Effectiveness of Cognitive Behavioral Therapy for Anxiety and Depression Among Orthodox Jews

Several clinical papers have provided clinical recommendations for how to provide cognitive behavioral therapy (CBT) for obsessive-compulsive symptoms among Orthodox Jewish individuals. However, no published studies have described culturally adapted CBT for anxiety or depression in this population or quantified the effectiveness of such approaches. We evaluated the effectiveness of CBT for symptoms of generalized anxiety and depression in a sample of Orthodox Jews (n = 65) and a comparison sample (n = 42) presenting to the Center for Anxiety, a private outpatient clinic with three offices in the New York area (www.centerforanxiety.org). A chart review revealed that all patients received CBT-based interventions with appropriate religious-cultural adaptations of treatment, which we present in two case studies. We observed statistically and clinically significant treatment gains from pretreatment to midtreatment (anxiety: t = 8.56, p < .001; depression: t = 8.01, p < .001), and again from midtreatment through termination (anxiety: t = 3.68, p < .001; depression: t = 3.62, p < .001). No significant differences in anxiety or depression were observed between Orthodox Jewish patients and controls at any time point or for treatment effects (anxiety: Wilks’ Lambda = .950, F = 2.65, p = .076, η_p² = .050; depression: Wilks’ Lambda = .99, F = 2.00,p = .49, η_p² = .014). This paper offers clinical insight into delivery of CBT to Orthodox Jewish patients, as well as preliminary support for the effectiveness of CBT in treating symptoms of generalized anxiety and depression within this population.     

守护受试者的权益——对“药物研究与应用的伦理监督”

如何保障和守护临床试验研究中受试者的权益?这既是医生、患者(受试者)、工业界与公众注目的问题,也是医院伦理委员会工作面临并要解决的基本而至关重要的问题。从华西医院伦理委员会工作角度出发,分析了临床试验研究中的权益冲突和对受试者权益的科学、伦理与政策守护的要素,论述了如何保障受试者权益问题。     

医院数字化管理在临床决策中的作用

医院数字化建设是管理行为中的重要手段,借助这一工具,医疗决策的制定和执行将更加科学和规范,但同时医院数字化管理在法律和具体操作上对临床决策的管理还有一定的影响。讨论医院数字化在医疗决策中的合法性、安全性及对临床决策基本原则的作用。     

The Hospital Room as Uncanny: Psychoanalytic Observations and Recommendations for Pastors and Chaplains

This essay in applied psychoanalysis is written for the field of pastoral psychology, and it also has obvious affinities with the medical humanities. The author uses Freud’s (The uncanny. In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 17, pp. 217–256). Vintage, London, 1919/2001) “The Uncanny” to question the concept of homelike hospital rooms. Instead of making patients feel more comfortable, the authors believes that these rooms could, in some cases, actually increase the anxiety of patients. The author uses Helena Michie’s personal story of her experience of touring a birthing suite to support this argument, as well as some poetry by Billy Collins. The author, however, does not stop with identifying a problem, as he also suggests that pastors and chaplains, when they provide care for their patients, should help them identify and use their own transitional and transformational objects. These objects, of course, will be highly idiosyncratic, and it is precisely this kind of attention—attention to the idiosyncrasies of individuals—that pastors and chaplains should be giving to those in their care. While there is a growing literature on D. W. Winnicott, who coined the term “transitional object,” and Christopher Bollas, who gave us the term “transformational object,” in medical and pastoral circles, the author suggests that attention to and the endorsement of the use of transitional and transformational objects should become a part of hospital policy, if only in chaplaincy handbooks, so as to recognize what many individuals are already doing.     

The Boston Naming Test: Norm data and cue utilization in a sample of normal 6- and 7-year-old children

The object-naming abilities of 83 normal children were examined using the Boston Naming Test developed by E. Kaplan, H. Goodglass, and S. Weintraub (1976, The Boston Naming Test (experimental edition), unpublished test, Veterans Hospital, Boston, Massachusetts). There is currently a lack of available norms for this instrument, especially for populations of younger children. Cue utilization in this sample is explored and attention is focused upon possible gender differences in naming performance and cue strategies. Seven summary scores derived from the test are presented in this report. Results indicate that the Boston Naming Test can discriminate within a normal population sample of young children and provides a relatively normal distribution for six of seven derived scores. Boys were found to have a significantly greater number of items correctly named but no gender differences in cue utilization were evident. A major proportion of the children in this sample of 6- and 7-year-olds used phonological cues almost exclusively, rather than semantic cues also provided. Cue use was not related to age or spontaneously given responses, and none of the children were found to be highly proficient at using both types of cues.     

Altered patterns of word associations in dementia and aphasia

The word associations of 38 demented, 17 aphasic, and 22 normal subjects were studied. Both normal and brain-injured subjects appear to make judgments about the grammatical class of the word stimulus. Certain stimulus words (especially nouns and adjectives) elicit paradigmatic responses whereas other words (especially verbs and adverbs) elicit syntagmatic responses. The mechanism producing syntagmatic responses seems relatively resistant to deterioration in dementia or aphasia. However, in dementia the mechanism that generates paradigmatic responses becomes progressively less efficient (possibly due to a loss of semantic markers) and consequently more random (idiosyncratic) responses emerge. Perseverative responses, inhibited in normal subjects, are more prevalent in dementia. Anomic aphasics show a pattern of word associations similar to that of subjects with mild dementia. Broca's aphasics, while making fewer paradigmatic associations than normals, retain enough self-monitoring mechanisms so that few idiosyncratic and perseverative responses are made while more null responses occur. Wernicke's aphasics show a marked shift away from a paradigmatic word association strategy, possibly due to an inability to access semantic markers or a true loss of these markers. Metalinguistic deficits (i.e., a failure to adopt an appropriate strategy) may also contribute to this shift away from paradigmatic associations. Furthermore, a disruption of self-monitoring mechanisms in Wernicke's aphasia leads to an increase in perseverative and idiosyncratic responses.     

Recovery of single word comprehension: CT-scan correlates

9tory comprehension for single words, as measured by the BDAE Word Discrimination subtest, was studied longitudinally in a group of 37 aphasic patients. The majority of the patients had impaired performance at 1 month postonset, but recovery by Month 6 postonset was quite striking. Damage to Wernicke's area did not preclude recovery of single word comprehension to within the normal range. Only patients with very extensive left hemisphere lesions had incomplete recovery of single word comprehension.     

Menstrual cycle effects on task performance examined in the context of stress research

The study examined the effects of degree of paramenstrual distress, signal frequency, task load and time on task on psychomotor performance across the menstrual cycle. Simple reaction time, choice reaction time and pursuit tracking were the tasks employed, and performance was assessed using the metrics of mean level, variability, and errors of omission and commission. The results showed performance as a function of menstrual cycle phase and paramenstrual distress to be highly task and metric specific, a finding typical of stressor variables: pursuit tracking was affected by phase, with mean performance at its worst premenstrually; choice reaction time was dependent on a complex interaction of experimental variables and measurement metrics; simple reaction time showed no significant effects. Patterns of attention allocation in a time-sharing situation combining both pursuit tracking and choice reaction time components were also investigated. Trends here indicated relatively better performance both menstrually and intermenstrually as components increased in signal/response frequency, with a corresponding deterioration premenstrually. Overall performance capacity appeared to be greatest at menstruation, and the degree of attentional selectivity was least. High distress women performed better on low frequency components, whereas asymptomatic women did better at higher signal rates.