Self-induced vomiting in eating disorders: Associated features and treatment outcome

Self-induced vomiting is adopted by people with a variety of eating disorders (ED) to control body shape and weight. We tested the prevalence, the associated features and the role on treatment outcome of self-induced vomiting in 152 ED patients consecutively admitted to an inpatient cognitive-behavioral treatment (CBT), based on the transdiagnostic CBT for ED. The Eating Disorder Examination, together with the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Temperament and Character Inventory were recorded at entry and at end of treatment. Self-induced vomiting was reported in 35.5% of cases, and 21.1% had multiple purging with vomiting. Individuals with vomiting and those with multiple purging had significantly higher BMI and a higher frequency of bulimic episodes, but individuals with multiple purging were also characterized by higher levels of depression, longer ED duration, more severe ED psychopathology and lower self-directness. Individuals with vomiting had higher eating concern and novelty seeking compared with those without purging behaviors. However, the three groups had similar dropout rates and outcomes in response to inpatient CBT, in keeping with the transdiagnostic theory of EDs.     

Affective state and preference for immediate versus delayed reward

Fifty-two 9-year-olds were randomly assigned to success and failure treatment conditions involving acceptance or rejection of a drawing made for an art show. In a pilot study, this treatment was shown to influence significantly subjects' affective states. Just after treatment, subjects were presented with choices between pairs of small immediate and large delayed rewards. As predicted, subjects who had experienced success chose more often the large delayed reward than those who failed (p < .02). Prior expectancy for success and sex were not significantly related to choice behavior. The influence of affective state on various parameters of the choice paradigm was discussed, and other evidence was cited indicating that affective state is a major determinant of self-gratification behavior.     

Panikattacken – mTGT ohne Pharmakotherapie

Only a limited number of medical studies referring to Animal Assisted Therapy have been published worldwide. The specific concept of medically oriented Animal Assisted Therapy (mAAT) was developed by the Austrian Institute for Animal Assisted Therapy & Research (AIAATR), based north of the city of Krems/Donau in Lower Austria, as a nonpharmacological treatment method for patients with mental or psychological overload. This particular case study describes a 30-year-old female academic who had been brought to the institute by her concerned neighbour because of repeated panic attacks. Despite extensive briefing, the patient vehemently refused any pharmacological intervention. Therefore, two-step management starting with an acute phase therapy of two therapeutic units (ThU), 90 min each over 5 days – during this period the patient stayed at the patient appartement of the institute – followed by a regular treatment cycle of 1 ThU/week over 12 weeks was selected. The HAMA-21 was used to evaluate treatment quality, therapy progress, and success. A total score of 30 at the beginning declined to 3 at the end of treatment.     

Comparing the effectiveness of behavioral treatment for chemotherapy-induced nausea and vomiting when administered by oncologists, oncology nurses, and clinical psychologists.

Adequate control of side effects during medical treatment of cancer increases patient compliance and quality of life. Antiemetic drugs are not an effective treatment for the one in three cancer patients on chemotherapy who experience anticipatory nausea and vomiting (ANV); the behavioral treatment of systematic desensitization has been found effective for ANV when delivered by clinical psychologists. This study examined the effectiveness of systematic desensitization when delivered by medical personnel versus clinical psychologists. Seventy-two consecutive cancer patients with ANV were randomly assigned to no-treatment control or to systematic desensitization from 5 behaviorally trained clinical psychologists, 6 clinical oncologists, or 10 oncology nurses. The treatment was found effective in reducing anticipatory nausea, anticipatory vomiting, posttreatment nausea, and posttreatment vomiting compared to control patients, with no significant differences in effectiveness found between clinical psychologists and oncology staff. Although medical personnel should not engage patients in psychotherapy or other interventions that cannot be completed successfully, they can treat patients effectively with systematic desensitization and should be encouraged to learn and use this and other behavioral intervention techniques to benefit total patient care.     

Personality factors associated with anticipatory nausea/vomiting in patients receiving cancer chemotherapy

One hundred cancer chemotherapy patients rated the severity of pre- and posttreatment nausea and emesis and completed the State-Trait Anxiety Inventory. In addition, scores on the Millon Behavioral Health Inventory were obtained for 59 of those patients. Thirty-three percent of the patients reported having experienced anticipatory nausea and 11% reported having experienced anticipatory vomiting. Patients who experienced anticipatory nausea had more posttreatment nausea and vomiting, were more depressed, and were characteristically more anxious than other patients. A personality profile including the future despair, social alienation, and inhibited style (from the Millon Behavioral Health Inventory) identified patients with anticipatory nausea.     

积极与分离认知重评负性情绪调节效果和成功程度的差异：青年、中老年和少年的实验结果

考察了少年、青年和中老年两种认知重评在负性情绪调节效果和成功程度上的差异。差异分析表明：少年分离认知重评的成功程度显著高于积极认知重评;青年积极认知重评的情绪调节效果显著好于分离认知重评;中老年积极认知重评的情绪调节效果和成功程度均显著好于分离认知重评。三组被试两种认知重评的情绪调节效果之间均无显著差异。青年分离认知重评的成功程度分别显著高于少年和中老年;青年和中老年积极认知重评的成功程度均显著高于少年。     

Breaking the cycle: cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome

The present article presents a case of cognitive behavioral therapy (CBT) along with heart rate variability (HRV) biofeedback training for the treatment of a medication unresponsive 13-year-old boy with cyclic vomiting syndrome (CVS). CVS is characterized by recurring stereotypic episodes of vomiting, interspersed with asymptomatic periods. Triggers for vomiting include anticipatory anxiety related to school examinations, family conflicts, and birthday parties as well as infectious diseases, and certain foods. Current treatment design addressed two pivotal etiological factors: autonomic dysregulation and anticipatory anxiety. Treatment outcome suggests that vomiting episodes may be successfully prevented by aiding the patient to identify and manage precipitant psychological stressors, to regulate HRV patterns, and gain a renewed sense of bodily control and self-efficacy. Further research is suggested using a controlled study with pre- and post-behavioral and stress measures to evaluate the effectiveness of CBT and biofeedback training compared to pharmacotherapy and placebo.     

Self-efficacy as a predictor of ability to learn control of heart rate increase with and without biofeedback

Abstract

The usefulness of self-efficacy as a predictor of success in controlling heart rate increase with and without biofeedback was investigated in an experimental study on 60 adult subjects. The first part of the study measured heart rate increase control without biofeedback training, the second part measured heart rate increase control with biofeedback training and a posttest measured subsequent heart rate increase control without biofeedback. The results revealed that higher levels of self-efficacy were predictive of success in controlling heart rate increase without biofeedback, but not with biofeedback.     

Treatment of Chronic Major Depression Using the Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

This article presents data from an ABAB single case design study of a 60-year-old Caucasian male diagnosed with chronic major depressive disorder. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was utilized throughout treatment, and both BDI scores and diagnostic interviews revealed states of partial, and ultimately full remission during the course of treatment. A focus was ultimately placed on generalizing what the patient learned in-session to his outside life. Additionally, the unique design of this case illustrated that the patient experienced a moderate reduction in depressive symptoms, prior to the long-term alteration of his coping style. A stable change in his coping style was necessary before full and sustained recovery was evidenced.     

Self-serving biases in the perception of freedom: the impact of previously experienced failure

The purpose of five experiments was to investigate the use by Israeli students of a perceived lack of freedom as a self-protective device against the negative implications of poor performance in an achievement task. I hypothesized that a reduction in perceived freedom might be used to protect self-esteem following failure. A reduction in perceived freedom would weaken a person's sense of responsibility for failure and thereby protect self-esteem. Experiments 1 and 2 showed that subjects exposed to failure retrospectively reported having had less freedom during the experimental sessions than those who experienced success or no feedback at all. Experiments 3, 4, and 5 demonstrated that failure reduces the perception of freedom when other external rationalizations for failure (high consensus, high distinctiveness, low consistency) are unavailable. The results are interpreted in the light of self-protective strategies.     

The communication of musical metre in piano performance

Six pianists of varying levels of experience were required to give repeated performances of a note sequence presented for sight-performance under two conditions. The two conditions differed only in the location of metrical stresses signified by the notation. In condition (b) the bar-lines and beams were shifted one note to the right in comparison to condition (a). Details of note duration and intensity were recorded by computer. This allowed the discovery of significant differences in expressive treatment between the two conditions. There were significant agreements between subjects concerning the position, nature and direction of expressive variation. The more experienced players, however, made greater use of expressive variation than did the less experienced players. In a second experiment listeners were asked to identify the metre of each performance from the first experiment. They achieved greatest success at this with the most experienced player, least success with the least experienced player. A detailed examination of between-performer agreements and disagreements, and their effects on listeners, allowed the isolation of a proposed set of generally effective procedures for signalling stress. These procedures imply the existence of an internal representation guiding performance which identifies the major metrical subdivisions of a bar in the absence of notational symbols specifically marking these subdivisions.     

Sexual addiction and compulsion: recognition, treatment, and recovery

The management of patients with compulsive sexual behavior requires an understanding of the profile of the sexually compulsive or addicted patient. This article summarizes patient characteristics and their implications for treatment. Data from a study of the recovery of 957 patients who had problematic, sexually excessive behavior are presented. Spanning 5 years, the study shows six distinct stages patients experienced and the clinical activities that were most useful to them. A trajectory of a typical diagnosis and treatment path is provided, as well as important resources for physicians and patients.     

Social skills training and systematic desensitization in reducing dating anxiety.

Cooper et al. (1969) have criticized the types of target behavior chosen for therapy analogue studies for being irrelevant to clinical practice. A potential target behavior which appears to be pervasive, complex and directly relevant to clinical practice is interpersonal anxiety. Of special concern to college students is the interpersonal anxiety elicited by members of the opposite sex. especially in dating situations (Martinson and Zerface, 1970).An individual may experience interpersonal anxiety because of a deficit in social skills (reactive anxiety) or because of prior conditioning (conditioned anxiety) or because of some combination of both reactive and conditioned components. While it is possible that a treatment program aimed at a reduction of either of these anxiety components may be instrumental in ameliorating the other component, it would appear that a comprehensive treatment program would attempt to teach social skills as well as reduce conditioned anxiety.Desensitization procedures have demonstrated success in alleviating conditioned anxiety for a wide variety of clinical problems (Paul, 1969a. 1969b) and appears to be a logical choice for the conditioned component of dating anxiety. A number of outcome studies have reported some success in the use of in vivo desensitization (Rehm and Marston, 1968; Martinson and Zerface, 1970) and systematic desensitization (Stark, 1970) in reducing anxiety in date anxious subjects.The literature on treatment programs aimed at social skills training for date anxious subjects is meager. Melnick (1973) reported success in improving the appropriateness of the social behavior of subjects who had experienced a minimal dating history by the use of modeling, behavioral rehearsal and self-observation techniques.The present study was designed to test the relative effectiveness of two different types of treatment programs in alleviating interpersonal dating anxiety. The two experimental groups consisted of a systematic densensitization program which focused on the condition anxiety component and a social skills training program which focused on the reactive anxiety component.     

Long-Term Psychoanalytic Therapy as a Life-Saving Procedure

A dramatic long-term psychoanalytic treatment of a psychotic character disorder is presented in detail. This patient began therapy with a long standing history of an eating disorder for which she had received many hospitalizations and forms of treatment without any success. She was in a deep despair and as a last resort agreed to a psychoanalytic therapy. During the many years of treatment the eating disorder completely resolved but was replaced by a series of very dangerous accidents that occurred each time she was betrayed and disappointed by a boy friend. This went on pari passu with a deepening understanding of her childhood and her psychodynamics but the middle of the therapy was very stormy and required tenacious efforts to maintain the treatment. The self-destructive behavior was traced to early and profound childhood disappointments and a sense that these were her fault because she was so unlovable and therefore deserved punishment. A dangerous stalemate developed in the treatment after a number of years. The analyst presented the case to colleagues several times and wrote it up in detail, which enabled him to understand his own countertransference and resolve it. This resulted in a dramatic change in the patient and a very favorable and happy ending to this very difficult treatment after 15 years. Although the author believes all patients in psychoanalysis should be approached with as neutral and objective a stance as possible, emphasizing free association and dream material in order to interpret the crucial childhood determinants of the patient's psychopathology, in cases such as psychotic character disorders the outcome clearly also depends on interpersonal factors. The case illustrates the deep partly conscious and partly unconscious interaction between a patient and her analyst over many years of treatment and the profound effect this has on the outcome. It underscores the importance of patients being allowed to heal in their own way and in their own time without intrusion or interference from the analyst. It also demonstrates the crucial importance of long-term psychoanalytic therapy as a life-saving procedure in cases where it is appropriate in spite of the great amount of time and expense involved.     

Health-related quality of life in patients with systemic lupus erythematosus and proliferative lupus nephritis

This study investigated the influence of two different treatments for a kidney inflammation (i.e. proliferative lupus nephritis) on health-related quality of life (HRQoL) in patients with the chronic auto-immune disease systemic lupus erythematosus (SLE). One treatment protocol, the National Institutes of Health (NIH) protocol, was characterized by a high dose of cyclophosphamide (CYC, an immunosuppressive drug), and the second treatment, the Euro-Lupus protocol, involved a low-dose CYC. Thirty-two SLE patients were included based on the received treatment for an episode of proliferative lupus nephritis, according to either the Euro-Lupus or the NIH protocol. The two groups were compared on HRQoL as measured by the SF-36 and the SLE Symptom Checklist (SSC). The Euro-Lupus group (N?=?16) tended to show a higher HRQoL than the NIH group (N?=?16) on four of seven scales of the SF-36. In addition, the Euro-Lupus group experienced less burden from nausea or vomiting than the NIH group as assessed by the SSC. Fatigue was the most disturbing symptom in both groups. The most burdensome aspects of treatment were related to chemotherapy (55.2%) and use of prednisone (34.5%). Patients with a low HRQoL and high levels of fatigue were more likely to have low levels of serum complement C4 (i.e. elevated immune activity). In conclusion, patients who are treated according to the Euro-Lupus protocol may experience a higher HRQoL than patients who receive the NIH treatment. However, chemotherapy remains burdensome in the low-dose treatment regimen. Potential interventions to further enhance the HRQoL in SLE patients with proliferative lupus nephritis are discussed.     

The influence of success and failure experiences on perceptual whole-part preferences

Summary Changes in perceptual part-whole preferences as a function of experienced success and experienced failure were investigated. All Ss went through one testing session in which their perceptual preference was established. Forty-two Ss of the experimental group went through two additional testing sessions, one in which success and another in which failure experiences were induced. Parallel sets of a Two-Alternative Perception Test were used after each session to measure part or whole preferences. The Ss of the control group were administered the three sets of the perception test at intervals of one week, with situations kept constant. Results of a three-way analysis of variance (p<0.0001) supported the hypotheses of success situations favoring whole perceptions and of failure situations favoring part perceptions. Highly significant correlations (p<0.01) were found between the three testing sessions of the Ss in the control group, indicating stability of perceptual part-whole preferences over time, with situations held constant.This article was based, in parts, on a doctoral dissertation submitted to the Graduate Faculty of Political and Social Science, New School for Social Research. The author would like to express her appreciation to Mary Henle, chairman of the dissertation committee.     

Neuropsychological screening for cognitive impairment using computer-assisted tasks

The aim of this study was to validate a computer-assisted screening battery for classifying patients into two groups, those with and without cognitive impairment. Participants were all patients referred to the neuropsychology clinics at four VA medical centers during a 1-year period. Patients meeting the study inclusionary criteria (N = 252) were administered the Neurobehavioral Evaluation System-3 (NES3) computer-assisted battery. A detailed neuropsychological examination was carried out by an experienced neuropsychologist, who diagnosed the patient as cognitively impaired or not impaired. The neuropsychologist's diagnosis was the gold standard. Recursive partitioning analyses yielded several classification procedures using the NES3 data to predict the gold standard These procedures produced a set of six NES3 tasks that provide good sensitivity and specificity in predicting di- agnosis. Sensitivity and specificity for the least random classification procedure were 0.87 and 0.67, respectively. The results suggest that computer-assisted screening methods are a promising means of triaging patients.     

Person-centered support and athletes' motivation for performance

The purpose of the study was to examine the effect of person-centered intervention on motivation for athletic performance. 74 volleyball players, 24 boys and 50 girls (M age = 13 yr., SD = 1.0), completed a motivation questionnaire, the Leistungs Motivations Test für Jugendlichen prior to and after an 8-mo. group treatment that included the application of Roger's person-centered method to the participants of the experimental group (1 boys' team n = 12; 1 girls' team n = 11), at a frequency of at least one session per week. In the control group (1 boys' team n = 12; 3 girls' teams n = 39), no particular method was used apart from the pedagogical methods that coaches selected. Results revealed a statistically significant decrease in boys' scores on desire for performance and success between the pre- and posttest measurements. No significant change in girls' scores was observed. Thus, the 8-mo. treatment using the person-centered method did not improve volleyball players' motivation for performance.     

Choosing an optimal motor-task difficulty is not trivial: The influence of age and expertise

An accurate estimate of one’s performance is an important prerequisite for success, and prevents people from taking excessive risks. Based on the selection-margins paradigm (Riediger et al., 2006), the current paper assessed maximum speed rope-skipping (study 1), soccer dribbling (study 2), and the fine motor task of tracing (study 3) in 5- to 37-year-olds. Participants predicted their performances for the upcoming trial. The better the predicted performance, the more points were gained in case of success. To discourage overestimations, participants received no points for unsuccessful trials. In rope skipping, older and more experienced athletes outperformed the beginners, and had fewer trials with 0 points. In soccer dribbling and tracing, older individuals again showed less overestimation, as reflected by a smaller deviation of predicted and actual performance (selection margins) and fewer 0 point trials. Athletes and coaches should be aware that younger and less-experienced athletes tend to overestimate their motor performances.     

成功经历能改善低耐挫大学生的挫折心理

为考察多次成功对低耐挫大学生挫折心理的改善,研究1以高、中、低耐挫大学生为被试,采用图形推理任务创设挫折-连续成功情境（即先经历挫折,后经历多次成功）;研究2以高、低耐挫大学生为被试,采用部件组字任务创设挫折-连续成功情境。结果发现,在经历挫折后：（1）成功1次能改善大学生的成功坚信程度,连续成功6或7次能使其趋于稳定;（2）成功1次能改善低耐挫大学生的情绪体验,连续成功6次能使其相对稳定;（3）成功1次能改善低耐挫大学生的继续意愿,连续成功7次能使其趋于稳定。表明多次成功能改善低耐挫大学生的挫折心理。