Självobservation och självregistrering av smärta: Några metodologiska aspekter

Abstract

Med utgångspunkt från en beteendeteoretisk modell för smärta diskuteras principer för utformningen av en metod för självobservation och självregistrering av smärtbeteende. Följande frågeställningar berörs: Vad skall observeras? Vilka krav bör ställas på registreringsmetodiken? Diskussionen utmynnar i konkreta förslag till registreringsmetodik för intensitet och duration av smärtupplevelser, samt förekomsten av smärtrelaterade beteendeöverskott och underskott. Metodikens begränsningar berörs kortfattat.     

Rökavvänjning genom självterapi

Sammanfallning : I artikeln presenteras kortfattat ett program för rökawanjning, vilket utvärderats på experimentell basis. Programmet, som består av olika självterapeutiska tekniker, föreligger i bokform och omfattar 5 veckor. Under derma period instruerades fpp att observera sig själva på olika sätt för att bli medvetna om sitt rökbe—teende. Därefter gavs de uppgifter som gradvis fick dem att minska sin cigarrettkonsumtion. Slutligen fick de lära sig nya beteendemönster som ersättning för den avlagda rökvanan. 150 personer del tog i försoket, indelade i 3 olika be—handlingsgrupper. Dessutom fanns en kontrollgrupp     

Behandling av städtvång

Abstract

En 33-årig kvinna med städtvång behandlades med modellering och träning i hemmiljö samt instruktion att gradvis begränsa städning i tid och omfattning. Behandlingen utvärderades bl a med en multipel baslinjedesign över olika städbeteenden. Resultaten visade att behandlingen hade effekt på tid för tvångsmässig städning. Både självrapport och terapeuternas bedömning visade på positiva resultat.     

Förändring av undvikandebeteende och hjartfrekvens som en effekt av systematisk desensibilisering: Fallstudie av en social fobi

En klient som hade radsla for att tala i andras narvaro behandlades med systematisk desensibilisering. Tekniken hade modifierats sa att en forestalld respons (att tala) forandrades till auditiv stimulering (banduppspelat tal) dar klienten gavs kontroll over exponeringen. Be—handlingen utvarderades subjektivt av klienten och med hjalp av hjart—frekvensregistrering. Resultaten tolkades i termer av motbetingning och exponering till den fobiska situationen.     

Obstipation: En jungfrulig tillämpning av beteendemedicin

Abstract

Denna artikel presenterar en introduktion till en beteendemedicinsk arbetesmodell för kronisk obstipation. Den bygger på en nyutkommen artikel om beteendeterapeutisk behandling av svår förstoppning. Studien visar att beteendeterapeutiska metoder är den kanske mest lovande behandlingsmetoden för obstipation. Problemet är att det finns lite intresse bland beteendeterapeuter att ta på sig denna behandling. Artikeln syftar till att entusiasmera beteendeterapeuer till detta mycket roliga och givande arbete.     

Träning av realitetsorientering hos en grupp patienter med senil demens

Abstract

Fem patienter med diagnosen senil demens tränades beträffande tids-rums-och personorientering i en klassrumssituation. Vissa förbättringar av möjligheterna till orientering på avdelningen företogs. Resultaten visade en ökad förmåga till realitetsorientering under själva träningen, men inte en halvtimme senare. En allmän aktivering av patienterna under och efter träning kunde iakttagas. Förmågan att svara rätt på tids-rums-och personorienteringsfrågor föreföll vara beroende av tillgång till klara stimuli i miljön i form av klockor, almanackor o dyl.     

Självpåverkan av studievanor - En litteraturgenomgång

Abstract

Artikeln är en litteraturgenomgång av forskning om självpåverkan av studievanor. De självpåverkansmetoder som har använts för att förändra studievanor beskrivs och den behandlade litteraturen presenteras med utgångspunkt från de använda metoderna. Metoderna är självobservation, stimulusstyrning, självförstärkning, problemlösning, beteendekontrakt och “goal-setting”. Forskningsrapporterna kommenteras och värderas ur teoretisk, metodologisk och praktisk synvinkel. Slutsatserna blir att 1) man kan förändra studievanor med självpåverkansmetoder, men man vet mycket lite om varför det går, 2) det behövs mera teoretisk och metodologisk stringens i framtida studier för att man skall producera mera kunskap inom forskningsområdet och 3) det finns ingen som helst ansats till beteendeanalys av studievanor och studiebeteende och det krävs en koncentration av ansträngningarna i denna riktning för att man skall kunna identifiera styrfaktorer för studiebeteende.

B.E. Rönnbäck: Self-management of study habits: A review. Research concerning self-management and self-control of study habits performed during the 1970's is reviewed. The techniques are self-monitoring, stimulus control, self-reinforcement, problem solving, contracting, and goal-setting. The presented studies are commented upon and evaluated from theoretical, methodological and practical viewpoints. It is concluded that l) self-control methods can change study habits, but that we know very little about why, 2) more theoretical and methodological rigor in future studies is needed in order to add basic knowledge to the research area, and 3) behavior analysis of study habits and study behavior is totally lacking and a concentration of efforts in this direction is needed to identify determinants of study behavior.     

Flygrädsla i Sverige. En enkätundersökning av svenskars rädsla för trafikflyg som transportmedel

Abstract

Föreliggande arbete avser en enkätundersökning av svenskars flygrädsla. Tvätusen svenska med-borgare i äldrarna 18–75 är erhöll en enkät med 25 frägor angäende flygrädsla och hur denna päverkar viljan att utnyttja trafikflyget.

Christer L. Nordlund: A questionnaire of Swedes' fear of flying. During the spring and summer of 1982, 1 992 randomly selected individuals received a written questionnaire concerning fear of flying. 1 484 individuals returned the questionnaire and 169 of the remainders were interviewed by telephone and were included in the material. 76% of the individuals in the material had flown one or more times, while 6% reported that because of fear they had never flown. 17% reported that they could not consider flying, owing to fear, or for other reasons. 10% answered that they experienced relatively great or greater fear when flying, while 15% answered that they felt the same when thinking about flying. When asked about different parts of a flight, 25% revealed that they felt relatively great or greater fear during some part of it, and about 30% reported the same level of fear when clear air turbulence was encountered. The prevalence of flight fear depends upon the definition used. If “daring to fly” is used as a criterion, 10% of the Swedish population, i.e. 600 000 Swedes, can be considered to be afraid of flying. Given that flying is quite safe (from a statistical point of view), anyone experiencing discomfort during a flight could be regarded as demonstrating fear of flying. With this criterion, 50% of the interviewed individuals (= 3 000 000 Swedes) could be regarded as apprehensive about flying.     

Psykologisk behandling av ihållande hallucinationer och vanföreställningar vid schizofreni

Abstract

Artikeln redogör för behandling av kvarstående hallucinos och vanföreställningar som cirka hälften av alla personer som drabbats av schizofreni besväras av, trots att de sköter sin medicinering. Enligt ett stort antal beskrivande studier verkar de flesta klienter ha en eller flera mer eller mindre välfungerande sätt att klara sina psykotiska upplevelser. Förutom att förmedla dessa personliga erfarenheter till andra klienter har en mängd olika strategier testats kliniskt och i ett fåtal kontrollerade studier. Artikeln redogör för cirka 20 beteendeterapeutiska och kognitiva metoder som visat större eller mindre framgång. Under senare år framstår kognitivt inriktad analys och behandling som mest hoppingivande. Bristande forskning, alltför knapphändiga kliniska rapporter och brist på personer som klarar beteendeanalys vid psykotiska tillstånd står i bjärt kontrast till lidandet hos det stora antal personer som drabbats av kvarstående psykossymtom.     

Behandling av tvångstankar med tankestopp

Abstract

I en intensivdesign studerades effektiviteten av tankestopp kombinerad med en systematisk bearbetning av utlösande situationer och in-vivo-träning på en klient med tvångstankar. Behandlingen, som även innebar vissa miljömässiga förändringar, visade sig vara effektiv för de aktuella problemen.     

Gewaltprävention statt Präventivschlag

Die Psychotherapie -     

Therapieverläufe von Sexualstraftätern

Throughout the past decades evaluation studies on sexual offender treatment have led to controversies. While numerous studies examined the effectiveness of different interventions, the possible underlying mediating mechanisms have largely been neglected. This study took a multimethod approach to investigate the measurability of change processes in sexual offenders serving a sentence in the social therapeutic institution (SothA) of the detention center in Tegel, Germany (n?=?105). A longitudinal design with three groups (i.e. waiting group, treatment group and day release group) from four perspectives on change processes (i.e. external criminal prognostic assessment, therapists’ view, staff observation and clients’ perspective) was employed. Most criminal prognostic risk and protective factors improved over the course of treatment and this effect was smallest in the waiting group. While therapists reported increased therapeutic constraints in the course of treatment, they were more favorable in the criminal prognosis and detected more differentiated patterns of needs and resources of clients as conceptualized by the primary and secondary assets of the good lives model (GLM). In contrast, during the course of treatment the sexual offenders showed an increased awareness of the criminogenically relevant problems in the sexual domain. Nonetheless, the overall number of problems they identified as criminogenically relevant decreased. The internal problem attribution in the sense of internal causes (“It is my fault”) and capability of change (“Only I can solve the problem”) was increased. The stronger the clients’ perception of own problems in the sexual context increased over the course of treatment, the more positive the change in the staff’s view of their behavior became and the more their dynamic risk factors improved. Overall, this study found strong evidence that change processes in SothA might already be detectable during ongoing social treatment. It is currently uncertain whether these changes influence future recidivism. A comparison with recidivism data is necessary and in planning.     

Zur Phänomenologie islamistisch-terroristischer Straftäter

Very little reliable information is currently known about the individual background of terrorist offences. The few empirical studies available are as a rule based on a consideration of the social statistical characteristics without reference to personality or psychopathological diagnostic findings. The present article is based on 40 expert opinions which were given by the author on a total of 29 subjects in the years 2000–2013. All subjects had committed crimes motivated by Islamic beliefs of which 23 could be explored and investigated in detail. Although the offenders included in this study consisted mainly of immigrants to Germany, in recent years a group of young offenders has crystallized, even in this sample of subjects, who were born and grew up in Germany. In the “immigrant” group (n?=?19) no psychopathological traits were detected and also only few ego-syntonic offenders who acted on convictions. In fact, these subjects were more a series of primarily conspicuously dissocial offenders and subjects who had failed to cope with their way of life or with their aims in life. Of the young Moslems who grew up in Germany (n?=?10) three subjects suffered from a schizophrenic psychosis and two had a primarily dissocial psychosis. Among the other subjects there were some special features in the developmental background, especially in the area of identity crises but without any noticeable uniform background pattern for a personality development to an Islamic offender.     

Stationäre Rehabilitation alkoholabhängiger Patienten

Systemic therapy concepts are widely used in therapy and rehabilitation of alcohol addictive patients. Although very useful in practice, evaluation studies are rare. Adequate evaluation strategies should be developed and implemented. This study was realized in a clinical rehabilitation centre (Hirtenstein, Allgäu/Germany), whose systemic concept is characterized by patient's wideranged possibilities of choice concerning therapy measures and therapy goals, the activation of social and personal resources, the development of an individually appropriate life-style, the training of desired competencies, and an offer for marital and family therapy. The evaluation is based on a repeated measures design without control group. The instruments and constructs of the evaluation are: F-SOZU (perceived social support), IIP (perceived interpersonal problems), MLDL (quality of life), SOC (sense of coherence), and an assessment sheet for personal resources (RI). Patients (n= 44) reported increased personal ressources as well as an increased level of quality of life. Perceived social support and the sense of coherence changed only moderately. Scaling of treatment satisfaction and goal attainment at the end of the rehabilitation program resulted in high positive scores. Patients reported only positive, no negative treatment side effects. The results indicate the usefulness of systemic and resource oriented concepts in the rehabilitation of alcohol addictive patients.     

Reduksjon av Sj⊘lvskadande Atferd hos ei 26 år Gamal Psykisk Utviklingshemma Kvinne

Abstract

Etter ein funksjonell analyse av målatferden slag mot hovudet, som resulterte i hypotesane om at sj?lvskadinga var opprettheldt av negativ forsterking og/eller sensorisk stimulering, vart basislinje av målatferd registrert. Sensorisk ekstinksjonsprosedyre, det vil seie kontinuerleg bruk av hjelm, vart deretter iverkett i forhald til ei 26 år gamal psykisk utveklingshemma kvinne. Resultata persenteras i eit N=1, ABAB-design. Etter 272 dagar vart basislinje- og ekstinksjonsapparaturf?resetnader gjeninnf?rt. Resultata illustrerer redusert slagfredkvens i forhald til basislinje. Studiet framstiller og prosedyrer for på sikt fierne, eventuelt redusere bruken av hjelm.     

Zur Häufigkeit der Schuldfähigkeitsbegutachtung von Sexualstraftätern im Erkenntnisverfahren

This study investigated how often and depending on which factors sexual offenders are examined by mental health experts regarding their criminal responsibility. Out of a total of 306 legal charges against sex offenders accused of child sexual abuse (CSA: n?=?145), rape or sexual assault (n?=?89), exhibitionism (n?=?39), sexual abuse of adolescents, mentally defective, physically helpless or warded persons (n?=?18) that were admitted by a criminal court in 2001 in the German federal state of Schleswig-Holstein, 209 (95.6 %) were analyzed regarding the following questions: how often was the accused examined by a mental health professional regarding mental responsibility? Was the chance of being examined systematically related to certain factors (e.g., personality of the accused)? Expert advice regarding the mental responsibility of the accused was obtained by the court in only 34 cases (11.7 %). No systematic relationships of personal variables as well as the modus operandi and the chance of commissioning a mental health expert were found. The main reason for assigning a forensic expert opinion was the vague impression of a psychic disorder. Re-offending increased the rate of a mental health examination only in CSA (34.6 % of re-offenders were examined compared to 9.2 % of first-time offenders), but not in rape or sexual assault. Also age does not predict the commissioning of an expert opinion. Only one fifth of all accused below the age of 21 were investigated by a mental health professional. Results are discussed in terms of legal background, consequences for risk assessment and relapse prevention.     

Ost-West-Verhältnis

The first question a psychoanalyst has to examine in connection with this topic is, whether psychoanalytical concepts apply to sociological and political developments (problems) at all, and which ones, if they do. The most adequate theories seem to be the psychoanalytical developmental and the object relation theories, the regression model, first of all in its group dynamical version as described by Bion and later on by Heigl-Evers, and the psychoanalytic-anthropological socialization model of Erich Fromm. Following the way of the author’s work in Balint groups, he examined the conscious and unconscious interactions between East- and West-Germany’s societies. Moreover, the consequences of the unresolved humiliation because of the lost war (denazification in West-Germany) and the comparison of the post-communist development of Czechia with that of East-Germany served me as further background screens.