Janel Gauthier

EXPOSURE VERSUS COGNITIVE RESTRUCTURING IN THE TREATMENT OF PANIC DISORDER WITH AGORAPHOBIA

The aim of this study was to assess the rate of change on clinical, behavioral and cognitive variables during exposure therapy and cognitive restructuring in the treatment of panic disorder with agoraphobia. A total of 28 Ss who received a diagnosis of panic disorder with agoraphobia were randomly assigned to either of two treatment conditions: exposure therapy or cognitive restructuring. Treatment conditions were kept as distinct as possible from each other. Subjects were assessed on five occasions: pretreatment, after 5, 10, and 15 (posttreatment) sessions of treatment and at a 6-month follow-up. Analyses of outcome data revealed strong and significant time effects on all measures. However, no group x time interaction reached statistical significance, suggesting that both strategies operate at the same pace. Furthermore, power analyses suggest that any difference that might exist in the rate of improvement between exposure and cognitive restructuring in the treatment of panic disorder with agoraphobia is marginal.

Reduced therapist contact in the cognitive behavioral treatment of panic disorder

This study compared the effectiveness of two cognitive behavioral therapy programs for panic disorder: One involved reduced therapist contact; the other was entirely therapist directed. Subjects were 21 adults who met the DSM-III-R criteria for panic disorder. They were treated over a 17-week period. Measures of frequency and apprehension of panic attacks, measures of perceived self-efficacy at controlling panic attacks and measures of agoraphobic symptomatology were obtained at pretest and posttest and at 6-month and 12-month follow-ups. Results demonstrated that both treatment procedures produced significant and comparable improvements on all of the outcome measures that were maintained or furthered at follow-ups. Over 73% of patients in each condition were panic-free and clinically improved at 6-month follow-up. The reduced therapist contact treatment was found to be more therapist-time efficient, especially when long-term treatment benefits were considered. The present findings suggest that cognitive behavior therapy with reduced therapist contact may be a viable, therapist-time-efficient alternative for the treatment of panic disorder.

Flooding and coping skills training in the management of dental fear

Abstract The effects of flooding and coping skills training in reducing fear and avoidance of dental treatment were examined by using a crossover design. Results showed that flooding and coping skills training were equally effective in increasing approach behavior, reducing subjective anxiety, and increasing level and strength of perceived self-efficacy. The combination of these treatments resulted in further clinical improvement which was maintained at 4-month follow-up. It was observed that dental appointments were more effectively promoted when coping skills training preceded rather than followed exposure to dental stimuli. The possibility that perceived self-efficacy could be a useful predictor of making and keeping dental appointments is raised.

Cognitive-behavioral therapy of panic disorder with secondary major depression: A preliminary investigation.

Controlled studies indicate that cognitive-behavioral therapy eliminates panic attacks in greater than 80% of patients who suffer from panic disorder. However, because most of the screening procedures used in those studies called for excluding patients who were depressed, a question arises as to the extent to which these results apply to patients who are clinically depressed in addition to having panic attacks. Accordingly, an attempt was made in the present study to determine whether or not panic patients who are clinically depressed could be treated as successfully as those who are not clinically depressed. Two multiple baseline A-A1-A-B across-subjects designs were used, one to test 8 panic Ss with major depression and the second to test 7 panic Ss without major depression. In Baseline (A), Ss monitored their panic attacks daily. During the A1 phase, a program of information on panic attacks presented as psychotherapy was instituted to assess the effects of nonspecific factors, followed by a second baseline phase (A). Cognitive-behavioral therapy (B) was then introduced. Results showed that cognitive-behavioral therapy was significantly superior to information-based therapy in the reduction of panic attacks. No significant differences were found between depressed and nondepressed patients.

Is health locus of control a 3-factor or a 2-factor construct ?

Although the Multidimensional Health Locus of Control (MHLC) scales are commonly used, uncertainty about their factorial validity still remains. In the present study, confirmatory factor analyses of a French-Canadian adaptation of the Multidimensional Health Locus of Control scales (MHLC) were conducted to compare in a non-clinical group of 224 adults two factor models. Multigroup analyses were also conducted using this group and a clinical group of 132 diabetics to assess the equivalence of the MHLC factor structure across these two groups. A 3-factor model postulating an internal, external, and chance dimension, and accounting for measurement errors provided the best fit to the data. Multigroup analyses failed to support the equivalence of the MHLC factor loadings across the non-clinical and clinical group. These findings suggest that comparisons of MHLC scores across such groups may be problematic.

Evaluation of skin temperature biofeedback training at two different sites for migraine

All combinations of cooling versus warming and finger versus temporal artery were used in the present study, the aim of which was to identify an optimal biofeedback training site and to assess the specific effects of skin temperature biofeedback upon migraine. After an initial 4-week baseline phase, during which daily records of headache activity and medication were kept, 24 migraine patients were randomly assigned to one of the four experimental conditions. Training sessions for all patients were of 50-min duration and occurred once per week for 8 weeks. The headache charts were completed for another 4 weeks after treatment was terminated and again at 6-month follow-up. The results showed significant reductions in migraine activity and drug usage. However, self-regulation of skin temperature in different directions at different sites did not in fact result in significantly different magnitudes of change in migraine activity across groups. The role of nonspecific factors is discussed and a physiological model is proposed to explain how warming and cooling may produce clinical improvement in migraine.

The Universal Declaration of Ethical Principles for Psychologists: A Culture-Sensitive Model for Creating and Reviewing a Code of Ethics

Psychologists live in a globalizing world where traditional boundaries are fading and, therefore, increasingly work with persons from diverse cultural backgrounds. The Universal Declaration of Ethical Principles for Psychologists provides a moral framework of universally acceptable ethical principles based on shared human values across cultures. The application of its moral framework in developing codes of ethics and reviewing current codes may help psychologists to respond ethically in a rapidly changing world. In this article, a model is presented to demonstrate how to use the Universal Declaration as a guide for creating or reviewing a code of ethics. This model may assist psychologists in various parts of the world in establishing codes of ethics that will promote global understanding and cooperation while respecting cultural differences. The article describes the steps involved in the application of the model and provides concrete examples as well as several useful comments and suggestions. This guide for the application of the Universal Declaration may also be used for consultation, education, and training relative to the Universal Declaration of Ethical Principles for Psychologists.

Nonpharmacological approaches in the management of recurrent headache disorders and their comparison and combination with pharmacotherapy

Abstract A comprehensive review of empirical findings from controlled studies of nonpharmacological treatments used either alone or in combination with pharmacological therapies for recurrent headache disorders is presented. Overall, the evidence support the value of approaches based on relaxation, biofeedback, and coping skills training. Their effects appear to be long-lasting and comparable to those obtained through the use of medications. The relative benefits, costs, and limitations of combining nonpharmacological and pharmacological treatments remain largely unknown. Efforts are being made to enhance the effectiveness of nonpharmacological interventions by focusing on subgroups of patients that have been identified as nonresponsive and learning how to tailor and combine treatment approaches. Progress in the understanding of the therapeutic mechanisms of nonpharmacological treatments remain rudimentary. Basic research is needed to shed light on the ways psychological and biological variables interact in producing migraines and tension-type headaches and to stimulate the development of more effective treatments. Clinical trials focusing on formats for treatment delivery have yielded encouraging results, but cost-benefit analyses are needed to address policy considerations for implementation of nonpharmacological treatments into mainstream health practice.

Biofeedback control of migraine headaches: A comparison of two approaches

In order to assess the relative effectiveness of finger warming and temporal blood volume pulse reduction biofeedback in the treatment of migraine, 22 female migraine patients were assigned to one of three experimental conditions: temporal artery constriction feedback, finger temperature feedback, or waiting list. Biofeedback training consisted of 12 sessions over a 6-week period. All patients completed 5 weeks of daily self-monitoring of headache activity (frequency, duration, and intensity) and medication before and after treatment. Treatment credibility was assessed at the end of Sessions 1, 6, and 12. Results showed that temporal constriction and finger temperature biofeedback were equally effective in controlling migraine headaches and produced greater benefits than the waiting list condition. Power analyses indicated that very large sample sizes would have been required to detect any significant differences between the two treatment groups. No significant relationships were found between levels of therapeutic gains and levels of thermal or blood volume pulse self-regulation skills. Likewise, treatment outcome was not found to be related to treatment credibility. Further analyses revealed that changes in headache activity and medication were associated with changes in vasomotor variability. Because blood volume pulse variability was not significantly affected by biofeedback training, questions about its role in the therapeutic mechanism are raised.

Screening Clinical Depression in HIV-Seropositive Patients Using the Hospital Anxiety and Depression Scale

The aim of this study was to verify the capacity of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), a self-report scale, to screen clinical depression in HIV-seropositive patients. Sixty-nine HIV-infected patients participated in this study, of whom 22 met diagnostic criteria for a depressive disorder or an adjustment disorder with depressed mood, while the remaining 47 did not. Results of the Receiver Operating Characteristic (ROC) analyses suggest that the HADS-D is a highly effective screening tool for clinical depression in this population. The Beck Depression Inventory (BDI) was also found to be effective, but it takes much longer to complete than the HADS-D (21 vs. 7 items) and is therefore less likely to be routinely implemented in HIV care settings. Moreover, the BDI contains somatic items that can be confused with HIV manifestations. For these reasons, health care providers are encouraged to use the HADS to screen depression in their HIV-infected patients.