Culture,psychology and ecology: An interview with Theodore Roszak

Objectives: This study investigates the efficacy of a standard cognitive behavioral group-program for chronic pain, in comparison with the same group program that integrates an existential perspective at treatment conclusion, 3-month, and 6-month follow-up. Design: This study is a quasi-experimental clinical trial with two treatment groups. Methods: We included 113 patients suffering from chronic pain who had been accepted for treatment at an interdisciplinary pain center. In addition to the specific therapy program, the patients received intense interdisciplinary treatment. Outcome measures include both pain-related disability and pain severity. Repeated-measures analyses of variance (ANOVAs) were used to test statistical significance, followed by tests of simple contrasts with pre-treatment as a reference-point. Results: Results indicated that the integration of an existential perspective leads to significantly lowered pain-related disability than the classic cognitive behavioral group-program. Additionally, existential aspects seem to be particularly important for patients with a spiritual orientation. The findings from this study support the importance of considering specific existential aspects in the cognitive-behavioral approach in treating chronic illness.     

Forum for Anvendt Atferdsanalyse

Abstract

A treatment package including relaxation training, electromyographic biofeedback, cognitive restructuring, contingency management, and social skills training was used to manage an outpatient who had become an overuser of the health-care system in her search for effective relief of her multiple chronic pain. Self-report and social validation measures showed that the treatment package was quite effective in reducing chronic pain behaviours. The data also indicate that the modification of perceived pain alone had limited therapeutic effects on these behaviours. While most therapeutic gains were maintained at one-year follow-up, an increase in the patient's drug consumption to near pre-treatment level was observed. However, this increase was not associated with a greater use of the health-care system, thereby suggesting that the patient had become more self-reliant in her attempt to obtain relief of her pain.     

Treatment of Insomnia within an Interdisciplinary Pain Rehabilitation Program: A Randomized Trial

Background/ObjectivePrior research indicates interdisciplinary pain rehabilitation program (IPRP) usual care (UC) does not sufficiently address sleep problems among individuals with comorbid chronic pain and clinical levels of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based insomnia intervention. The current study investigates the translation of CBT-I into an IPRP.MethodIn this single-site, prospective, randomized controlled pilot study, insomnia and pain-related outcomes were examined for adults participating in a 10-week IPRP (N = 79) who were allocated to a 4-session group-based CBT-I (IPRP+CBT-I) or usual care (IPRP-UC) condition.ResultsPatients in the IPRP+CBT-I group showed improvements in insomnia symptoms at the end compared to the beginning of the CBT-I group; however, there were no IPRP outcome differences relative to the IPRP-UC condition. Both groups reported statistically significant reductions in insomnia, pain severity, pain-related life interference, and depressed mood. Fewer than one-third of participants reported clinically meaningful reductions in insomnia symptoms following IPRP participation.ConclusionsFurther efforts are needed to address sleep problems in pain rehabilitation settings.     

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Abstract

An outpatient cognitive-behavioural treatment programme for pain control was administered to chronic pain patients in three primary care practices with a medical psychologist as a group therapist. The patients suffered from headaches, migraines, cervical pain, shoulder-arm pain, and low back pain. A matched sample of patients with the same disorders served as a waiting-list control group. The programme consisted of training in progressive muscle relaxation, several attention related techniques, and cognitive restructuring as well as reinforcing non-pain behaviour, and aimed at an improvement of self-control strategies. At the six month follow-up, the treated subjects showed improvements in their average scores of anxiety, depression and bodily symptoms compared with the untreated controls. Pain intensity was reduced by 34% in those subjects (9 out of 25) who were most adherent to the treatment regimen. Our results indicate a long-term improvement in well-being as a consequence of the treatment. This was confirmed by the ratings of the physicians and by the reduced number of patient-physician contacts three months post treatment as compared to the controls. Treatment adherence seems to be a most important agent in maintaining long-term reductions of pain intensity.     

Behavioral Treatment of Non-Ulcer Dyspepsia

Abstract

A behavioral treatment program, largely based on applied relaxation was tested in a group of patients (n=32) suffering from non-ulcer dyspepsia. They were compared to a randomized Control group (n=33) and a non-randomized Extra control group (n=29), consisting of patients who had declined the offer of behavioral treatment. Self-recorded pain intensity had decreased significantly more in the Treatment group than in the Control group at post-treatment. Also, the Treatment group experienced fewer pain occasions than the Extra controls at post-treatment. There were no differences between groups at the one-year follow-up.     

Self-focused attention and safety behaviors across group therapies for social anxiety disorder

Background: Self-focused attention (SFA) and safety behaviors are two variables implicated in the maintenance of social anxiety disorder (SAD).

Design: The present study examined SFA and safety behaviors across two therapies for SAD, cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT).

Method: Participants with symptoms meeting criteria for SAD (N?=?137) were randomly assigned to the 12-week-treatment groups (n?=?53 for each condition) or a waitlist control (n?=?31). Variables were assessed at baseline, midtreatment, posttreatment, and a 3-month follow-up.

Results: Both treatment conditions reported significantly lower SFA and safety behaviors compared to control, but did not differ from one another at posttreatment. Mediation analyses supported the following models: (1) safety behaviors mediating the relationship between SFA and social anxiety, and (2) SFA mediating the relationship between safety behaviors and social anxiety. These models were supported for both treatment groups.

Conclusions: Both treatments may have the potential to reduce the SFA and safety behaviors that serve to maintain SAD.     

Internet-based parent management training: a randomized controlled study

ObjectiveThe current study evaluated the efficacy of an Internet-based parent-training program for children with conduct problems. Dose–response ratio and costs for the program were also considered.MethodParents of 104 children (aged 3–12 years) were randomly allocated to either parent training or a waitlist control condition. Diagnostic assessment was conducted at baseline and parent ratings of child externalizing behaviors and parent strategies were completed before and after treatment and at 6-month follow-up.ResultsAt post-treatment assessment, children whose parent(s) had received the intervention showed a greater reduction in conduct problems compared to the waitlist children. Between group intent-to-treat effect sizes (Cohen’s d) on the Eyberg Intensity and Problem scales were .42 and .72, respectively (study completers .66 and 1.08). In addition, parents in the intervention group reported less use of harsh and inconsistent discipline after the treatment, as well as more positive praise. Effects on behavior problems were maintained at 6-month follow-up.ConclusionsThe results support the efficacy of parent training, administered through Internet, with outcomes comparable to many of the group-based parent training programs. The efficacy, low cost, and higher accessibility make this intervention a fitting part in a stepped-care model.     

A behavioral medicine intervention as an adjunctive treatment for HIV-related illness

Abstract

This investigation assessed the efficacy of a behavioral medicine intervention in the adjunctive treatment of symptomatic HIV seropositive men. Twenty-six, well coping, seropositive gay males were randomly assigned to either a treatment group or a waiting list control group. The treatment group received eight weeks of training in thermal biofeedback, guided imagery and hypnosis Significant results (p < 0.05) indicated that HIV-related symptoms (fever, fatigue, pain, headache, nausea and insomnia) decreased and that vigor and hardiness increased. No significant changes were found in absolute numbers of CD4 cells, tension-anxiety or depression.     

Behavioral Approaches to Low Back Pain

Abstract

A review of the literature shows that low back pain is a perplexing disorder which is prevalent and costly. Further, treatments based on the medical model often fail because an accurate diagnosis of organic abnormalities cannot be made. However, two behavioral approaches are examined which are based on psychological rather than organic processes. First, the “muscle relaxation” method contends that low back pain results from muscle contraction. Consequently, learned muscle relaxation is deemed at the best method of alleviating the pain. The second treatment considers pain to be a set of overt responses which are maintained by the prevailing reinforcement contingencies. Treatment is therefore centered on altering the contingencies to extinguish pain behaviors and to reinforce other behaviors. While conclusive evidence is not available, these two behavioral approaches seem to be positive alternatives to medical approaches. However, additional systematic studies are badly needed to clarify the efficiency of these treatments.     

Preventative Behavioral Parent Training: A Preliminary Investigation of Strategies for Preventing At-Risk Children From Developing Later Conduct Problems

Children exhibiting conduct problems comprise the largest source of referrals to children's mental health services. The treatment for conduct problems that possesses the greatest amount of empirical support is behavioral parent training. Unfortunately, a cogent approach to the identification of risk factors and prevention of chronic conduct problem display has not been developed. This project was an initial longitudinal assessment examining the merits of preventative behavioral parent training as a primary prevention strategy for at-risk children. Results demonstrated that prevention participants were engaging in normative rates of disruptive behaviors at 6-month follow-up, whereas comparison children showed a behavioral decline over time.     

Aerobic exercise training ameliorates craving and inhibitory control in methamphetamine dependencies: A randomized controlled trial and event-related potential study

ObjectiveMethamphetamine (MA) usage has been recognized as a prominent substance-abuse issue. While exercise training reportedly improves fitness and mental status in the MA-dependent, how exercise training affects addiction and cognitive deficiency has yet to be established. The current study aimed to determine the effects of aerobic exercise training on both MA-associated cravings and inhibitory control among those with MA dependencies.DesignA 12-week randomized controlled trial.MethodSixty-two people with MA dependencies recruited through the Drug Rehabilitation Bureau were assigned to either an aerobic exercise or attentional control group, with 50 participants completing the trial. The aerobic exercise program involved three 30-min sessions of moderate-intensity exercise per week. Along with a pre-test assessment, craving levels were evaluated every three weeks, and data on neutral and MA-related inhibitory control as well as its elicited neuroelectric activation were collected at the end of the intervention.ResultsCompared with the control group, the exercise group experienced attenuated MA craving levels after 6 weeks of the exercise program, and the decreased trend was maintained until the termination of treatment. In the post-test, the exercise group also demonstrated more accuracy in behavioral inhibitory control as well as greater N2 amplitude in the Nogo condition of both the standard and MA-related tasks than those in the control group or pre-test.ConclusionsThe current study provides the first evidence that aerobic exercise training may be efficacious for MA-associated cravings and inhibitory control from behavioral and neuroelectric perspectives among MA-dependent individuals.     

Do the benefits from autonomy-supportive PE teacher training programs endure?: A one-year follow-up investigation

ObjectiveAn earlier study (Cheon, Reeve, & Moon, 2012) showed wide-ranging benefits from a training program designed to help teachers be more autonomy-supportive toward students during PE instruction. The present study collected a follow-up data set to determine whether those earlier-observed benefits endured one year later.DesignWe used an experimentally-based 3-wave longitudinal design. The experimental group consisted of 8 PE teachers from the original teacher training study and their 470 middle- and high-school students; the control group consisted of 9 matched PE teachers and their 483 students. Dependent measures included 3 manipulation checks, 3 measures of student motivation, and 6 course-specific outcomes.MethodTrained raters scored teachers' instructional behaviors at mid-semester, while students reported perceptions of their teachers' motivating style and their own course-related motivation and outcomes at the beginning, middle, and end of the semester. We tested our hypotheses using hierarchical linear modeling to account for the hierarchical structure of data in which repeated measures were nested within students who were nested within teachers.ResultsCompared to teachers in the control group, teachers in the experimental group were scored by raters and perceived by students as more autonomy supportive and less controlling. Their students consistently reported greater motivation and more positive outcomes than did the students of teachers in the control group. All 8 teachers in the experimental group reported being significantly more autonomy supportive than a year earlier.ConclusionTeacher- and student-related benefits from the earlier autonomy-supportive training program endured.     

Alcohol interlocks and prevention of drunk-driving recidivism

IntroductionAlcohol interlock programs (AIP) are aimed at preventing drunk-driving recidivism. They first appeared in Europe in the nineties.ObjectivesThe purpose of this study was investigate whether AIPs are effective in reducing recidivism and determine what factors of such programs contribute to their positive impact.MethodWe performed a follow-up of AIP participants (n = 175) and control participants (n = 234) for five years. Data such as blood alcohol concentration (BAC) at time of arrest, previous and subsequent violations (alcohol-related or other types) were collected from the official driver's license files. For self-evaluation and evaluation of the program (since November 2009 only), we used questionnaires based on two theoretical models: the Transtheoretical Model of Change (Prochaska & DiClemente, 1984) and the Diamond of Change Model from the DRUID project, build to explain which are the elements of driver rehabilitation training courses that favor behavioral modification (Bukasa et al., 2009).ResultsThe data obtained allowed us to describe these populations of alcohol-drinking offenders, for both the interlock program group and the control group. Two salient features were male proneness to alcohol-related violations and a very high BAC (between 1.5 and 2 g/l) among the majority of drivers who drink under the influence of alcohol. In terms of recidivism reduction, the interlock program was not clearly linked to a beneficial effect. An analysis of behavioral change among the AIP participants showed that consciousness raising took effect more quickly than did environmental reevaluation or reinforcement management.ConclusionsThe application of Prochaska et al.’s model to the follow-up of AIP programs would be more fruitful in the future if psychologists are involved in the program. As we have seen, medical/psychological monitoring may not have been strong enough in the program studied here.     

Conflict management: A premarital training program in mutual problem solving

Abstract

The purpose of this study was to evaluate the effectiveness of a structured educational program designed to train premarital couples in communication and mutual problem-solving skills. Twenty-six couples participated in an eight-week, 24-hour problem-solving training program, while 28 similar couples participated in an eight-week, 24-hour relationship discussion group. Results indicated that the problem-solving group, as compared to the relationship-discussion group, showed a significant increase in communication and mutual problem-solving skills. Discussion focused on the benefits for premarital couples of learning effective problemsolving procedures as well as the need for follow-up assessments of both behavioral skill level and relationship satisfaction and adjustment.     

Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study

IntroductionChronic pain is difficult to treat and often precedes or exacerbates sleep disturbances such as insomnia. Insomnia, in turn, can amplify the pain experience. Both conditions are associated with inflammatory processes, which may be involved in the bi-directional relationship between pain and sleep. Cognitive behavioral therapy (CBT) for pain and CBT for insomnia are evidence based interventions for, respectively, chronic pain and insomnia. The study objectives were to determine the feasibility of combining CBT for pain and for insomnia and to assess the effects of the combined intervention and the stand alone interventions on pain, sleep, and mood outcomes compared to a control condition.MethodsTwenty-one adults with co-occurring chronic pain and chronic insomnia were randomized to either CBT for pain, CBT for insomnia, combined CBT for pain and insomnia, or a wait-list control condition.ResultsThe combined CBT intervention was feasible to deliver and produced significant improvements in sleep, disability from pain, depression and fatigue compared to the control condition. Overall, the combined intervention appeared to have a strong advantage over CBT for pain on most outcomes, modest advantage over both CBT for insomnia in reducing insomnia severity in chronic pain patients.DiscussionCBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia.     

Association of Mu opioid receptor (A118G) and BDNF (G196A) polymorphisms with rehabilitation-induced cortical inhibition and analgesic response in chronic osteoarthritis pain

Background/objectiveChronic pain due to osteoarthritis (OA) is a prevalent cause of global disability. New biomarkers are needed to improve treatment allocation, and genetic polymorphisms are promising candidates.MethodWe aimed to assess the association of OPRM1 (A118G and C17T) and brain-derived neurotrophic factor (BDNF [G196A]) polymorphisms with pain-related outcomes and motor cortex excitability metrics (measured by transcranial magnetic stimulation) in 113 knee OA patients with chronic pain. We performed adjusted multivariate regression analyses to compare carriers versus non-carriers in terms of clinical and neurophysiological characteristics at baseline, and treatment response (pain reduction and increased cortical inhibitory tonus) after rehabilitation.ResultsCompared to non-carriers, participants with polymorphisms on both OPRM1 (A118G) and BDNF (G196A) genes were less likely to improve pain after rehabilitation (85 and 72% fewer odds of improvement, respectively). Likewise, both carriers of OPRM1 polymorphisms (A118G and C17T) were also less likely to improve cortical inhibition (short intracortical inhibition [SICI], and intracortical facilitation [ICF], respectively). While pain and cortical inhibition improvement did not correlate in the total sample, the presence of OPRM1 (A118G) and BDNF (G196A) polymorphisms moderated this relationship.ConclusionsThese results underscore the promising role of combining genetic and neurophysiological markers to endotype the treatment response in this population.     

Dialectical Behavior Therapy Adapted for the Vocational Rehabilitation of Significantly Disabled Mentally Ill Adults

Twelve vocational rehabilitation clients with severe mental illness received a comprehensive adaptation of dialectical behavior therapy (DBT) delivered in a group format. Treatment consisted of 2 hours of standard DBT skills training per week and 90 minutes of diary card review, chain analysis, and behavioral rehearsal. Participants were selected based on previous failure to obtain or maintain employment. The participants had a mean of 3 psychiatric diagnoses each, and all participants met criteria for a personality disorder, with 58.3% having a diagnosis of borderline personality disorder. There were 4 dropouts and 8 treatment completers. The treatment completers improved significantly and maintained their improvements (at 6-month follow-up) in depression, hopelessness, and the experience of anger. In addition, the completers improved significantly from pretreatment to 6 months follow-up on anger expression, control of anger expression, work role satisfaction, and on number of hours worked weekly.     

The Psychiatrist and the Dying Patient by Kurt R. Eissler

Abstract

In this study behavioral processes in the individual and group therapies of aggressive boys were compared and the relationship between these variables and treatment outcome was examined. Level of aggression was the outcome variable, measured by both self-report and teacher-report instruments. Hill’s Client Behavior System (CBS; Hill, 1986) with our own ad hoc categories of Reference to Literary Figures and Response to Another, and therapist Helping Skills System (HSS; Hill &; O’Brien, 1999) were the behavioral process measures. In terms of the boys’ behaviors, discriminant function analyses revealed that Reference to Literary Figures and Response to Another differentiated the treatment formats; with regard to therapists’ behaviors, Questions and Challenge differentiated the modalities. Results offered partial support for the greater effectiveness of group, compared to individual, therapy in reducing aggression. Outcome, however, as measured by teacher reports of aggression, was adversely affected in group therapy by the presence of specific behaviors in the boys. Implications of the findings for modifying the group therapy program as well as for the search for process variables appropriate to the treatment of aggressive children are discussed.     

Fathers as Intervention Agents for Their Children with Developmental Disabilities

ABSTRACT

Parent training aimed at aiding children to overcome social and behavioral problems is an area that has continued to gain attention and support. Very little of the current research has been with developmentally disabled children, the focus of this study. Additionally, for most parent training programs, “parents” actually refers to mothers. In this study three fathers and their developmentally disabled children, who ranged in age from 2 years 10 months to 4 years 5 months, were studied. A multiple baseline across fathers' behaviors was utilized for participants to evaluate effects of parent training on fathers' target behaviors. Child compliance and inappropriate behaviors were also addressed. Parent training resulted in desirable changes on a range of target behaviors. The implications of these findings are discussed.