Assertive training for agoraphobics

Twenty-one unassertive agoraphobic patients were assigned to one of three treatments: (1) prolonged exposure in vivo, (2) assertive training and (3) a combination of assertive training and prolonged exposure in vivo. Each treatment was conducted in groups which were led by two therapists. Assessments involved both phobic targets and assertiveness, and were made before and after treatment, and at 1-month follow-up. Exposure in vivo was found to be superior to assertive training on phobic targets. Assertive training produced greater gains in assertiveness than exposure in vivo. The combination of treatments produced results comparable to exposure in viro. Results indicated that the type of change produced by the treatments is a rather specific one and is related to the specific target of treatment.     

Disintegrated experience: the dissociative disorders revisited

We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.     

Group psychotherapy in chronic psychiatric outpatients: a Toronto model.

Seventy to 80 chronic psychiatric patients are treated in an aftercare clinic with a goal of tertiary preventive care. The major component of the treatment approach is reality-oriented group psychotherapy with an emphasis on interpersonal relationships. Attention to three factors in group psychotherapy with this population of patients has facilitated our work and outcome. These are the concept of the core group, diagnostic heterogeneity, and staff structure.     

Manifestations, acquisition and diagnostic categories of dental fear in a self-referred population

This study aimed to clarify how manifestations and acquisition relate to diagnostic categories of dental fear in a population of self-referred dental fear patients, since diagnostic criteria specifically related to dental fear have not been validated. DSM III-R diagnostic criteria for phobias were used to compare with four existing dental fear diagnostic categories, referred to as the Seattle system. Subjects were 208 persons with dental fear who were telephone interviewed, of whom a subsample of 155 responded to a mailed Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory and a modified FSS-II Geer Fear Scale (GFS). Personal interviews and a Dental Beliefs Scale of perceived trust and social interaction with dentists were also used to evaluate a subsample of 80 patients selected by sex and high dental fear. Results showed that the majority of the 80 patients (66%), suffered from social embarrassment about their dental fear problem and their inability to do something about it. The largest cause of their fear (84%) was reported to be traumatic dental experiences, especially in childhood (70%). A minority of patients (16%) could not isolate traumatic experiences and had a history of general fearfulness or anxiety. Analysis of GFS data for the 155 subjects showed that fear of snakes and injuries were highest among women; heights and injections among men. Fear of blood was rarely reported. Spearman correlations between GFS individual items and DAS scores indicated functional independence between dental fear and common fears such as blood, injections and enclosures in most cases. Only in specific types of dental fear did these results support Rachman and Lopatka's contention that fears are thought to summate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anxiety induced by cardiac perceptions in patients with panic attacks: a field study

In panic disorder bodily sensations appear to play an important role as a trigger for anxiety. In our psychophysiological model of panic attacks we postulate the following vicious circle: individuals with panic attacks perceive even quite small increases in heart rate and interpret these changes as being catastrophic. This elicits anxiety and a further increase in heart rate. To evaluate this model we conducted a field study of 28 subjects with panic attacks and 20 healthy controls. A 24 hr ambulatory ECG was recorded and the subjects were instructed to report any cardiac perceptions during this period and to rate the anxiety elicited by these perceptions. The incidence of cardiac perceptions was about the same in both groups, but only subjects with panic attacks reported anxiety associated with such perceptions. Analysis of the ECGs revealed that in both groups heart rate accelerations preceded cardiac perceptions. Following cardiac perceptions, the healthy controls showed a heart rate deceleration, whereas the subjects with panic attacks had a further acceleration. This heart rate increase after cardiac perceptions was positively related to the level of anxiety elicited by the perceptions. These results provide clear evidence in support of the vicious circle model of panic attacks.     

Dichotic listening during forced-attention in a patient with left hemispherectomy

A young left-handed girl with an extensive posttraumatic lesion in the left hemisphere was tested with dichotic listening (DL) under three different attentional instructions. The major aim of the study was to evaluate a structural vs attentional explanation for dichotic listening. As both her expressive and receptive language functions were intact after the lesion, it was assumed that the right hemisphere was the language-dominant one. In the free-report condition, she was free to divert attention to and to report from both ear inputs. In the forced-right condition, she was instructed to attend to and report only from the right ear input. In the forced-left condition, she was instructed to attend to and to report only from the left-ear input. Her performance was compared with data from a previously collected sample of normal left-handed females. Analysis showed that the patient, in contrast to the normal sample, revealed a complete right-ear extinction phenomenon, irrespective of attentional instruction. Furthermore, she showed superior correct reports from the left ear, compared with those of the normal sample, also irrespective of attentional instruction. It is concluded that these results support a structural, rather than attentional explanation for the right-ear advantage (REA) typically observed in dichotic listening. The utility of validating the dichotic listening technique on patients with brain lesions is discussed.     

Subliminal stimulation, choice behavior and some personality correlates of subliminal sensitivity

The aim of this study was to investigate the possible relations between specific personality variables and the effect of subliminal stimulation on choice behavior. It was hypothesized that subjects with low anxiety, less neuroticism, and external locus of control and the trait of extraversion would be more susceptible to subliminal stimulation. 38 undergraduate students were exposed to subliminal messages urging them to choose symbols instead of numbers or letters. Analysis showed that subliminal stimulation did not generate a preference for symbols over numbers or letters. No support was observed for the hypothesis of an association between susceptibility and personality variables. These results may be explained in terms of symbol choice being a neutral message that did not relate to the subjects' needs and motivation.     

Sensorimotor synchronization: motor responses to regular auditory patterns.

Subjects (N = 32) were asked to synchronize a motor response with tones in auditory patterns. These patterns were created from six tones and six intertone intervals of equal duration. The pitch of the first tone differed from the others. It was found that subjects used three types of timing in their motor response: (1) the first intertone interval was prolonged and the second interval was shortened, (2) the second intertone interval was prolonged and the first interval was shortened, and/or (3) the first interval and the second interval were of approximately the same length. The prolongation of the fifth interval was observed during all three types of timing. The results are explained using the concept of suprasegmental control of timing, which explains a prolongation of intervals at critical control point of the patterns. The occurrence of three different strategies of timing is discussed in connection with similar principles in musical performance.     

Two-stage model for order discrimination

Ulrich (1987), exploring the shapes of psychometric functions obtained in the ternary-response paradigm, indicated several inconsistencies between observed and predicted relationships providing evidence against most popular models of temporal-order judgment. In this paper, a new model is presented. It assumes that there are two mechanisms involved in the order discrimination task: one is responsible for the recognition of whether or not the stimuli are successive, and the second is able to determine their order. The model was tested using Allan's (1975a, 1975b) and Ulrich's (1987) data; the model predictions were found to be consistent with the experimental results.