerers. Reasons for success and failure are discussed in relation to objective and subjective data collected at the final follow-up interview.     

Long-term follow-up study of children developmentally retarded by early environmental deprivation

In 1972, two children representing a case of severe developmental retardation were discovered and taken into custody. The children, an older sister (referred to as F) and a younger brother (referred to as G), were found to have achieved no more than the physical and mental age level normal to children 1 year of age or less, in spite of their actual respective chronological ages of 6 and 5. Investigation revealed that the children's developmental retardation was due both to extreme social isolation and to complex deprivation. By following their sensorimotor, linguistic, cognitive, and socio-emotional development from the time of discovery to the date of this writing, we have found that their physical and motor development or recovery has proceeded smoothly, whereas their linguistic and cognitive development has continued to show such weaknesses as defective functioning of internal speech (Vygotsky, 1962) and poor ability to deal with abstract, linguistic subjects. F and G have continued to exhibit a tendency toward undersocialization, but this has at times been rather a positive factor in the process of attaining ego identity during adolescence, especially for G, serving to protect him from unreasonable social pressures to conform to group behavior. In combination with other cases of severe deprivation, the case of F and G holds some interesting implications for theories of human development, particularly the notion of critical periods.