Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia

In this study we compared the efficacy of virtual reality exposure combined with cognitive-behavioral therapy (VRET) to that of traditional cognitive-behavioral therapy (CBT) alone in reducing phobic symptoms in a sample of patients with long-term agoraphobia. The study was a between-subject design with three experimental conditions (VRET group, N = 30; CBT group, N = 30; and medication only group, N = 20) and repeated measures (pre-treatment, post-treatment, and six-month follow-up). All patients were receiving antidepressant medication. Results showed that all therapies were statistically effective both at post-treatment and six-month follow-up. The VRET group showed clinical improvement in most variables measured at follow-up. The CBT group showed the highest dropout rates. These results are discussed pointing out that VRET probably serves as an intermediate procedure for an efficient exposure to phobic stimuli. Besides describing the advantages of VRET for the treatment of agoraphobia symptoms in cost-benefit terms, the study also considered issues related to higher treatment adherence and motivation.     

El constructo ansiedad en Psicología: una revisión

RESUMEN

Se trata en este artículo de dar una visión sucinta y comprensiva del tratamiento que, desde el ámbito de la Psicología científica, ha recibido el tema de la ansiedad. Casi todas las escuelas, tanto clínicas como experimentales, han intentado dar una explicación, cada cual con su método y de sus principios teóricos a este complejo fenómeno. Aquí se analizarán cuatro enfoques: Psicodinámica y humanística; Experimental motivacional; Psicométrico-factorial; Cognitivo-conductual. También se presenta, al final, de modo sintético, un resumen que trata de integrar las diferentes aportaciones que se han producido en el desarrollo del estudio científico del tema ansiedad.     

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single‐case study comprise couple therapy process videotapes recorded in a multi‐camera setting, and measurements of participants’ SNS activity. The voluntary participants were a marital couple in their late thirties and two middle‐aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.     

Procesos de aprendizaje y terapia de conducta en la adicción a la heroína

Resumen

Múltiples principios de condicionamiento clásico y operante interaccionan en la adición a la heroína. Destacan la presencia de RC Compensatorias en forma de Síndrome de Abstinencia Condicionado (SAC) y distintos programas de reforzamiento en el estilo de vida, argot y efectos de la heroína. En evaluación conductual se estudian los correlatos subjetivos y psicofisiológicos del SAC; la validez externa de los autorregistros se logra mediante análisis de orina. En terapia de conducta los programas de amplio espectro se combinan con la intervención comunitaria y apoyo médico. A nivel metodológico se resalta la necesidad de usar múltiples criterios de medición, introducción del análisis multivariado y uso de diseños estadísticos, realización de seguimientos a largo plazo.     

Silence and Memories of War: An Autoethnographic Exploration of Family Secrecy

A personal journey and a scientific challenge, this is an autoethnographic study about my own family's secrecy. I knew my grandfather had been a German prisoner of war during World War II. We all knew. But nobody talked about it. Then one day I decided I wanted to do systematic research on the issue of family secrecy around my grandfather's war experiences. Researching one's own family can be called autoethnography. It could be said that autoethnography is an approach to research that aims to describe and systemically analyze (graphy) personal experience (auto) to understand social and cultural phenomena (ethno). This scientific approach is quite new in the field of family therapy. This study has been an important personal quest, but it also led to important reflections on silences in families, on my own professional development, and on methodological issues concerning autoethnographical research. For one thing, it highlights some of the positive aspects of family secrecy and silences, and invites us—when confronted with family secrecy in clinical practice—to carefully consider the potential destructive and life‐giving aspects of the silence.     

Parents Plus Systemic,Solution‐Focused Parent Training Programs: Description,Review of the Evidence Base,and Meta‐Analysis

Parents Plus (PP) programs are systemic, solution‐focused, group‐based interventions. They are designed for delivery in clinical and community settings as treatment programs for families with child‐focused problems, such as behavioral difficulties, disruptive behavior disorders, and emotional disorders in young people with and without developmental disabilities. PP programs have been developed for families of preschoolers, preadolescent children, and teenagers, as well as for separated or divorced families. Seventeen evaluation studies involving over 1,000 families have shown that PP programs have a significant impact on child behavior problems, goal attainment, and parental satisfaction and stress. The effect size of 0.57 (p < .001) from a meta‐analysis of 10 controlled studies for child behavior problems compares favorably with those of meta‐analyses of other well‐established parent training programs with large evidence bases. In controlled studies, PP programs yielded significant (p < .001) effect sizes for goal attainment (d = 1.51), parental satisfaction (d = 0.78), and parental stress reduction (d = 0.54). PP programs may be facilitated by trained front‐line mental health and educational professionals.     

Effectiveness of therapy group in women with localized breast cancer

Background/ObjectiveBreast cancer causes high levels of anxiety and depression, deteriorating quality of life of patients. Several studies have found that group therapy reduces depression and anxiety also improves the quality of life. The aim of this study is to analyze group therapy effectiveness in emotional state and quality of life in women with breast cancer after finalized medical treatments.MethodParticipants in this study were 100 adult women diagnosed of breast cancer non-mestastasic and were divided into two types of intervention groups (Self-esteem-Social Skills and Cognitive-Behavioral Therapy). Evaluation instruments were questionnaire Functional Assessment of Breast-cancer Therapy (FACT-B) and Hospital Anxiety and Depression Scale (HADS).ResultsA statistically significant effect of group therapy in reducing anxiety and depression were observed. Quality of life and emotional well-being significantly improved. These effects remain three months after intervention.ConclusionsThe results show that the psychological intervention group is efficient to improve emotional state and quality of life of women with breast cancer.     

Oedipal aspirations and phallic fears: on fetishism in childhood and young adulthood

The main theoretical position on fetishism remains that outlined by Freud, the splitting of the ego and castration anxiety being central to the establishment of the fetish. The dangers and attractions of an oedipal resolution are outlined in the case of 'Stanley', an older adolescent whose nappy wearing, transvestism and obsession with pregnant mothers and their babies brought him to therapy. The paper demonstrates some of the technical difficulties in such work, the slow ego-structuring that is necessary, the patient's swift perception of danger at any failure of attunement by the therapist and subsequent flight to the perverse defence, and the impetus that acceptance of oedipal gain may bring to development. Die wesentliche theoretische Position bezüglich Fetischismus bleibt die von Freud umrissene, dass Ichspaltung und Kastrationsangst bei der Etablierung des Fetischs zentral sind. Es werden die Gefahren und Anziehungspunkte einer ödipalen Lösung im Fall von 'Stanley' dargestellt, einem älteren Jugendlichen, den sein Windeltragen, Transvestismus und Besessenheit mit schwangeren Müttern und ihren Babies zu Therapie brachte. Der Artikel zeigt einige der technischen Schwierigkeiten in solch einer Arbeit, das langsame Ich-strukturieren, das notwendig ist, die schnelle Gefahrenwahrnehmung des Patientens bei jeglicher Missanpassung des Therapeutens und die darauffolgende Flucht in perverse Abwehr, und den Antrieb, den das Akzeptieren des ödipalen Gewinns zur Entwicklung bringen kann, auf. Des conceptions théoriques du fétichisme, la plus connue reste encore celle proposée par Freud, dans laquelle le clivage du moi et l'angoisse de castration sont à l'origine de la mise en place de l'objet fétiche. Les dangers et les charmes d'une résolution ?dipienne sont esquissés à travers le cas de û Stanley ý, garçon en fin d'adolescence qui entreprend une thérapie en raison de certains de ces comportements?:?il aime porter des couches, il se travestit et il est obsédé par les femmes enceintes et leurs bébés. L'auteur souligne quelques-unes des difficultés techniques posées par ce travail, la lenteur avec laquelle il faut laisser se structurer le moi, la perception rapide par le patient d'un danger imminent dès que sa thérapeute n'est plus tout à fait en accordage avec lui, sa fuite alors vers une défense perverse, et la stimulation que l'acceptation des enrichissements ?dipiens peut entraîner pour son développement. La posizione teorica principale sul feticismo resta quella illustrata da Freud, secondo la quale la scissione dell'Io e le ansie di castrazione sono determinanti alla formazione del feticcio. I pericoli e le attrazioni di una risoluzione del complesso edipico sono illustrate nel caso di 'Stanley', un tardo adolescente arrivato in terapia perche' usava i pannolini, si travestiva e aveva un' ossessione per le donne incinte e i loro bambini. L'articolo tratta di alcune delle difficolta' tecniche in questo tipo di lavoro, della lenta e necessaria ricostruzione dell'Io, della rapida percezione del pericolo del paziente quando egli sente una mancanza di sintonia con il terapeuta e la conseguente fuga verso difese perverse, e dell'impeto che l'accettazione dei vantaggi edipici possono portare allo sviluppo.