Markku Ojanen

The Impact of CBT and ACT Models Using Psychology Trainee Therapists A Preliminary Controlled Effectiveness Trial

The present study compares the impact of individualized treatment provided by trainee therapists based on a traditional cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT) model. Fourteen therapists were given initial training in CBT and ACT. Outpatients (N = 28) were randomized to either approach, with each therapist treating one client within each model, linked to a functional analysis. Clients treated within an ACT model showed better symptom improvement than the CBT clients, despite the fact that students felt initially less knowledgeable about ACT and were more fearful throughout when it was used. CBT improved client self-confidence more rapidly than ACT, and ACT improved acceptance more than CBT. Both processes predicted better outcomes; acceptance remained predictive when controlling for self-confidence but not vice versa. Overall, therapists with limited training in both models got better results with ACT and the processes of change fit with the ACT model.

Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers : A cluster randomized controlled cross-over trial

&NA; The purpose of the study was to examine the effects of a workplace physical exercise intervention on the perceived intensity of headache and the intensity of symptoms in the neck and shoulders, as well as on the extension and flexion strength of the upper extremities. The study was a cluster randomized controlled trial. The cross‐over design consisted of physical exercise intervention (15 weeks) and no‐intervention (15 weeks). The subjects (n=53) were office workers (mean age 46.6 (SD 8.4)) who reported headache (n=41) symptoms in the neck (n=37) or shoulders (n=41), which had restricted their daily activities during the last 12 months. Pain symptoms were measured using the Borg CR10 scale and muscular strength with a 5RM test. Statistical analyses were based on linear mixed models. Physical exercise intervention resulted in a slight, but statistically significant, decrease in the intensity of headache and neck symptoms, as well as an increase in the extension strength of the upper extremities. The mean decrease in headache during the 5‐week period was 0.64 CR10 (95% CI 0.28–1.00) (P=0.001) or 49% (95% CI 22–77), and 0.42 CR10 (95% CI 0.11–0.72) (P=0.002) or 49% (95% CI 13–85) in the intensity of neck symptoms. The mean increase in the extension strength of the upper extremities was 1.3 kg (95% CI 0.5–2.1) (P=0.001) or 4% (95% CI 1–6). The intervention had no effect on the intensity of shoulder symptoms or the flexion strength of the upper extremities. Specific exercise may be clinically important to alleviate headache and neck symptoms.

Effects of a physical exercise intervention on subjective physical well‐being, psychosocial functioning and general well‐being among office workers: A cluster randomized‐controlled cross‐over design

The purpose of the study was to examine the effects of a workplace physical exercise intervention on subjective physical well‐being, psychosocial functioning and general well‐being.

Cancer-specific social support received by newly diagnosed cancer patients: validating the new Structural-Functional Social Support Scale (SFSS) measurement tool

Goals of workTo investigate potentially health-enhancing domains of cancer patients’ social relationships we evaluated various dimensions of social support as experienced in early cancer.Patients and methodsIn consecutive samples of 72 melanoma and 103 breast cancer patients diagnosed 3–4 months earlier, we evaluated the cancer-specific social network and received social support by the Structural-Functional Social Support Scale (SFSS) validated within the study. In addition, social support was measured by the MOS Social Support Survey as perceived support, and by Seeking Social Support items from the Ways of Coping Questionnaire as coping activity. SFSS measures the number of people who have been aware of the patient’s cancer and the amount of social support the patients have received from them.Main resultsA large number of people from various potential support-providing sources had been aware of the patients’ cancer, and the patients had received support through these interactions. A greater number of support providers did not mean an increase in the support received. Social support was distinguished into subgroups according to its source, but the division into functional support types was weak. Support assessed as perceived support or as a coping activity did not cover the received disease-specific support of several sources.ConclusionsWith the SFSS, it was possible to obtain detailed information on the disease-specific social network and social support. It may be beneficial to distinguish support according to the sources and to also measure support beyond the closest relationships. We hope that our measure and the results obtained will assist in identifying the targets for psychosocial interventions.

The Finnish National Schizophrenia Project 1981–1987: 10-year evaluation of its results

This study reports the 10‐year evaluation of the Finnish National Schizophrenia Project. The aims of the national project were achieved. The number of long‐stay schizophrenic patients in psychiatric hospitals decreased by 63% between 1982 and 1992. Both the treatment of schizophrenic patients and the structure of mental health services have changed greatly in Finland. Psychosocial treatment methods in particular have developed. The major innovations of the Project are the acute psychosis teams now serving over 50% of the country, and social skills training programmes. The 10‐year evaluation of the Finnish National Schizophrenia Project shows that it is possible to conduct successfully nation‐wide projects to develop the treatment of schizophrenic patients and psychiatric practices across an entire country.

Need for community care among psychotic outpatients

Psychiatric teams examined a representative sample of 177 psychotic patients in community care. The patients’ need for care was assessed using a standardized method. The need for alternative, noninstitutional forms of care (i.e. day and residential services) was greater than the actual use of these services. The same was true of the need for support in social activities, for occupational therapy, training in domestic skills, counselling for relatives and psychotherapy. Unmet needs for care were commonest among patients who were young, who drank heavily, and who suffered from many psychotic symptoms and drug side effects. Outpatient care based primarily on visits to the community mental health centres did not provide adequate services for the most disabled patients. It is concluded that decrease of hospital care has brought a growing need for psychiatric day and residential services among outpatients suffering from psychotic disorders.

Effects of a workplace physical exercise intervention on the intensity of low back symptoms in office workers: A cluster randomized controlled cross-over design

Objectives. The purpose of the study was to examine the effects of a workplace physical exercise intervention on the intensity of low back symptoms. Methods. The study was a cluster randomized controlled trial with department (n = 4) as the unit of randomization. The subjects were office workers [(n = 36), mean age 47.1 (SD 8.4) years] who self-reported low back symptoms, which restricted their daily activities during the last 12 months. Low back symptoms were measured using the Borg CR10 scale. The cross-over design consisted of one intervention period of light resistance training and guidance and no training and no guidance of 15 weeks duration. Statistical analyses were based on linear mixed models. Results. The active component of the intervention, light resistance training, resulted in a slight, but statistically significant, decrease in the intensity of low back symptoms (p = 0.020). At the average training time of 5 minutes per working day (25 min/week) the average decrease during the 15-week period was 0.42 CR10 (95% CI 0.07–0.77) and 19% (95% CI 3–35). Conclusion. A physical exercise intervention, which included daily light resistance training, conducted during the working day affected low back symptoms in a positive direction among symptomatic office workers.

The need for social support among out-patients suffering from functional psychosis

From an original sample of 177 patients in community care and suffering from functional psychosis, the psychiatric teams involved in the treatment of these patients interviewed 136 patients and 103 relatives. The interviews aimed at determining the patients problems in social-role behaviour, as evaluated both by the patients themselves and by their relatives, and to measure the stress caused to the relatives. According to the patients themselves, over 60% had considerable difficulties in at least one area of social-role behaviour; the same conclusion was reached by over 50% of the relatives. The patients had a more positive view of their abilities to cope with housework, self-care, and managing money than their relatives. One-third of the relatives said they were dissatisfied with the situation, and more than 40% displayed a resigned attitude to the amount of support required by the patient. Problems in social-role behaviour were commonest in patients who were dissatisfied with their treatment, in male patients, and in patients who lived together with their spouse, and among the relatives dissatisfaction with the situation as a whole was also highest in these cases. On the basis of these findings it is stressed that the treatment of psychotic patients should be based on a broad approach involving not only the patients themselves but also their relatives.

Effects of Workplace Physical Exercise Intervention on the Physical Perceived and Measured Physical Functioning among Office Workers - A Cluster Randomized Controlled Cross-Over Design

Purpose: The main aim of the present study was to investigate the effects of a workplace exercise intervention on physical functioning. Dose of the exercise and other physical activity outside the intervention were controlled for. The other aims were to determine the physical strain of training and determine training force as a percentage of work time (OPA), leisure time (LTPA) and time spent on all activities (AT). Methods: The study was a cluster randomized controlled trial (CRT) with each department as the unit of randomization (n=36, n=19, n=15, n=25). The cross-over design consisted of one 15-week intervention period of resistance training (30% 1RM) and training guidance, and another period of the same length with no training or guidance. The subjects (n=90) were office workers [mean age 45.7 (SD 8.5) years]. Percentage body fat was measured using bioelectrical impedance, spinal flexibility with goniometer and a cervical measurement system, muscular strength with a 5RM test and a hand grip test. Subjective physical condition was assessed by questionnaire and physical activity by questionnaire and diary. The statistical analysis was based on linear mixed models. Results: The active component of the intervention, light resistance training, significantly increased both subjective physical condition (p=0.015) and upper extremity extension strength (p= 0.001). Intervention had no effect on percentage body fat, spinal flexibility, hand grip strength or lower extremity strength. The estimated increase in subjective physical condition during the 15-week period was 4 units (95% CI 1-7) or 6% and in upper extremity extension strength 1.3 kg (95% CI 0.5- 2.1) or 4%. Relative physical strain, measured as percentage of maximal oxygen consumption, was 33.7%. Training force was 1.12 metabolic equivalent hours per week, representing 2.0% OPA, 5.9% of LTPA and 1.2% of AT. Conclusion: Light resistance training during the working day had a positive effect on the office workers` subjective physical condition and strength of upper extremities. Controlling for training dose and other physical activity outside the intervention and confounding factors provides for a better specificity and understanding of the dose-response and effectiveness of exercise intervention on physical functioning among office workers.

Persuasion Strategies Applied in Psychosocial Rehabilitation

Theoretically one of the most important questions in applied psychology is how people influence and control each other. What theoretical concepts can be used to explain these influences? Learning theory explanations have been popular in psychology, but other alternatives are also possible. In this article, rehabilitation is analysed through interactional persuasion strategies. Six strategies are proposed: coercion, threat, offer, guidance, appeal and appreciation. Each strategy corresponds to a specific atmosphere, and arouses either compatible or incompatible reactions from the target of a specific strategy. In the present model the major component of the persuasion strategy is the choice it provides. Choice depends on the amount of information and sense of personal control it provides. In order to attain specific rehabilitation objectives certain persuasion strategies are applied. Coercion, threat and offer are used for behavioural objectives and guidance; appeal and appreciation for cognitive-experiential objectives. In the last part of the article, various rehabilitation programmes are described by persuasion strategies.