Irmela Florin

The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome.

OBJECTIVE:Although the standard treatments for the irritable bowel syndrome (IBS) are medical, growing evidence indicates the substantial therapeutic value of psychological therapy. However, it has not been investigated whether the combination of multicomponent behavioral therapy plus medical treatment is more effective than medical treatment alone. The aim of this study was to investigate this question in patients consulting a tertiary gastrointestinal (GI) referral center.METHODS:Twenty-four IBS outpatients were randomly assigned to the combination of standardized multicomponent behavioral therapy plus standard medical treatment (SMBT) or standard medical treatment alone (SMT). SMBT included IBS information and education, progressive muscle relaxation, training in illness-related cognitive coping strategies, problem-solving, and assertiveness training in 10 sessions over 10 wk. SMT included standardized symptom-oriented medical treatment and regular visits to a gastroenterologist every second week. Posttreatment outcome measures consisted of quantification of GI, vegetative, and psychological symptoms by means of daily symptom diaries and the assessment of changes in rectovisceral perception thresholds, as well as of questionnaire measures on psychological distress, overall well-being, illness-related coping abilities, and quality of life. Follow-ups were conducted at 3- and 6-month intervals.RESULTS:Pre- and posttreatment evaluations showed significantly (p < 0.01) greater IBS symptom reduction as measured by daily symptom diaries for the SMBT group than for the SMT group. Rectovisceral perception remained unchanged by either treatment. Overall well-being significantly improved in the SMBT group but remained unchanged in the SMT group. Subjects in the SMBT group, unlike those in the SMT group, felt significantly more in control of their health, and quality of life was significantly improved in the SMBT group but remained unchanged in the SMT group.CONCLUSIONS:The data provide evidence that the combination of medical treatment plus multicomponent behavioral treatment is superior to medical treatment alone in the therapy of IBS.

Prevalence of body dysmorphic disorder in a German college student sample

The prevalence of body dysmorphic disorder (BDD) was investigated in a non-clinical sample. German college students (n=133; 73.7% female) completed self-report questionnaires assessing BDD, self-esteem, symptoms of depression, obsessive-compulsive disorder and skin picking. Based on our data, seven participants (5.3%) satisfied DSM-IV BDD criteria. Significant differences were found between students with and without BDD in the number of endorsed obsessive-compulsive disorder symptoms. Poor body image was associated with poor self-esteem, symptoms of depression and obsessive-compulsive disorder. One student with BDD also reported severe skin picking. In conclusion, BDD is a common psychiatric disorder in college students.

Directed forgetting in obsessive-compulsive disorder

We tested whether patients with obsessive-compulsive disorder (OCD) are characterized by dysfunction in the ability to forget disturbing material. Employing a directed forgetting procedure, we presented OCD patients and healthy control subjects with a series of negative, positive, and neutral words, and instructed them either to remember or to forget each item after it was presented. Subjects received free recall and recognition tests for all words, regardless of instructions. Orthogonal planned contrasts indicated that OCD patients exhibited deficits in the ability to forget negative material relative to positive and neutral material, whereas control subjects did not. Additional analyses suggested that OCD patients elaboratively encoded negative words, regardless of instructions, thereby enhancing their memorability.

Selective processing of emotional information in body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a syndrome characterized by distress about imagined defects in ones appearance. Though categorized as a somatoform disorder, BDD is marked by many characteristics associated with social phobia (e.g., fear of negative evaluation) and obsessive-compulsive disorder (e.g., intrusive thoughts about ones ugliness, checking). In the present experiment, we tested whether BDD patients exhibit selective processing of threat in the emotional Stroop paradigm as do anxiety-disordered patients. Relative to healthy control participants, BDD patients exhibited greater Stroop interference for positive and negative words, regardless of disorder-relevance, than for neutral words. Further analyses suggested that interference tended to be greatest for positive words related to BDD. These data suggest that BDD patients are vulnerable to distraction by emotional cues in general, and by words related to their current concerns in particular. Results suggest that BDD may indeed be related to anxiety disorders such as social phobia.

Need for Supportive Counselling – the Professionals’ versus the Patients’ Perspective

Background: The aim of the study was to identify melanoma patients who suffered significant distress and were judged to be in need of supportive counselling, on the one hand, and, on the other, to investigate patient interest in such support. Methods: Out of 236 melanoma patients, who constitute a representative sample of melanoma patients in Western Austria, 215 patients participated in the study and were assessed with regard to psychosocial distress, coping strategies, social networks and interest in receiving psychosocial support. Multiple logistic regression analyses were performed with regard to patient interest in receiving psychosocial support either from the attending oncologist or from a mental health professional. Results: 65 patients (30.2%) experienced moderate and 30 patients (14.0%) severe distress, which was predominantly caused by tumour-related fears, tension and disturbance of emotional well-being. 83% of the severely distressed patients wanted psychosocial support from their oncologists, whereas only half of them were interested in additional support from a psychotherapist. In particular, patients who showed fear of tumour progression and felt that they were insufficiently informed about their disease preferred to consult their dermatologist for psychosocial support. On the other hand, patients with poor prognosis, receiving only low levels of support from their social network, and exhibiting a depressive coping style, showed interest in getting supplementary support from a psychotherapist. Conclusions: These findings underline the importance of educating oncologists with a view both to improve their communication skills and to help them identify patients making poor adjustment to illness in order to offer them appropriate emotional support.

Cognitive-Behavioral Therapy for Idiopathic Infertile Couples

Background: The purpose of this pilot study was to evaluate the impact of a 6-month cognitive-behavioral therapy for infertile couples. Methods: Seventeen idiopathic infertile couples participated in a therapy program comprised of modules to behaviorally optimize the chance of conception, improve sexual functioning and satisfaction, reduce thoughts of helplessness and, if necessary, improve marital communication skills. Pre- to posttreatment changes in the therapy group were compared to changes in two control groups. Results: The therapy group showed an improvement in sperm concentration, a reduction in thoughts of helplessness and a decrease in marital distress. By the end of therapy participants practiced timed intercourse more reliably and reported unchanged sexual pleasure and satisfaction during the nonfertile period of the menstrual cycle. At the 6-month follow-up, problem-focused thoughts had decreased. The live birth rate was higher in the therapy group than in epidemiological samples. Conclusion: Preliminary data suggest that cognitive-behavioral treatment may be an effective approach for the treatment of infertility.

Psychophysiological responses to food exposure : An experimental study in binge eaters

OBJECTIVE The aim of the present study was to investigate psychophysiological responses to food exposure in binge eaters. METHOD Thirty female volunteers reporting regular binge attacks were compared with 30 nonbinge eaters. Subjects attended individually for the single laboratory session. Continuous measures of heart rate (HR), blood pressure (BP), electrodermal activity (EDA), and respiration rate were taken during rest and exposure to their favorite binge food. In addition, psychophysiological monitoring continued while subjects were allowed to eat after food exposure. Participants also completed inventories assessing restrained eating style (FEV, Revised Restraint Scale). Ratings of nervousness, distress, desire to binge, and hunger were collected repeatedly throughout the experiment. RESULTS The results indicate higher psychophysiological arousal in binge eaters than in nonbinge eaters. Binge eaters maintained a higher arousal level in BP and EDA throughout the food exposure trial than controls. HR during food exposure predicted the relative amount of food consumed during the eating trial across all subjects. This relationship, however, was more pronounced in binge eaters than controls and in restrained compared to unrestrained binge eaters. DISCUSSION The implications of these results are discussed in terms of conditioning and arousal models of cue reactivity in binge eating.

Bulimia nervosa: sex role attitude, sex role behavior, and sex role related locus of control in bulimarexic women.

Thirty-four women with bulimia nervosa and 34 women without bulimarexic symptoms (but matched for age, weight, deviance from ideal weight, and educational status) were compared as to how liberated their attitude towards the womans role in society (= their sex role attitude, SRA) and their actual own behavior as females (= their sex role behavior, SRB) were. The degree to which their general attitude towards sex role and their own sex role behavior differed from each other was also investigated. Experimental and control group were also compared concerning their sex role related locus of control (SRLC). SRA and SRB were significantly less liberated in the bulimarexic group than in the control group. In addition, the bulimarexic group showed a wide gap between their general attitude (SRA) and actual behavior (SRB) as to the degree of liberation. No such discrepancy was found in the control subjects. The sex related locus of control data showed that bulimarexic women had significantly higher external and fatalistic control, and lower internal control than the comparison subjects.

Facial expressions of emotion and physiologic reactions in children with bronchial asthma.

&NA; Eighteen children with bronchial asthma (ages 7.5 to 12) and 18 control children were exposed to a pleasant comic film and a stress‐inducing achievement task. Facial expressions of emotion and heart rate (HR) were recorded, and pre‐ and posttest forced expiratory volume at 1 sec (FEV1) were assessed. The asthmatic children showed significantly fewer expressions of emotion than the control subjects in the stress‐inducing but not in the joy‐inducing situation. Their FEV1 decreased significantly under both experimental conditions, whereas no significant changes were found in the control group. The asthmatic childrens mean HR was significantly higher under both experimental conditions than during the preceding pauses. In the control group, no significant changes in mean HR were found from the pause to the stressful situation; during the comic film, mean HR was significantly lower than during the preceding pause. No significant correlations were found for either group between number of emotions expressed, pre‐ to posttest changes in FEV1, and changes in mean HR.

Priming panic interpretations in children of patients with panic disorder

Cognitive and psycho-physiological models of panic disorder stress the role of interpretation bias in the maintenance of the disorder. Several studies have reported results consistent with this hypothesis, but it is still unclear whether this bias precedes panic disorder or is a consequence of it. In the present study, we compared the interpretations of ambiguous scenarios of children of individuals with panic disorder, children of individuals with animal phobia, and children of healthy controls. Children were presented with three types of scenarios each including one of the following descriptions: panic-relevant physical sensations, animal-relevant stimuli, and panic-irrelevant physical sensations (i.e., cold symptoms). To test, if childrens interpretation bias is affected by priming, we compared their responses to the scenarios before and after watching a panic, a spider phobic, and a cold model. The results revealed that (a) children of panic disordered parents but not of parents with animal phobia and of healthy controls showed a significant increase in anxious interpretations after priming; and (b) this significant increase emerged only after priming through presentation of a panic-relevant model and not after priming through presentation of a phobia-relevant or cold-relevant model. Because the children of panic disordered parents did not have panics themselves, their increase in panic interpretations can be viewed as a vulnerability factor. Longitudinal studies should clarify the role of interpretation style in the etiology of panic disorder.