Risks,choices and behavioral treatment

Recent arguments against the use of intrusive behavioral interventions in the treatment of handicapped people are examined. The anti-aversive position was found to be based on assumptions about the negative impact of aversive procedures, and to consider only a small subset of the variables that should be taken into account when treatment decisions are made. A preliminary application of formal decision-analysis techniques that have been developed in response to other controversial technologies had a number of benefits including: (a) sharpening the distinction between scientific and social criteria; (b) sensitizing decision-makers and scientists to the range of costs, risks, and benefits associated with treatment decisions; and (c) identifying critical areas of research. Decision-analysis techniques were found to be helpful in directing scientists and policy-makers towards more informed decision-making.     

Prevention,not treatment,is the only hope

If our goal is the reduction or elimination of emotional disorders in our country, or in the world, a major social revolution is required. Individual psychotherapy is available to a small number only. No mass disorder has ever been eliminated by treating one person at a time. Psychotherapy is useful in teaching the possibility of unlearning damaging habits and thus it contradicts the organic-brain disease model advanced by political conservatives. Organic explanations of mental disorder find causes inside the person and ignore or deny the pathological environments of poverty, racism, sexism and exploitation. The organic model is supported by corporate power and conservative citizens' groups. It is time for radicals to come together to expose the power elite for its control of invalid ruling ideas.     

Web-based, psychosocial treatment for substance use disorders in community treatment settings

The purpose of this multisite clinical trial was to evaluate the effectiveness of a web-based version of the Community Reinforcement Approach, plus motivational incentives, within community-based, outpatient substance abuse treatment. This ongoing study is being conducted within the National Drug Abuse Treatment Clinical Trials Network, funded by the National Institute on Drug Abuse. Midway through the enrollment of 500 participants, the study is being implemented in 10 treatment programs across the United States. Information is provided on design, sample, intervention and technology, and preliminary lessons learned.     

Diagnosis,assessment, and comorbidity in psychosocial treatment research

This paper identifies problems in prevailing terminology and conceptual models that may hinder research on treatment. To avoid the multiple meanings of diagnosis,the term assessmentis used in reference to identifying the distinguishing features of individual cases, while taxonomyis used to designate the grouping of cases according to their distinguishing features. Treatment research requires clear specification of the behavioral/emotional problems and competencies targeted for intervention. Artifactual comorbidity can be avoided by specifying treatment targets at several levels, including competencies, specific problems, syndromes, profiles of syndrome scores, and global problem scores. To select subjects for treatment research and to evaluate outcomes, multisource data can be coordinated by using a cross-informant computer program, taxonomic decision tree, and averaging of multisource standard scores. This work was supported by NIMH grant MH40305 and W. T. Grant Foundation grant 92145892.     

Psychological assessment, treatment, and outcome with sex offenders

The frequency and impact of sexual offenses have led to the recent enactment of sexual "predator" laws. Such laws are intended to reduce sexual violence through treatment and involuntary confinement. Sixty years ago, similar laws identifying "sexual psychopaths" were enacted and, in many states, eventually repealed for multiple reasons; among those reasons was an inability to demonstrate that treatment had any significant impact on recidivism. That inability forced us to reexamine, among other issues, the population(s) which undergo treatment, the outcomes that are used to measure treatment effectiveness, and the processes that constitute treatment itself. Those issues are considered in this paper through a review of treatment programs based on psychodynamic, behavioral, and cognitive-behavioral theories. Although the evidence is sparse, it is fair to conclude that the latter have been found to be effective. We call for dynamic measures, effective treatments, and the resources necessary for both developments.     

Adolescent pregnancy: contributing factors, consequences, treatment, and plausible solutions

Adolescence, although not always necessarily a period of extreme stress, is a time of profound physical changes which increase the adolescent's awareness of and interest in sexual behavior. This issue of sexuality, which begins in early adolescence, creates new challenges to personal and gender identity formation as the person matures. Sexual maturation is a three-fold process, requiring growth in understanding of oneself as a sexual being, in the ability to handle interpersonal relationships effectively, and in the capacity to plan behavior in view of future outcomes and present problems. A current concern is that today's adolescents, including early adolescents, may be making important life choices such as parenthood before they are developmentally ready for such roles (Chilman, 1980). This paper deals with pregnancy in adolescents and modes of responding to this phenomenon by those in the counseling and other helping professions.     

Pathophysiology, prevention, and potential treatment of neural tube defects

Neural tube defects (NTD) remain a major cause of morbidity in spite of the reduction in liveborn incidence with periconceptional folic acid. However, the etiology remains unknown. This article reviews studies that address causation and potential treatment of NTD in humans and in animal models that resemble aspects of the common human NTD. Studies of nutritional markers of vitamin B12 and folic acid support a defect in homocysteine metabolism; a thermolabile variant of methylene tetrahydrofolate reductase, an enzyme that remethylates homocysteine to methionine, correlates with a risk of NTD in some human populations. Numerous mouse mutant models of NTD exist, attesting to the ease of disruption of neurulation, and a genetic basis for this malformation. Of these models, the curly tail mouse mutant most closely resembles the common human NTD. Folic acid does not prevent NTD in this model; however inositol supplementation does result in a significant reduction in incidence. Recent advances in fetal surgery, and evidence from mechanically created myelomeningocele in large animals amenable to surgical intervention suggest that the handicaps associated with myelomeningocele and associated Chiari Type II malformation may be prevented by in utero NTD closure. Success will depend on preservation of neurological tissue until such intervention is possible. Further research in animal models at the genetic and cellular levels, together with technological surgical advances, provide hope that prevention of more NTD and the associated handicaps may be possible. MRDD Research Reviews 6:6-14, 2000.     

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.     

Cluttering: Assessment, treatment planning, and case study illustration

Successful treatment of clients who present with a multitude of interrelated impairments is frequently dependent upon thorough and accurate diagnosis of the problems. Individuals who clutter often demonstrate a variety of speech and language deficits that make diagnosis difficult. Two clinical tools believed to be useful for obtaining and organizing diagnostic data and for planning treatment with clients who show symptoms of cluttering are discussed. The case study report illustrates the utility of these tools for collecting and organizing all pertinent data.     

Evidence-based treatment research: Advances, limitations, and next steps

This article highlights the development of evidence-based treatments (EBTs), the accomplishment their development reflects, and the limitations of current variations as a way of providing mental health services and care. Rather than review EBTs, I use the occasion to provide an overview of my work on the development of treatments for children referred clinically for aggressive and antisocial behavior. This work reflects a larger genre of intervention research that has developed treatments for a variety of disorders. After years of research and a healthy list of EBTs, where are we and where do we need to be? It is still the case that most people in need of services do not receive them, and disparities in providing services remain enormous. The vast majority of therapies, whether evidence based or not, use a model of delivery (one-to-one in-person treatment) that is inherently limited as a way of reaching the large swath of people in need of services. Multiple models of delivery of treatment are needed. The article underscores the importance of developing these models of delivery and optimizing that development by understanding better the mechanisms of therapeutic change. (PsycINFO Database Record (c) 2011 APA, all rights reserved).