bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic Depression: Can Cognitive Therapy Succeed When Other Treatments Fail?
Authors: Scott Jan
Published: June 2009

This paper describes the use of cognitive behaviour therapy (CBT) with 24 chronically depressed in-patients. These individuals had previously failed to respond to all other standard antidepressant treatments and had been persistently depressed for at least two years. The clients were divided into two cohorts. The first (n=8) received a standard CBT package of 15 sessions combined with pharmacotherapy. The second cohort received a combined treatment, but the style of delivery of CBT was changed to try to take into account the special needs of the client population. At 12 weeks, 70% of the second cohort of clients showed a greater than 50% change on their pre-treatment objective and subjective depression ratings. The implications of these findings are discussed and further therapy trials in this difficult-to-treat population are encouraged.
Applying Functional Analysis: A Reply to Samson and McDonnell
Authors: Jones Robert S. P. , Owens R. Glynn
Published: June 2009

This paper builds on the suggestions of Samson and McDonnell (1990) concerning functional analysis and challenging behaviour and argues that although presenting an excellent outline of the general use of functional analysis, Samson and McDonnell (1990) have failed to sufficiently address the complexities of a functional approach to complex behaviour. The present paper emphasizes the need for caution when including “unobservables” in a functional analysis and discusses the contextual nature of the functional relationships between variables.
Extending the Role of Functional Analysis in Challenging Behaviour
Authors: Owens R. Glynn , Jones Robert S. P.
Published: June 2009

This paper responds to the comments of McDonnell and Samson concerning the Jones and Owens article which raised some issues related to the use of functional analysis in challenging behaviour. It is concluded that there is considerable agreement between the authors of both papers. The present paper raises some brief questions concerning the issues of a “correct” functional analysis and discusses dispositional characteristics in functional terms.
The Impact of Three Gross Irn Bru on an Out-Patient Clinic for Depressed Men
Authors: Atkinson Jacqueline M. , Coia Denise A.
Published: June 2009

Using an ABA design, the impact of the unexpected delivery of Irn Bru to an out-patient clinic for depressed men was investigated using the Montgomery-Åsberg scale for depression. A significant improvement in both behaviour and affect was seen immediately, some benefit still showing at one month follow-up. The effect of the procedure on the multidisciplinary team is also discussed. Some methodological issues, including small sample size are explored. Despite the methodological problems the serious element of the study points to the important impact of unexpected, non-therapeutic elements on clinical behaviour, possibly as a result of the challenge to the therapist-patient relationship.
Anxiety Management in the Community: A Social Support Model and Preliminary Evaluation
Authors: Milne Derek , Jones Rosemary , Walters Pam
Published: June 2009

It is becoming increasingly evident that informal psychotherapy plays a significant part in the coping strategies people use to alleviate personal distress. A form of this “social support” was evaluated in a pilot study in which ex-clients served as therapists for informal community groups made up of people experiencing clinical anxiety. Three major questions were addressed: what are the training effects of a short workshop on the ex-clients' social support skills?; can the trained ex-clients help people suffering with clinical anxiety?; and finally, does this involvement have an adverse effect on the psychological well being of these lay therapists. Between and within group analyses with multiple measures indicated that the workshop was successful in all three targeted areas. Implications are drawn for the pattern of formal psychotherapy services.
A Multi-Dimensional Model for Conceptualizing the Design of Child Behavior Therapy
Authors: Evans Ian M.
Published: June 2009

Four dimensions thought to be basic to all child behavior therapy are specified. These are: (a) manipulation of the consequences of inappropriate behavior; (b) short-term prevention by ecological change; (c) teaching more appropriate alternatives and (d) long-term prevention by remedying more fundamental behavioral deficits. It is proposed that all four dimensions are needed for the design of any clinical treatment. The model therefore illustrates how ostensibly opposing intervention strategies in behavior therapy are really complementary. Since children's clinical problems rarely occur as isolated behaviors, and since behavioral psychotherapy involves development of more adaptive skills that influence the target problems indirectly, the dimensional model allows cross-referencing of the interrelated target behaviors in the child-client's repertoire. This is illustrated by describing typical intervention designs for two children with behavior problems. By formally specifying the realities of clinical treatment design, the relevance of therapy outcome research to clinical practice should be enhanced.
Teaching Nurses Behavioural Methods for Pain Management: A Pilot Study
Authors: Fisher Keren , Nurse Moira , Kennedy Paul
Published: June 2009

This study explores the possibility of teaching nurses behavioural tehniques so that patients with intractable pain problems can be treated confidently, and subjective labelling, which obstructs a goal oriented approach, can be avoided.

Three seminars were given which included formal teaching, role-plays and practical between-session tasks.

Of the four assessment procedures used, the nurses showed a significant change in their knowledge of behavioural principles, their attitudes to disabled people, and their response to pain behaviours. Their ability to specify problem behaviour did not improve and some reasons for this are discussed
The Importance of Cultural Factors in the Exposure to Obsessive Ruminations: A Case Example
Authors: Martin Cheree , Tarrier Nicholas
Published: June 2009

A chinese woman suffering from obsessional ruminations of harming herself and others was treated using an audio loop tape to facilitate exposure to these thoughts. The initial treatment using a tape of her ruminations in English produced little anxiety or improvement. Subsequent recording of her ruminations in Cantonese evoked considerable distress which habituated over treatment. The importance of cultural factors in assessment and treatment is emphasized.
Multimodal Therapy for Generalized and Social Anxieties: A Pilot Study
Authors: Gross Peter R.
Published: June 2009

Generalized and social anxieties are common psychological problems which frequently coexist. The present study examined the efficacy of a multimodal therapy strategy for these problems. As there is no close correspondence between the three response systems in which anxiety is manifested, therapeutic strategies were selected for inclusion in the programme with the aim of targeting irrational cognitions, non-assertive behaviours, and physiological arousal. A battery of self-report instruments as well as a blood-pressure meter were used to monitor changes in these response systems. Questionnaires were rated by the 24 participants on two pre-and two post-treatment occasions. While significant reductions were found for nine questionnaires, no change was observed for blood-pressure levels. It was submitted that benefits of multimodal therapy can be best appreciated by giving attention to the number of areas of change produced in therapy as well as absolute levels of change.
A Multiple Treatment Approach to the Group Treatment of Insomnia: A Follow-up Study
Authors: Davies Dilys R.
Published: June 2009

The present study was carried out to evaluate the effectiveness of psychological methods on the group treatment of insomnia. Assessments were administered on measures of general and physical health, symptoms associated with anxiety and benzodiazepine usage and specific measures related to sleep pre- and post-treatment, and at a one year follow up. Fifteen patients were referred from GPs in one practice, and were sequentially assigned into three groups. Treatment took the form of 11 to 13 sessions of weekly group therapy. The group treatment consisted of (1) cognitive-behavioural strategies, including sleep monitoring, stimulus control, cognitive restructuring, problem solving, anxiety management and progressive relaxation; (2) sleep education; (3) gradual drug withdrawal. The results indicated that immediate post-treatment improvements on measures of general health, symptom reduction, reduction of hypnotic-sedative medication, and on the quantity and quality of sleep were maintained after an interval of one year after treatment. Insomnia was less severe, less frequent, of shorter duration and more easily managed. However, there were no improvements on measures aimed to assess general coping strategies nor on measures of sleep maintenance insomnia between the three periods. The findings and implications for future research in this area are discussed.
Expectancy and Compliance as Predictors of Outcome in Obsessive-Compulsive Disorder
Authors: Lax Teresa , Başoǧlu Metin , Marks Isaac M.
Published: June 2009

Forty-nine obsessive-compulsive ritualizers had clomipramine and live exposure in a randomized controlled design. The effect on outcome of pre-treatment expectations from psychological and from drug treatment and of subsequent compliance with exposure instructions was studied. Exposure instructions led to greater pre-treatment expectations than did anti-exposure instructions, but this did not affect outcome, suggesting that the effect of exposure was not due to expectation. Initially, more ill patients expected more from drug but improved less. Compliance with psychological treatment did not predict better improvement, but most patients were fairly compliant.
A Case of a Worried Well Obsessional (or an 8 month one-night stand)
Authors: Dupont Simon
Published: June 2009

Obessional-compulsive neurosis is quite a rare phenomenon with a prevalance of about 3% in all neurotics and 0.05% in the general population (de Silva, 1987). The form an obsessional-compulsive neurosis takes varies tremendously and its aetiology is not always easily identifiable. Salkovskis and Westbrook (1989) highlight the importance of a thorough assessment in distinguishing obsessional thoughts and “cognitive rituals”.
Negative Outcome in Cognitive-Behaviour Therapy: A Case Study
Authors: Wells Adrian , Dattilio Frank M.
Published: June 2009

This paper reports an exacerabation of health fears in response to cognitive modification in a patient with Somatoform Disorder (NOS). The results of the intervention present interesting theoretical implications for the conceptualization of cognitive events in clinical disorders and those characteristics that may contribute to treatment failure.
Dream Anxiety Disorders (Nightmares): A Review
Authors: Blanes Tomas , Burgess Mary , Marks Isaac M. , Gill Michael
Published: June 2009

Knowledge of the aetiology, epidemiology and treatment of nightmares has improved with more accurate definition of the problem. This review summarizes what is known about nightmares and their relationship with other medical and psychiatric disorders. Treatment methods are discussed, with particular reference to behavioural methods, which have become increasingly popular in recent years. Further research is suggested in order to determine the most efficient method of treating distressing nightmares.
Predictive Factors in the Treatment of Obsessive-Compulsive Disorders with Fluvoxamine and/or Behaviour Therapy
Authors: Cottraux Jean , Messy Philippe , Marks Isaac M. , Mollard Evelyne , Bouvard Martine
Published: June 2009

Fisher's stepwise discriminant analysis was carried out on 10 baseline variables searching for posterior prediction of success in a sample of sixty DSM-III obsessive-compulsive patients. The patients' median score on Hamilton rating scale of depression was 19. In a controlled study they were randomized into three groups: fluvoxamine with antiexposure, fluvoxamine with exposure, or placebo with exposure. In the whole sample, five variables accounted for 76% of the correctly classified patients: avoidance score of the behavioural avoidance test, behaviour therapy expectations, fluvoxamine expectations, Beck depression inventory and rituals repetition. High avoidance score predicted 68% of the correctly classified patients in the whole sample. The discriminant function classified correctly 70% of the patients in the antiexposure with fluvoxamine group, versus 75% in the exposure with fluvoxamine group, and 85% of the patients receiving exposure with placebo (χ2, d.f.2, NS).
A Social Therapy for Long-term Mentally III Inpatients: A Pilot Study
Authors: Webb Rhona , Mangrobang Julie T. , Conning Alison , Orrell Martin W.
Published: June 2009

Long-term inpatients with severe psychiatric illness such as chronic schizophrenia can be very socially disabled. This makes it difficult for them to move on to more independent living because they lack many of the necessary social and practical skills. Social Economy Therapy (SET) is a practical approach which aims to improve social functioning. On a hostel ward, eight long term inpatients with severe and disabling psychiatric disorders started a SET programme. After two months the social and living skills of several patients were improved and a number were discharged to other accommodation.
Social Skills Training with Chronic Schizophrenic Patients Living in Community Settings
Authors: Payne P. V. , Halford W. K.
Published: June 2009

Six patients meeting DSM III criteria for schizophrenia, residual phase who lived in community hostels underwent social skills training. The training programme utilized was “Stacking the Deck” developed by Foxx et al. which involves a structured board game incorporating modelling, behaviour and feedback. A multiple baseline across subject design was used to assess acquisition of targeted social behaviours in the training settings. Generalization of skills to a community setting was assessed by a structured interaction in the patients' homes at pre-treatment, post-treatment and follow-up. All subjects improved their social skills in the training setting, the improvement showed partial but weak generalization to the community setting, with some gains maintained to a three-month follow-up. Pre-treatment, post-treatment and follow-up measures of general social skills and psychiatric status indicated improvements for some of the subjects. The results suggest this approach has promise for achieving clinically significant change with chronic schizophrenic patients, but that strategies to enhance generalization of training effects are needed.
Relapse in Children Treated for Nocturnal Enuresis: Prediction of Response using Pre-Treatment Variables
Authors: Butler Richard , Brewin Chris , Forsythe Ian
Published: June 2009

Thirty-seven children successfully treated for nocturnal enuresis were followed-up. Short term relapse was determined by clinical contact for 6 months whilst long term monitoring was measured by a mailed questionnaire up to 4 years after treatment. The relationship between pre-treatment variables and relapse was examined with particular reference to maternal and child perceptions of the enuresis. Results suggest relapse was particularly related to the child's lack of concern over bedwetting.
Services for Schizophrenic Patients and Their Families: What They Say They Need
Authors: Reid Amanda M. , Lang C. Mandy , O'Neill Tara
Published: June 2009

The effects of education and stress reduction groups for the relatives of schizophrenic patients and their perception of services available to them is presented. 76% of relatives refused invitation to groups because they were overburdened. Those attending the groups said that they found them beneficial but measurable improvements were slight. Relatives' perception of the shortfalls of the services and the difficulties faced differed from that of patients. As the majority of patients turn to their relatives for help and support, rather than approaching hospital services directly, relatives were better able to identify service shortfalls. Patients' perceived needs included employment and increased income, which are not amenable to direct hospital intervention. Relatives were able to express needs that could be addressed by services. Both patients and relatives were able to identify the main difficulties faced, though there was a difference in emphasis.
Adapting Behavioural Marital Therapy to the Needs of a Secondary Marriage: A Case Evaluation
Authors: Kelly Adrian , Halford W. Kim
Published: June 2009

This paper describes and evaluates the adaption of Behavioural Marital Therapy (BMT) to the needs of a couple in a secondary marriage (the husband was in his second marriage and brought three dependent children to this marriage). The couple presented with specific difficulties in negotiating parenting roles within the reconstituted family. BMT focused on promoting adaptive cognitions, affect and communication when discussing this specific issue. Evaluation used a multiple probe design assessing self-monitored stressful interactions about parenting, and daily marital satisfaction. Results showed significant reductions in the intensity and frequency of arguments from pre- to post-therapy, and increases in marital satisfaction. These gains were maintained at follow-up. Discussion focuses on future directions for adapting BMT to problems particular to secondary marriages.
Intervention Package for Treating Encopresis in a 6 Year Old Boy: A Case Study
Authors: Ronen Tammie
Published: June 2009

The paper presents a single case study of the treatment of primary encopresis in a 6 year old boy. The boy had never had regular bowel movements, suffered from retention for periods of 4–5 days, and soiled himself when he finally passed a bowel movement. The subject was treated using behavioural and cognitive techniques, and the progress was evaluated using a single subject design. The findings revealed that the intervention succeeded in stopping the boy's soiling and retention and in his achieving regular bowel movements. Two follow-up interviews after six and twelve months demonstrated that the improvement had persisted. The results suggested that the behavioural therapy package constituted an effective means for the treatment of encopresis.
Eye Movement Desensitization of Body Image
Authors: Hassard Alan
Published: June 2009

This single case history reports the use of eye movement desensitization, a new cognitive therapy procedure originally developed for post-traumatic stress disorder and similar problems, to treat anxieties and body image problems resulting from operation scars and a degree of physical disability. The procedure was effective within one session and subsequent improvements in behaviour and cognitions reported.
“Subconscious Retraining”: A Placebo Strategy for Generalized Anxiety Disorder
Authors: White Jim
Published: June 2009

This report describes a placebo strategy which engendered a reasonable degree of positive expectation in 10 Generalized Anxiety Disorder patients and was perceived by them as being credible, sensible and appropriate at pre- and post-therapy and at six month follow-up. The significant improvement noted on a range of measures suggests that the strategy is not inert.
Cognitive—Behaviour Therapy with Depressed Primary School Children: A Cautionary Note
Authors: Liddle Barbara , Spence Susan H.
Published: June 2009

Thirty-one children, aged 7 to 11 years, were selected on the basis of depressive symptomatology over a two week period, as assessed by self-report questionnaires and a diagnostic interview. Subjects were randomly assigned to one of three groups, namely Social Competence Training (SCT), Attention Placebo Control (APC) and No Treatment Control (NTC). Intervention was conducted on a group basis for eight, weekly sessions. The results indicated a decline in depression scores during the treatment period for subjects in all conditions, and this continued during the two month follow-up period to within the normal range. The SCT programme did not produce significantly greater reductions in depression than either the APC or NTC conditions and was not effective in producing improvements on measures of social competence.
The history of health technology assessment in Norway
Authors: Mørland Berit
Published: June 2009

Objectives: The aim of this study was to describe the Norwegian contribution to the broad picture of our international health technology assessment (HTA) history.

Methods: A general examination of some pre-HTA activities, as consensus conferences, closer reading of all background papers to the establishment of an HTA agency in Norway, the ongoing activities of this agency, its evaluation, and its merge into a broader knowledge center for the health services were performed. All information and statements are the authors’ own understandings, but also were reviewed by some of the people taken part in these processes.

Results: The Norwegian HTA activity was set up rather late compared to, for instance, Sweden, and our involvement in Nordic early warning activities. This may be related to Norwegian scientists being more involved in the Cochrane Collaboration. However, when established, the HTA agency was regarded as highly successful in involving clinical experts and responding to questions arising from the macro- as well as micro-levels of decision makers. International collaboration was essential in building the capacity to serve all levels. After 6 years, the agency was merged with some related health service knowledge activities, into a new center.

Conclusions: During the 10 years’ time, HTA has become a well-established activity in Norway.
From idealistic rookies to a regional leader: The history of health technology assessment in Poland
Authors: Niżankowski Rafał , Wilk Norbert
Published: June 2009

In 1989, Poland started to slowly release itself not only from the burden of a half-century of communist indoctrination and soviet exploitation, but also from the consequences of the Semashko model of healthcare organization: low doctors' salaries, primary care based on multispecialty groups, overdeveloped hospital infrastructure, and limited access to sophisticated interventions overcome by patients' unofficial payments.

A few years after the 1998 workshop on health technology assessment (HTA) in Budapest, the first HTA reports were elaborated in the National Center for Quality Assessment in Health Care, which could mark the beginning of HTA in Poland. Several individuals and organizations have been involved in developing HTA, both from noncommercial and commercial standpoints.

A goal to establish a national HTA agency appeared among the priorities of the Polish Ministry of Health in 2004 and was realized a year later. The Agency for HTA in Poland published guidelines on HTA and established a sound and transparent two-step (assessment-appraisal) process for preparing recommendations on public financing of both drugs and nondrug technologies. The recommendations of the Agency's Consultative Council were warmly welcomed by the public payer. However, the recent major restructuring of the Agency and new drug reimbursement decisions aroused doubts as to keeping transparency of the decision-making processes.
Health technology assessment in Malaysia
Authors: Sivalal Sadasivan
Published: June 2009

Objectives: Malaysia, as a rapidly developing country, has been facing tremendous pressures in its attempts to maximize scarce resources. Despite this problem, Malaysia has made great strides in developing its health services, and has successfully provided good access to the population to healthcare services, reduced the incidence of many communicable diseases, and improved life expectancies and other global indices of health care, some of which are comparable to that of developed countries.

Methods: The Health Technology Assessment (HTA) Unit was set up in Malaysia in August 1995 in the Ministry of Health Malaysia and has since grown tremendously in size and resources. To date, forty-three in-depth assessments have been carried out, and the recommendations of these assessments were subsequently implemented. In addition, approximately 140 rapid assessment reports were produced in response to requests from policy and decision makers. HTA has been able to provide input into formulation of national and Ministry of Health Malaysia policies, and provide a basis for clinical practice guidelines development, input into purchasing decisions, regulation of drugs, as well as advertisements related to health.

Results: A major challenge is sustainability of the program, to be able to have trained personnel competent to take on the demanding tasks of assessments and the sustained efforts that are required. In addition, there need to be constant efforts to create awareness of the utility of HTA so that its services are used and its full potential realized. The scope of services may also need to be expanded to include an early warning system.

Conclusions: Malaysia has successfully implemented a health technology program that has had major impact on policy formulation and decision making at various levels. Challenges may be faced in sustaining and developing the program further.
Health technology assessment in Singapore
Authors: Pwee Keng Ho
Published: June 2009

The Republic of Singapore is an island city-state in Southeast Asia. Its population enjoys good health and the Singapore Ministry of Health's mission is to promote good health and reduce illness, ensure access to good and affordable health care, and pursue medical excellence. This is achieved through a healthcare system that includes both private and public sector elements. The financing philosophy of Singapore's healthcare delivery system is based on individual responsibility and community support. Health care in Singapore is financed by a combination of taxes, employee medical benefits, compulsory health savings, insurance, and out-of-pocket payment. The capability for health technology assessment in Singapore was developed concurrently with its medical device regulation system in the 1990s. The first formal unit with health technology assessment (HTA) functions was established in September 1995. Today, HTA features in decision making for the Standard Drug List, licensing of medical clinics, the Health Service Development Programme, healthcare subsidies, and policy development. The public sector healthcare delivery clusters have also recently started health services research units with HTA functions. Singapore is organizing the 6th Health Technology Assessment International (HTAi) Annual Meeting in June 2009. Bringing this prestigious international conference to Asia for the first time will help raise awareness of HTA in the region.
Development and implementation of health technology assessment in Argentina: Two steps forward and one step back
Authors: Rubinstein Adolfo , Pichon-Riviere Andrés , Augustovski Federico
Published: June 2009

Objectives:The objectives of this study are to review the financing and organization of the Argentine healthcare system, the licensing and drug price setting mechanisms, the benefit packages and coverage policies of pharmaceuticals and other medical technologies, as well as the development of HTA in Argentina, and the role of the Institute of Clinical Effectiveness and Health Policy (IECS) as an HTA agency. Finally, the perspectives and future of HTA as a tool to make resource-allocation decisions and priority setting in Argentina is discussed.

Methods:The study is a discussion/review based largely on the experiences of the authors, but supported by available literature.

Results:Argentina is an upper-middle income country with major healthcare problems related to both equity and efficiency. Its healthcare system consists of a multitier system divided in three large sectors: public, social security, and private, where the federal Ministry of Health has a rather limited role in national health policy stewardship. Many of Argentina's shortcomings are due in part to its pluralistic and fragmented healthcare system. In the past decade, Argentina, like many other Latin American countries, has undergone a profound reform of its healthcare system. Whereas some of the objectives of the reforms were specific to each country, a common issue among all of them was to establish a mechanism that ensured a more efficient allocation of scarce resources, and guaranteed a wider provision of healthcare services on the basis of the local population needs and equity. Although some signals from the national government and congress show that there are plans to formally incorporate HTA to inform reimbursement policies, these signals are still very weak. Paradoxically, even though Argentina was the first country in the region to require formal health economic evidence for the adoption of technologies into the mandatory benefit package of the social security, this “fourth hurdle” is no longer required. Nevertheless, there is an increasing interest and demand for a more explicit and transparent resource-allocation process that include HTA as a formal tool to inform decision making, in most of Argentine healthcare stakeholders.

Conclusions:In conclusion, what is needed in Argentina is a clear political will to push forward for a national agency of HTA that, similar to other developed countries, advance the regulation on the adoption of new health technologies to improve not only technical or allocative efficiency, but also health equity. Until this milestone is accomplished, the HTA production and use to inform healthcare coverage policies will continue to mirror the current fragmented healthcare system.
A new Antarctic foraminiferal species for detecting climate change in sub-Recent glacier-proximal sediments
Authors: Majewski Wojciech , Tatur Andrzej
Published: June 2009

Cribroelphidium webbi sp. nov. is the only adequately described sub-Recent elphidiid foraminifer from Antarctica. In Admiralty Bay (King George Island, South Shetland Islands), it is found at several locations within inner fiord setting at water depths between 33 and 165 m, but most commonly shallower than 100 m. In outer basins this foraminifer is absent. In the cores analysed, C. webbi sp. nov. is present in well-constrained sub-Recent horizons that are clearly related to climate warming and deglaciation. These horizons represent a diachronous facies marker rather than a single stratigraphic layer. Cribroelphidium webbi sp. nov. shows clear association with retreating tidewater glaciers, therefore it is an important sensitive glacier-proximal indicator. It appears that it shares similar ecologic affinities with Cribroelphidium excavatum clavatum, which is widely distributed throughout the Arctic.
Complex splitting of self-representations in sexually abused adolescent girls
Authors: Calverley Rosemary M. , Fischer Kurt W. , Ayoub Catherine
Published: June 2009

Recent work on psychopathology supports a connection between repeated childhood maltreatment and disturbances in self-definition and -regulation. This study tested the hypothesis that chronic childhood sexual abuse is associated with developmentally complex affective splitting of representations of self-with-others, including both a negativity bias in evaluating core self and a high degree of affective splitting of scripts for self-in-relationships. Sixteen inpatient adolescent girls with affective disorders participated in the Self-in-Relationships Interview to produce and analyze a self-diagram; seven had been victims of prolonged sexual abuse, and nine had not. The results supported the hypothesis, showing two powerful differences in splitting between the groups, (a) The abused girls placed negative characteristics as central to their core self and also produced an unusually large overall number of negatives. The nonabused girls regarded negative characteristics as mostly peripheral in their self-diagram and produced fewer negatives, (b) The abused girls showed a form of complex dissociative coordination calledpolarized qffective splitting, which was not produced by the nonabused group. They also showed slightly higher developmental levels in general than the nonabused group, thus contradicting the traditional view that maltreatment produces splitting through developmental fixation or regression. Psychopathology from abuse arises along a complex, distinctive developmental pathway, not as a result of a delay or failure of development.
Challenging Behaviours and Severe Learning Disabilities: Recent Developments in Behavioural Analysis and Intervention
Authors: Emerson Eric
Published: June 2009

Recent years have witnessed the gradual emergence of a technology of nonaversive behavioural support for people with severe learning disabilities and seriously challenging behaviours. Three key aspects of these developments are reviewed, including: the functional perspective to analysis and intervention; the incorporation of the analysis and modification of setting events into behavioural practice; and the use of experimental techniques to conduct functional analyses of the contextual control of challenging behaviours. Attention is drawn to the practical implications and limitations of these developments.
Interactions Between Self-Exposure and Alprazolam in the Treatment of Agoraphobia Without Current Panic: An Exploratory Study
Authors: Echeburúa Enrique , De Corral Paz , Bajos Elvira García , Borda Mercedes
Published: June 2009

The aim of this work was to test the comparative efficacy of four therapeutic modalities (self-exposure, self-exposure + Alprazolam, Alprazolam, and self-exposure + placebo) and also to determine the combined effects of self-exposure with Alprazolam and self-exposure with placebo in the treatment of agoraphobia without current panic. The sample consisted of 31 patients selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures of assessment (pre-treatment, post-treatment and 1, 3 and 6-month follow-up) was used. The results indicated that there was a similar therapeutic improvement (in about 75% of the cases) between pre- and post-treatment in all therapeutic modalities, except for the Alprazolam group, where improvement did not take place, was rather weak or tended to fade as time passed. This improvement increased at the follow-ups in the self-exposure + placebo group, remained stable in the self-exposure group, and was irregular or fairly unpredictable in the self-exposure + Alprazolam group. There was a positive combined action between self-exposure and placebo and a negative interaction between self-exposure and Alprazolam. The highest relapse rate appeared in the therapeutic modalities where the active drug was administered. The intratreatment evolution was faster in the self-exposure group than in the others, but it tended to remain stable in the second part of the therapy. It is therefore concluded that the efficacy of self-exposure therapy may be the same if reduced to half the number of sessions. Finally, several topics that may contribute to future research in this field are commented upon.
Cue-Controlled Relaxation and “Aromatherapy” in the Treatment of Speech Anxiety
Authors: Spector Ilana P. , Carey Michael P. , Jorgensen Randall S. , Meisler Andrew W. , Carnrike C. L. M.
Published: June 2009

The purpose of this investigation was to examine the separate and combined effects of cue-controlled relaxation training and “aromatherapy” as treatments for reducing speech anxiety. Thirty-six speech anxious subjects were randomly assigned to one of four conditions: cue-controlled relaxation with a word cue, cue-controlled relaxation with an aroma cue, “aromatherapy” alone, and a wait list (i.e., control) group. Prior to treatment, subjects completed the Personal Report of Confidence as a Speaker, Fear of Negative Evaluation questionnaire, S-R Inventory of Anxiousness-Speech Form, Cognitive Somatic Anxiety Questionnaire, and Multiple Affect Adjective Check List; subjects also performed a speech which was rated for behavioral signs of anxiety. The assessment protocol was repeated following treatment, and at a two-month follow-up. Thirty-two of 36 subjects (89%) provided complete data at post-treatment, and 23 of 28 treated subjects (82%) provided complete data at follow-up. Results indicated that subjects in both cue-controlled relaxation conditions decreased their speech anxiety more than did the subjects in the aromatherapy or control conditions.
The Acceptability of Physical Restraint Procedures for People with a Learning Difficulty
Authors: McDonnell Andrew A. , Sturmey Peter , Dearden Bob
Published: June 2009

Three methods of physical restraint were videotaped and presented to two groups of subjects (undergraduate students and teenagers). Two of the methods recommended restraining a person with a learning difficulty on the ground; the other method proposed seating the individual in a chair. Subjects were asked to rate the social acceptability of the procedures using the Treatment Evaluation Inventory (TEI). Both undergraduate students and teenagers rated the chair method as more acceptable. The implications of these findings for the use of physical restraint procedures were discussed.
Imagery and Core Beliefs in Health Anxiety: Content and Origins
Authors: Wells Adrian , Hackmann Ann
Published: June 2009

A preliminary investigation of the content and origins of intrusive imagery and core beliefs as they occur in health anxiety is reported. The exploration of patients' images proved to be a particularly effective means of determining underlying core beliefs. Images appeared to reflect a wider range of idiosyncratic meanings than were apparent in the automatic thoughts alone. Two types of core beliefs were revealed by the images: beliefs about the self, and beliefs about death and illness and their implications, which included themes to do with abandonment and isolation. All patients had metaphysical or superstitious beliefs. It is suggested that a conjunction between the beliefs about the self and those about death and illness may contribute to individual tendencies to misinterpret bodily sensations in health anxiety.
Attentional Bias for Appetitive Cues: Effects of Fasting in Normal Subjects
Authors: Lavy Edith H. , van den Hout Marcel A.
Published: June 2009

A long series of earlier studies demonstrated that fearful subjects selectively allocate attention to sources of perceived threat. Such attentional bias may not be limited to negative cues. It is hypothesized that attentional bias serves to enhance early identification of action-relevant cues and that such bias also occurs when subjects are confronted with positive valenced cues that evoke an urge to act immediately. In order to determine whether or not the attentional bias effect is limited to unpleasant stimuli, we studied the effects of 24 hours of fasting, focusing our attention on a possible attentional bias for (positively evaluated) food stimuli. The experiment controlled for emotionality effects. It is shown that fasting results in a positive evaluation of food stimuli and an increased desire for these stimuli. The attentional bias effects found were slight and more likely attributable to the increased urge to act than to general emotionality effects. The power of the experimental manipulation and the computerized Stroop task are discussed.
Psychological Treatment of Chronic Auditory Hallucinations: Two Case Studies
Authors: Haddock Gillian , Bentall Richard P. , Slade Peter D.
Published: June 2009

Two cases involving the cognitive-behavioural treatment of hallucinations are described. In both cases, a focusing strategy was used with a view to enabling patients to reattribute the nature and meaning of their experiences. One patient showed a marked reduction in the frequency and content of his voices. The second patient showed little change. The implications of observations made during therapy for the future development of cognitive-behavioural strategies for use with psychotic patients are discussed.
Brief Psychotherapy in Two-Plus-One Sessions with a Young Offender Population
Authors: Day Andrew , Maddicks Richard , McMahon David
Published: June 2009

This study represents an attempt to evaluate Barkham and Shapiro's (1988) two-plus-one model of brief psychotherapy with a young offender population as a way of significantly improving service delivery for clinical teams working in prisons. Brief cognitive-behavioural interventions were administered to young offenders referred for problems with depression, alcohol and anger whilst in custody. Significant treatment effects were found at the time of follow-up, suggesting that the interventions significantly accelerated improvement in these problem areas. It is suggested that the two-plus-one model is both an appropriate and effective model of service delivery in working with this client group.
Worry: Mechanisms and Modulating Influences
Authors: Tallis Frank , Eysenck Michael W.
Published: June 2009

A new model of worry is presented, differing from previous work in which worry was set within a broader theory of anxiety. It is proposed that threat is initially evaluated in terms of imminence, likelihood, and cost set against perceived self-efficacy; this evaluation can produce worry as a relatively automatic response. Worry serves the functions of alarm, prompt, and preparation; in terms of processes, it leads to an unfocused attentional style, sensitivity to emotional information, and arousal (which produces self-absorption). Threat (and worry) are maintained if there are elevated evidence requirements or inappropriate problem solving. The therapeutic implications of the model are discussed briefly.
The Saga of Behavioural Cognitive Intervention
Authors: Arnarson Eiríkur Örn
Published: June 2009

It is of interest to link behavioural paradigms with the past and see whether the cultural roots of behavioural and cognitive therapies can be found in medieval literature. In this context the attention is drawn to the Icelandic Sagas. Iceland was destined to become a chosen sanctuary for Norse culture, a place where the memories and history of Northern Europe were more diligently preserved than anywhere else, and recorded in books that are today the richest source of knowledge of the Viking Age.
Motivational Interviewing: III. On the Ethics of Motivational Intervention
Authors: Miller William R.
Published: June 2009

This article is intended to promote consideration and discussion of ethical issues in motivational interventions. The popular concept of client “denial” encompasses a broad range of motivational behaviors including lying, perceptual bias, unawareness, ambivalence, resistance and reactance. The “problem of motivation” typically arises when a therapist perceives a problem and sufficient need for change in someone who does not share this perception. In considering how to respond to such situations, one can conceive of a continuum of levels of readiness to change, and of therapeutic strategies ranging from passivity to coercion. Ethical concerns arise when there is a perceived mismatch between readiness level and intervention strategy. Motivational interviewing is a middle way between passivity and coercion, seeking to evoke intrinsic motivation for change by making salient the inconsistency of problem behavior and that which is more deeply valued. The concern that this approach is “manipulative” combines a descriptive element and an evaluative component. Three possible descriptive meanings are discussed: that it effectively alters behavior, that it does so in persons not seeking or requesting change, and that it may operate through processes not immediately apparent. Ethical concerns regarding motivational intervention are considered within this broader context.
Should We Intervene to Modify Type A Behaviours in Patients with Manifest Heart Disease?
Authors: Bennett Paul
Published: June 2009

Until the mid 1980s Type A Behaviour (TAB) was considered to confer the same magnitude of risk for CHD as smoking, hypertension and raised serum cholesterol. As such, it was considered a suitable target for modification, particularly in post-infarction populations. More recently, three arguments have been suggested that counter such optimism: (i) recent evidence may suggest TAB is not predictive of heart disease in post-infarction populations; (ii) interventions do not influence physiological processes underpinning TAB and, accordingly, do not reduce risk for disease progression; (iii) there are other, more useful, interventions that may be conducted with cardiac patients. The validity of each of these challenges is critically examined. It is concluded that interventions to modify TAB in patients with manifest heart disease are still of value in reducing risk for further disease progression.
Psychological Factors in Childhood Asthma
Authors: Benedito-Monleón Carmen , López-Andreu Juan Alonso
Published: June 2009

The influence of the personality of asthmatic children and their mothers on the course of their illness is analysed, taking as a basis a sample of 48 asthmatic children. This is done through the assessment of the role of personality in the change that takes place, after the application of various psychological treatments (relaxation, systematic desensitization and stress inoculation) in three variables: number of days of illness, symptomatic relief drug use and school absences. The results obtained highlight the influence of personality on therapeutic success. Consequently, this study shows the importance of tending to personality traits in order to forecast and improve the effectiveness of psychological treatment.
Behavioural Psychotherapists in Practice: A Survey of UK Practitioners
Authors: Milne Derek
Published: June 2009

A questionnaire survey of a random sample of the members of the BABP (N= 191) served to clarify the relationship between research and practice in behavioural psychotherapy in the UK. The predicted gap between research and practice was only obtained in one of eight targeted areas, i.e. training. Overall, this indicated that behavioural practitioners were conforming to the standards set out in behavioural research. However, as the research standards were not challenging, it is argued that theory provides a better benchmark against which to judge practice. This leads to the view that considerable progress remains to be made, particularly in terms of becoming more environmental in the formulation and treatment of problems, and in becoming more objective and systematic in measuring such problems. Developments in the analysis of practitioner behaviour should, it is suggested, form the basis of more effective training and contingency management, in relation to behavioural practice.
Cognitive Behaviour Therapy For Auditory Hallucinations Without Concurrent Medication: A Single Case
Authors: Morrison Anthony P.
Published: June 2009

A 38 year old patient with auditory hallucinations was treated with a brief cognitive-behavioural intervention without concurrent medication. This intervention was based upon the theory of Bentall (1990a, b) and the methods of Haddock, Bentall and Slade (1993). The patient's ratings for frequency of hallucinations and distress caused were significantly reduced at end of treatment, and her belief in the reality of these voices was correspondingly diminished. These gains were maintained at one and three month follow-up.