Brief treatment with alprazolam and behavioral guidance in panic disorder

Abstract

Thirty-two patients with panic disorder, with or without agoraphobic limitations, were treated with alprazolam (mean dose 3.5 mg/d) plus brief behavioral guidance in an open study during eight weeks. The sample had a notorious severity in the frequency of panics and phobic avoidance but was only mildly depressed. Before starting treatment the presence of demoralized mood and extensive avoidance were significant indicators of clinical severity, whereas the presence of dizziness as a relevant somatic complaint was not related to higher severity. After eight weeks of treatment a clinical improvement equal to or exceeding 80% of change was obtained in all cases (29) who completed treatment. Ninety-two percent of the patients were panic free at the end of treatment. There were significant reductions in all the scales with comparable declines in the subgroups formed according to the presence or absence of agoraphobic avoidance and demoralization. The data suggested that moderate doses of alprazolam could be a quick and effective treatment for panic-agoraphobic patients in the short term. The behavioral guidance probably helped in reducing agoraphobic avoidance and in obtaining global good effectiveness although this awaits controlled tests. Finally, the similarity in the response to treatment regardless of the presence of extensive avoidance or demoralized mood argues in favor of not considering the different variants of panic-agoraphobic syndrome differently, at least in samples with similar severity to the present one.     

Consider the Children

Summary

In this article, we consider interventions for children exposed to family violence in light of the research on children's problems associated with witnessing family violence. Next, we review risk and protective factors related to these children's adjustment with the view that all children are not similarly affected by exposure to family violence. Against this background, we then move to consider directions for interventions from a systemic perspective. We take into account not only the exposure to interactions between their mother and father, but also children's relationships with their mother, father, and siblings, as well as within broader systems such as the peer group, the school, and the community. We consider the critical challenges within each of these important systems for children exposed to family violence, and we propose some potential interventions to address the problems. Finally, we summarize an evaluation of an intervention that incorporates some of the elements identified by a systemic perspective. The evaluation revealed a significant improvement in children's self-reports of depression and anxiety over the course of the program. Mothers rated their children as significantly improved in emotional and hyperactive behaviour problems. There was no relation between mothers' involvement in counselling and children's improvement. Overall, the results suggest that the Peer Group Counselling Program effectively provided support to children exposed to family violence. Finally, we discuss the steps necessary to support children and families in moving toward violence-free lives.     

Searching through the hierarchy: How level of target categorization affects visual search

Does the same basic-level advantage commonly observed in the categorization literature also hold for targets in a search task? We answered this question by first conducting a category verification task to define a set of categories showing a standard basic-level advantage, which we then used as stimuli in a search experiment. Participants were cued with a picture preview of the target or its category name at either superordinate, basic, or subordinate levels, then shown a target-present/absent search display. Although search guidance and target verification was best using pictorial cues, the effectiveness of the categorical cues depended on the hierarchical level. Search guidance was best for the specific subordinate-level cues, whereas target verification showed a standard basic-level advantage. These findings demonstrate different hierarchical advantages for guidance and verification in categorical search. We interpret these results as evidence for a common target representation underlying categorical search guidance and verification.     

Mind-reading without the scanner: Behavioural decoding of working memory content

ABSTRACT

Sophisticated machine learning algorithms have been successfully applied to functional neuroimaging data in order to characterize internal cognitive states. But is it possible to “mind-read” without the scanner? Capitalizing on the robust finding that the contents of working memory guide visual attention toward memory-matching objects, we trained a multivariate pattern classifier on behavioural indices of attentional guidance. Working memory representations were successfully decoded from behaviour alone, both within and between individuals. The current study provides a proof-of-concept for applying machine learning techniques to simple behavioural outputs (e.g., response times) in order to decode information about specific internal cognitive states.     

Categorical target templates: Typical category members are found and identified quickly during word-cued search

What information do people use to guide search when they lack precise details about the appearance of their target? In this study, we employed categorical (word-cued) search and eye tracking, to examine how category typicality influences search performance. We found that typical category members were fixated and identified more quickly than atypical categories. This finding held when the participant was cued at the superordinate level (finding “clothing” among non-clothing items) or the basic level (finding a “shirt” among other clothing items). This suggests that categorical target templates may be constructed by piecing together features from the most typical category member(s).     

Solicited diary studies of psychotherapy in qualitative research–pros and cons

Diary studies are scarce within the field of qualitative psychotherapy research. In this article arguments for and against the employment of solicited diary studies in qualitative psychotherapy research are investigated. The strengths of diary studies are presented along with arguments concerning their pertinence to the field. Limitations and potential critiques regarding the use of diaries are also addressed.     

Universities are not a good place for psychotherapy and counselling training

This paper outlines eight aspects of institutional practice in university teaching that are at odds with the ethos of therapy: the linearity of university training has consequences for conceptual and cultural issues that may be antithetical to genuine therapeutic practice; certain notions about what reality is and what counts as truth may be reinforced by university trainings; academic knowledge in universities is standardized so as to sabotage therapeutic work; the university privileges a cognitive account; the university trains therapists in ways that are antithetical to the ethos of therapy; universities keep alive hierarchies that sit uneasily with the project of therapy; university training encourages the therapist to develop an identity that is anathema to many traditions in therapy; and compartmentalization of ethics in university-based trainings would run against the ethics of therapy.     

‘Othering’ and ‘selving’ in therapeutic dialogue

In this article we consider therapeutic conversations about suffering and sexual identity through an ethical and practical lens we refer to as ‘othering’ and ‘selving’. The ethical lens is shaped by recent developments in discursive theory and approaches to therapy. Our practical lens draws from research by discourse analysts showing how conversational practices feature in consequential ways in delicate discussions such as those about suffering and sexual identity. After helping readers understand these lenses we then use them in examining actual discussions about identity and suffering. We conclude with some general ideas and reflective questions for therapists wishing to extend these kinds of sensitivities and conversational practices in their work with clients.     

Adventure based counselling,individual counselling and object relations: a critical evaluation of a qualitative study

Adventure based counselling is a short-term experiential psychotherapeutic approach, which utilises adventurous activities and being in natural environmental in order to facilitate therapeutic change in clients. The present paper critically appraises the results of a qualitative study that investigated how clients with self-reported anxiety and depression experienced participating in an innovative counselling intervention with combined individual counselling with such an adventurous outdoor transaction. Interpretative Phenomenological Analysis, as described by Smith and Osborn (2008), was used in order record and analyse the experiences of four male and six female students who were treated at the Teesside's University Counselling Service. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing, whereas the outdoor transaction as providing an experiential venue for achieving personal change. Interviewees felt that without the outdoor transaction the therapeutic significance of the counselling process would not have reached its full potential. Likewise, without the individual counselling, the outdoor transaction would just have an entertaining event and not a venue for personal change. These findings are discussed in relation to object relations theory.     

A trans-disciplinary study of the therapist's self

Participation in personal therapy during training is required by British accreditation bodies for counselling psychology as well as by most psychotherapy trainings. By contrast, trainee clinical psychologists are not required to undertake personal therapy, although they may elect to. Prior research in Britain and the US suggests that practitioners have a wide range of motives for entering therapy as well as motives for not doing so (Norcross &; Connor, 2005). This study addresses the fact that no research to date has specifically explored what individuals beginning their counselling psychology, clinical psychology and counselling training think and feel about participation in personal therapy during training. Data from open-ended questionnaires was analysed using inductive thematic analysis. Two main themes were identified. These consisted of: ‘Personal therapy helps me to be a better practitioner’, and ‘Personal therapy costs me’. The study results are considered in light of the limited prior research and recommendations for training are made.