Spouse involvement in the treatment of obsessive-compulsive patients

Twelve married obsessive-compulsive patients were randomly allocated to either selfcontrolled exposure or partner-assisted exposure. Treatment in both conditions consisted of homepactice.The results at the Post-test showed that both versions of exposure in vivo resulted in significant improvements but the partner-assisted group improved more. After a 1-month treatment-free period no significant differences between conditions were found due to a continuing improvement in the selfcontrolled exposure condition. Results were maintained at a 6-month follow-up.It was concluded that home-practice is a cost-effective treatment procedure for obsessive-compulsives and that couple training may be useful with selected patients.     

Effects of decreasing intersession interval duration on graduated exposure treatment during simulated routine dental care

Reports suggest that individuals with developmental disabilities often engage in behavior during dental visits that precludes regular dental care. Graduated exposure therapies are an effective treatment for avoidant behavior in people with developmental delays, and some studies show that the duration of the intersession interval (ISI) can impact the effectiveness of graduated exposure treatments for typically developing individuals. The current study examined the effects of decreasing ISI on outcomes of a graduated exposure treatment during simulated routine dental care for 3 individuals diagnosed with autism. Treatment consisted of graduated exposure and extinction for disruptive behavior. Initially, sessions were conducted once per week. In subsequent conditions, treatment sessions were conducted 3‐5 times per week. A nonconcurrent multiple baseline across subjects design was used to demonstrate experimental control. Results suggest that decreasing ISI durations can produce improved treatment outcomes.     

Evidence-based treatment and therapist drift

Cognitive-behavioural therapy (CBT) has a wide-ranging empirical base, supporting its place as the evidence-based treatment of choice for the majority of psychological disorders. However, many clinicians feel that it is not appropriate for their patients, and that it is not effective in real life-settings (despite evidence to the contrary). This paper addresses the contribution that we as clinicians make to CBT going wrong. It considers the evidence that we are poor at implementing the full range of tasks that are necessary for CBT to be effective - particularly behavioural change. Therapist drift is a common phenomenon, and usually involves a shift from ‘doing therapies’ to ‘talking therapies’. It is argued that the reason for this drift away from key tasks centres on our cognitive distortions, emotional reactions, and use of safety behaviours. A series of cases is outlined in order to identify common errors in clinical practice that impede CBT (and that can make the patient worse, rather than better). The principles behind each case are considered, along with potential solutions that can get us re-focused on the key tasks of CBT.     

The effects of physostigmine during the acquisition of avoidance behaviour as a function of the intersession interval

Rats were trained and tested on an avoidance task in a shuttle box. The change in the performance of the control rats over two sessions was found to be a U-shaped function of the interval between the sessions. The change in performance of rats injected with physostigmine prior to the second session was also found to be a U-shaped function of the intersession interval, although the drug was shown to impair avoidance behaviour. These results are consistent with those of Hamburg (1967) and of Biederman (1970), and support the general contention that cholinergic mechanisms in the brain are involved in the control of avoidance and escape behaviour in the rat. They do not, however, necessarily support the hypothesis advanced by Deutsch (1969, 1971) to describe a biochemical basis of learning and memory, especially if it is used to explain the effects of cholinesterase inhibitors on avoidance behaviour in the shurtlebox.     

Duration of flooding sessions in the treatment of obsessive-compulsive patients

This study investigated the duration effect of flooding ‘in vivo’ and ‘in fantasy’ in twelve obsessive-compulsive patients treated in a balanced Latin square design. Clinical assessments regarding twenty one clinical variables were carried out before and after each treatment condition. Long practice sessions proved significantly superior to other treatment conditions. Short and long sessions ‘in fantasy’ did not diner significantly. Long fantasy sessions appear to have potentiating effects on in vivo practice sessions. The order effect and the intercorrelation of the variables prior to treatment and to the outcome, are also presented. Some prognostic factors and the follow-up findings are discussed.     

Venlafaxine treatment of obsessive-compulsive disorder: case reports

About one-third of patients affected by obsessive-compulsive disorder fail to respond to serotonergic drugs and different strategies have been proposed for these resistant cases. This article reports experiences with venlafaxine in patients with obsessive-compulsive disorder who did not respond or did not tolerate serotonergic drugs.     

Successful treatment of obsessive-compulsive disorders

Behavioral therapy and drugs have significantly improved obsessive-compulsive disorder (OCD) symptoms. A variety of behavioral therapy methods have been employed, but exposure and prevention of response, particularly, have reduced ritualistic actions of many OCD patients. Many psychoactive drugs have been tried; the tricyclic antidepressant drugs (clomipramine or Anafranel), especially in research outside the United States, have alleviated OCD symptoms as well as depression. Compulsive rituals have responded more often than obsessive actions to both behavioral and psychopharmacological therapy. Recent research has suggested that psychophysiological as well as traditional psychogenic factors may contribute to the etiology, course, and alleviation of OCD.     

Behavioral treatment of obsessive-compulsive neurosis

Three chronic and severe obsessive-compulsive neurotics were treated with behavioral intervention strategies and psychotropic medication. The effects of treatment were evaluated in three separate experiments with single case experimental designs. The results suggest that response prevention was effective in reducing ritualistic behavior while the effects of flooding and antidepressant medication added little to outcome. The results also suggest that strategies aimed only at reducing compulsive behavior per se are insufficient in eliminating other associated difficulties (e.g., depressive symptoms, interpersonal problems) and that a comprehensive approach to treatment is needed.     

Being a therapist in eating disorder treatment trials: constraints and creativity

This paper gives a brief overview of the sequence and content of the eating disorder treatment trials at the Maudsley Hospital in London, and describes the experience of the author working as a research therapist on these trials. It considers the different ways research constraints affected the therapist, how she learnt to make creative use of what appeared to be therapeutic restrictions, and how having her clinical freedom curtailed taught her to be more flexible and showed her new ways of understanding her patients.     

Family treatment of an obsessive-compulsive child: a case report

This paper presents a family therapy approach to the treatment of an obsessive-compulsive child. Psychodynamic, behavioral and family therapy approaches to the etiology and treatment of this dysfunction are described briefly, and a detailed case report of a 15-session treatment utilizing behavioral interventions designed to change the family context is presented. Various procedures for dealing with the obsessive-compulsive behavior have been reported in the literature, including eliminating it directly by interruption or ordeal and modifying it. In this case, the author proceeded by ignoring the compulsive behaviors and concentrating on more functional ones using a paradoxical charting intervention. At one-year follow-up, the child was symptom free. Relationship factors, technical interventions, and stylistic aspects of the therapy are discussed, and the importance of rapid symptom alleviation in these children is underscored.     

Possible psychosomatic hazards to the therapist: patients as self-objects

This speculative paper concerns certain fundamentals of healing and psychotherapy which we mistakenly tend to take for granted. I discuss our need for the feeling of harmony, wholeness, and oneness. I call this archetypal need our 'normal autistic expectation'. When met, we experience well-being and 'healing'. If not sufficiently and reliably met, this expectation becomes an omnipotent demand ('autistic demand'). Frustration then brings about angry destructiveness, either outwardly directed or inwardly directed, with bodily changes which must be processed if bodily damage is to be minimized. Bereavement, the loss of a person necessary for one's feeling of wholeness (a 'self-object'), is an extreme and well-researched example of such damage. Our selfobjects are 'healing' when they help us to complete our sense of self. Our patients-, our profession, our colleagues, our place of work and our financial security are normally all part of our self-object structure. I give examples where patients' own needs for survival or intactness mean that they have to externalize their own hurt and anger for long periods of their therapy. This often means that the therapist's own wholeness and health are under attack, and even damaged permanently, or at least until the damage can be processed. The nature of 'processing' in this sense is therefore in need of energetic research.