Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children

Supplementing bibliotherapy with therapist-client communication has been shown to be an effective way of providing services to under-resourced and isolated communities. The current study examined the efficacy of supplementing bibliotherapy for child anxiety disorders with therapist-initiated telephone or email sessions, or with client-initiated contact in a randomised trial using a waitlist control. Participants were 100 anxiety-disordered children and their parents from rural and remote communities. All treatment conditions resulted in improvement on self-report measures and clinician rated severity. Telephone sessions produced superior outcomes with 79% of children being anxiety disorder free post-treatment compared with 33% of email and 31% of client-initiated participants. The results suggest that therapist supplemented bibliotherapy could provide an efficacious treatment option for families isolated from traditional treatment services.     

Habit reversal versus supportive psychotherapy in Tourette's disorder: a randomized controlled trial and predictors of treatment response

Tourette syndrome (TS) is characterized by chronic motor and vocal tics. Habit reversal therapy (HR) is a behavioral treatment for tics which has received recent empirical support. The present study compared the efficacy of HRT in reducing tics, improving life-satisfaction and psychosocial functioning in comparison with supportive psychotherapy (SP) in outpatients with TS. In addition, we investigated whether impairments in response inhibition in patients with TS predict response to HR treatment which specifically aims to inhibit tics. Thirty adult outpatients with DSM-IV TS were randomized to 14 individual sessions of HR (n = 15); or SP (n = 15). HR but not SP reduced tic severity over the course of the treatment. Both groups improved in life-satisfaction and psychosocial functioning during active treatment. Reductions in tic severity (HR) and improvements in life-satisfaction and psychosocial functioning (HR and SP) remained stable at the 6-month follow-up. The extent of pre-treatment response inhibition impairment in the HR group predicted reductions in tic-severity from pre- to post-treatment. Our results suggest that HR has specific tic-reducing effects although SP is effective in improving life-satisfaction and psychosocial functioning. Assessments of response inhibition may be of value for predicting treatment response to HR.     

The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction

Insomniacs commonly complain that they are unable to get to sleep at night due to unwanted thoughts, worries and concerns. The present study investigated whether brief training in identifying and elaborating an interesting and engaging imagery task for use during the pre-sleep period can reduce unwanted pre-sleep cognitive activity and sleep onset latency. Forty one people with insomnia were given one of three instructional sets to follow on the experimental night; instructions to distract using imagery, general instructions to distract, or no instructions. Based on previous findings reported by Salkovskis & Campbell (1994) 'Behaviour Research and Therapy 32 (1994) 1' and ironic control theory (Wegner, 1994) 'Psychological Review 101 (1994) 34', it was predicted that (1) "imagery distraction" would be associated with shorter sleep onset latency and less frequent and distressing pre-sleep cognitive activity compared to the "no instruction" group and that (2) "general distraction" would be associated with longer sleep onset latency and more frequent and distressing pre-sleep cognitive activity compared to the "no instruction" group. Support was found for the first but not the second prediction. The success of the "imagery distraction" task is attributed to it occupying sufficient "cognitive space" to keep the individual from re-engaging with thoughts, worries, and concerns during the pre-sleep period. In addition, "imagery distraction" involved a very specific alternative cognitive task hence the operating process was given a feature positive search, conditions where mental control is likely to be achieved.     

Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb

Studies in academic research centres with selected patients have shown that several cognitive behaviour therapies are effective in the treatment of PTSD following traumas affecting individuals or small groups. Little information is available on the extent to which these positive findings will generalize to more routine clinical settings with less selected patients or to a trauma that affects a whole community. The present study addresses these generalization issues. A consecutive series of 91 patients with PTSD resulting from a car bomb which exploded in the centre of Omagh, Northern Ireland in August 1998 were treated with cognitive therapy, along lines advocated by Ehlers and Clark (2000). There were no major exclusion criteria and 53% of patients had an additional axis I disorder (comorbidity). Therapists were NHS staff with heavy caseloads and modest prior training in CBT for PTSD. A brief training in specialist procedures for PTSD was provided. Patients received an average of eight treatment sessions. Significant and substantial improvements in PTSD were observed. Degree of improvement was comparable to that in previously reported research trials. Comorbidity was not associated with poorer outcome, perhaps because comorbid patients were given more sessions of treatment (average 10 vs 5 sessions). Patients who were physically injured improved less than those who were not physically injured. Overall, the results indicate that the positive findings obtained in research settings generalize well to a frontline, non-selective service.     

Clinical perfectionism: a cognitive-behavioural analysis

This paper reviews the characteristics of clinical perfectionism and proposes a new definition of the phenomenon. It is suggested that the defining feature of clinically significant perfectionism is the overdependence of self-evaluation on the determined pursuit (and achievement) of self-imposed personally demanding standards of performance in at least one salient domain, despite the occurrence of adverse consequences. It is suggested that such clinical perfectionism is maintained by the biased evaluation of the pursuit and achievement of personally demanding standards. Specifically, it is suggested that people with perfectionism react to failure to meet their standards with self-criticism. If they do meet their standards, the standards are re-evaluated as being insufficiently demanding. Anorexia nervosa and bulimia nervosa are considered to have a particular relationship to perfectionism, with both disorders often being direct expressions of perfectionism. Under these circumstances self-evaluation is dependent on the pursuit and attainment of personally demanding standards in the domain of control over eating, shape and weight. The implications of this analysis for research and practice are considered.     

Meta-analysis for single-case consultation outcomes: Applications to research and practice

The application of meta-analysis holds much appeal for single-case consultation outcome research. We review a meta-analytic method for using within-study treatment effect sizes in reporting consultation outcomes. The strengths and limitations of traditional group design meta-analysis are examined. Various methods for analyzing single-case outcomes are discussed briefly, followed by an examination of the use of meta-analysis in single-case reviews across independent studies. Within-study meta-analytic results are presented that were derived from treatments implemented in consultations in natural settings. To conclude the article, an illustration is offered of a single-case data analysis display that incorporates meta-analytic results along with other indices of treatment outcome. Recommendations are provided for using meta-analytic methods to evaluate outcomes of single-case consultation treatment.     

细胞凋亡与疾病的治疗

２０年前,人们就开始注意细胞凋亡现象,但由于当时人们细胞信号传导及真核基因调控所知甚少,因此只能孤立地看待“细胞凋亡”,２０年后,人们重新认识“细胞凋亡”发现它是一种生理性死亡,是通过一种细胞固有的ＤＮＡ编码的自杀程序,系统思维方法,使人们将凋亡与当今疾病的治疗联系起来,科学家们一方面通过诱导细胞凋亡来达到治疗肿瘤目的,另一方面又通过阻止这种细胞凋亡来治疗艾滋病,我们从中看到事物的辨证统一,充分体     

从中西医学的竞争和渗透谈现代中医临床思维的变革

现代中医的临床思维正在发生着变革,一个以辨病为纲,辨证为目,辨病论治为经,辨证论治为纬的临床思维新模式,已经呼之欲出。这正是２１世纪中医学发展的必由之路,学术界必从唯物辩证法的角度来审视这场变革,并因其势而利导之。