Behaviour therapy: Criticisms and confusions

An attempt will be made in this paper to show that the two most frequent criticisms of behaviour therapy are based on confusions. These confusions, it will be shown, are not solely the responsibility of the critics. The behaviour therapists themselves, in their writings, are partly responsible for the confusions.     

Behaviour therapy with identical twins

Among the patients treated by the writer during the past five years were two pairs of identical twins. Each respective pair of twins suffered from similar neurotic disabilities. While the patients undergoing behaviour therapy either recovered completely or improved substantially, their untreated twin siblings retained their maladaptive habits until they too underwent a course of behaviour therapy. A fifth patient, also one of an identical twin, derived benefit from therapy while his twin brother, opposed to therapeutic intervention on religious grounds, has remained neurotically incapacitated. These eases are followed by comments drawing didactic inferences. Emphasis is placed on the fact that behaviour therapy does not ignore the complex causality of neurotic disturbances. Interpersonal considerations at both causal and remedial levels are discussed.     

Behaviour therapy for agoraphobic men

Eighteen men and 49 women with agoraphobia were offered behaviour therapy based on graded exposure in vivo to feared situations. Eight of the men and 6 of the women refused or terminated treatment prematurely, the men because of unmanageable anxiety, and the women for reasons unrelated to anxiety levels. The 10 men who completed the programme were compared with 10 women matched for age. Women experienced significantly more panic attacks during exposure than men, who instead were concerned mainly with fears of losing control of aggressive impulses. The effects of exposure were broadly comparable: both men and women reported over 65% improvement in their main phobias, and between 30 and 50% improvement in other symptoms, 12 months after treatment.     

Behaviour therapy and encopresis: The complexities involved in treatment

This paper reports the treatment of continuous encopresis in an adolescent boy. The importance of careful analysis of the symptom; the selection of an appropriate method of treatment for a particular patient; and the complications which may arise during the course of treatment are discussed.     

Current concepts in the prevention of Alzheimer's disease

Alzheimer's disease represents a significant challenge to the aging population. Since most estimates suggest that AD has a multifactorial etiology, the challenge to find preventative approaches is particularly great. With the aging of the population and the very high incidence from the eighth decade on, the challenge is further enhanced by the need to think of relatively safe interventions given the relative frailty of this elderly population. The need to find safe treatments, or ones with well-understood safety profiles, has led to the examination of known agents for potential dementia-preventing properties. Data supporting these interventions comes from observational studies, laboratory analyses, and clinical trials. Potential mechanisms for prevention of AD include anti-inflammatory and antioxidant approaches. Modulation of risk factors associated with cardiac disease may also reduce the risk of AD. Known agents have been examined for their potential to modify amyloid pathology. Trial designs to address prevention of AD include both primary and secondary prevention studies as well designs to assess slowing disease progression. Information can also be gathered when dementia evaluation is added to ongoing studies. As results from these studies becoming available, we will be able to refine our approach to managing this disease.     

Behaviour therapy for obesity: The role of clinicians in the reduction of overweight

Behaviour therapists are often required to help those who are unhealthily overweight to reduce. Unfortunately, these interventions are often ineffective in the long-term. Many clients never achieve reduced weight. Often, those who do reduce weight are unsuccessful in keeping the weight off. A review of the relevant literature suggests that most therapeutic approaches do not enable people to change their lifestyles in the ways likely to be necessary for permanent reduction of weight to a healthy level. Clinical support for weight reduction would be more effective if it were more culturally realistic and therapeutically sensitive in empowering clients to make informed choices for themselves among sustainable habits of eating and exercise that contribute to negative energy balance. Approaches which encourage client self-efficacy and self-assertion are likely to be more effective in facilitating lasting change.     

Behaviour therapy for addicted cigarette smokers: A preliminary investigation

The apparatus and experimental procedure of a behaviour therapy approach to cigarette addiction are described. The aim of the methd is to develop a dislike for the taste of cigarettes, which may help in giving up the habit of smoking. An account is given of some preliminary experiences and results.     

Making family therapy easier for the therapist: burnout prevention

Burnout prevention for family therapists can be enhanced by careful consideration of the degree of responsibility taken by the therapist contrasted with responsibility placed on the family. Attention to issues of expectations, role definition, sharing of feelings, and therapeutic ambition can ease the strain on the therapist.     

Autonomy and coercion in disease prevention and health promotion

Most of the attention regarding the balance between autonomy and paternalism has been focused on the therapeutic relation. Much less attention has been devoted to the problem of autonomy in the application of medical knowledge for preventive purposes. Here, because the good to be achieved is social as well as individual, an unavoidable dilemma ensues. Effective preventive measures of benefit to all must necessarily limit autonomy and involve some coercion. I argue that there are principles which can be established to guide society in a moral use of coercion. The question of employing medical knowledge is not, as it is in therapeutic medicine, to preserve or enhance autonomy. Rather its aim is to enhance voluntary co-operation. Principles for moral use of coercion must thereby be derived from health as a moral value.     

Sickle cell disease: primary stroke prevention

Stroke is an important and common complication of sickle cell disease (SCD), affecting children as well as adults. Clinically evident stroke, usually brain infarction, is usually associated with stenosis or occlusion of the intracranial arteries of the Circle of Willis, sometimes with formation of moyamoya (a Japanese word for "hazy" or "like a puff of smoke" that describes the appearance of a abnormal microvasculature on angiography believed secondary to internal carotid artery stenosis or occlusion and the resultant extensive collateralization). Several types of intracranial hemorrhage are observed but usually in older children and adults. Cerebrovascular diseases restricted to small vessels may go unrecognized but is associated with cognitive and learning problems. Prevention of recurrent stroke has been accomplished with chronic blood transfusion. A primary prevention strategy for clinical stroke, based on the Stroke Prevention in Sickle Cell Anemia Trial, has been tested in a randomized clinical trial. Over 2,000 young children with SCD were screened with transcranial Doppler ultrasound (TCD) to detect elevated blood flow velocity indicative of vessel disease and high risk of future stroke. Those randomized to standard care (no transfusion) had a 10%/year risk of stroke, which was reduced >90% with chronic transfusion. This approach is the only primary stroke prevention strategy so far tested in SCD in a randomized controlled trial. Silent lesions on magnetic resonance imaging are associated with an approximately 1.5%/year risk of clinical stroke and a trial is now starting in children with these lesions who do not meet Stroke Prevention in Sickle Cell Anemia Trial criteria for transfusion based on TCD. A controlled trial, based on intervention for nocturnal hypoxemia, is also underway. Hydroxyurea, bone marrow transplantation, antiplatelet, and antithrombotic agents may work but have not been tested in primary prevention in a systematic way. If early and repeated, TCD screening of children, as recommended by National Heart Lung and Blood Institute and the American Stroke Association, were implemented broadly the incidence of new strokes could be greatly reduced in these children.     

Prediction of Behaviour vs. Prediction of Behaviour Change: The Role of Motivational Moderators in the Theory of Planned Behaviour

Research has identified moderating variables of the cognition–behaviour relationship in the Theory of Planned Behaviour (TPB). These include intention certainty, affective–cognitive congruence of attitudes, attitudinal ambivalence, and past behaviour. It has not yet been systematically tested if these moderators apply in similar ways to the prediction of behaviour and behaviour change (when past behaviour is controlled). A sample of 1,418 university students completed measures of the direct predictors of the TPB (perceived behavioural control; PBC and intention), intention certainty, affective–cognitive congruence of attitudes, attitudinal ambivalence, and the Godin Leisure Time Physical Exercise Questionnaire at the beginning of the academic year and two months later. Data were analysed using moderated hierarchical linear regressions. Without controlling for baseline behaviour, intention certainty and affective–cognitive congruence moderated both the intention–behaviour and PBC–behaviour relationships and showed additional main effects. Attitudinal ambivalence did not contribute to the prediction. When past behaviour was controlled, the main effects were attenuated and only the intention certainty* PBC interaction remained significant. Predictors of behaviour do not necessarily predict behaviour change. The TPB-related moderators studied here weakly contributed to the prediction of behaviour change. Proposals for increasing the predictive power of TPB for behaviour change are discussed.     

Common Sense and the Theory of Human Behaviour

I offer an analysis of Reid's notion of the will. Naturalism in the philosophy of action is defined as the attempt to eliminate the capacity of will and to reduce volition to some class of appetite or desire. Reid's arguments show, however, that volition plays a particular role in deliberation which cannot be reduced to some form of motivation present at the time of action. Deliberation is understood as an action over which the agent has control. Will is a higher-order mental capacity enabling us to control our own attitudes, decisions and actions. Reid investigates several distinct forms of this control. I conclude with some remarks about the relation between Reid's arguments about the function of the will and his moral rationalism.     

Group therapy of schizophrenia in the inital phase of the disease

The initial (prepsychotic) period of schizophrenia is characterized by different degrees of involvement of various levels of personality organization depending upon the basic tendencies of the disease process, and the going forward of unimpaired personality reactions, which are not related to processes of alteration (including inadequate forms of psychological defense), allows the states of patients and the characteristics of their adaptation to be determined. There is a need to differentiate the functions of group psychotherapy and its methods at the level of emotional stimulation, social activation and stimulation of communication, development of certain behavioral stereotypes and increasing the degree of social security, optimizing associations, partial changes of attitude and behavior, discussion of conflicts, finding adequate forms of psychological compensation, and development of a behavioral pattern. It is in this way that it is possible to work out a certain "hierarchy" of methods that may be used successively.